
Olass^RCH 
Book : 



COPYRIGHT DEPOSIT 



DICTIONARY 



OF 



DOMESTIC MEDICINE 



HOUSEHOLD SURGERY. 



By SPENCEE THOMSON, M.D. 

L. R.C. S., EDINR. 

FIRST AMERICAN, FROM THE LAST LONDON EDITION. 
REVISED, WITH ADDITIONS, 

By HENRY H. SMITH, M.D. 

SURGEON TO ST. JOSEPH'S HOSPITAL, PHILADELPHIA. 



thty-f^ 

Si 



PHILADELPHIA: 

LIPPINCOTT, GRAMBO & CO. 

1853. 




Entered according to the Act of Congress, in the year 1853, by 

LIPPINCOTT, GKAMBO & CO. 

in the Clerk's Office of the District Court of the Eastern District of Pennsylvania. 



STEREOTYPED BY L. JOHNSON AND CO. 
PHILADELPHIA. 



TO 



THE RIGHT HONOURABLE 

W$t € ix\ ,rf Carlisle, 

THIS WORK IS DEDICATED 



IT IS OFFERED, AS A TRIBUTE OF UNFEIGNED RESPECT, 

TO A NOBLEMAN, 

WHOSE EXALTED RANK HAS BEEN ADORNED BY PERSONAL EFFORTS 'TO 

ELEVATE THE MINDS, AND TO AMELIORATE THE 

PHYSICAL CIRCUMSTANCES OF 

HIS COUNTRYMEN. 



EDITOR'S PREFACE. 



The Dictionary of Domestic Medicine and Household Surgery, written by 
Dr. Spencer Thomson, of England, having been originally published in parts, 
and just completed, has received the highest encomiums from the various jour- 
nals of G-reat Britain. "Many a useful life might have been spared, and many 
an insidious disease checked in the bud, had works such as that of Dr. Thomson 
been earlier in existence. To the traveller by sea or by land, to the settler 
and emigrant far from medical aid, it must prove invaluable." 

Being written, however, with a view to the peculiar wants of his own coun- 
trymen, the author has presented many items of information which possess 
rather too local an interest to prove useful to the American reader, such as the 
" Act of Victoria regulating the sale of Arsenic," recommendations of London 
manufacturers, advantages of "English Watering-places," &c. &c. In revising 
the volume for the American press, the Editor has therefore omitted these 
articles, corrected typographical errors, furnished many new illustrations, and 
added such matter of a practical kind as could be briefly incorporated with 
the text without impairing its original character. All the additional matter 
will be found included in brackets [ ] in such a manner as to be readily 
apparent to the reader, and will, it is hoped, aid, rather than impair the 
efforts of its accomplished author in the extension of such knowledge as 
will furnish, in "thinly peopled colonies, ready information respecting what 
is best to be done in many of the emergencies and accidents of daily life," 
as well as serve, "as a counter-agent to the impudent quackery which preys 
upon the credulity and lamentable ignorance of the simplest principles of health 
that pervades the mass of the people." In the United States quackery has 
certainly free scope, and nothing will be more likely to check it, than the 
extension of such knowledge as shows the community how they are imposed 
on by unprincipled men. A desire to increase the circulation of such informa- 
tion, especially as presented by the Author, has therefore been a prominent 
object with the Editor in the prosecution of his duties. 

No. 120 South Ninth Street, Philadelphia. 
April, 1853. 



a2 



AUTHOR'S PREFATORY ADDRESS. 



That works professing to afford popular information on medical subjects may 
thoroughly answer the purpose for which they are designed, one especial point 
requires ever to be kept in view — the information given must be safely usable 
by those who are put in possession of it. It is an objection frequently adduced 
against such works, that they place a little dangerous knowledge in the hands of 
the public, in a form so apparently simple, as to make it a source rather of evil 
than of benefit; and, undoubtedly, the allegation has in some respects been cor- 
rect. But is it necessary, in preparing a work on domestic health, to incur this, 
hazard ? I think not. For without entering upon that difficult ground which 
correct professional knowledge and educated judgment can alone permit to be 
safely trodden, there is a wide and extensive field for exertion, and for useful- 
ness, open to the unprofessional, in the kindly offices of a true Domestic Medi- 
cine ; the timely help and solace of a simple Household Surgery, or better still, 
in the watchful care, more generally known as "Sanitary Precaution," which 
tends rather to preserve health than to cure disease. "The touch of a gentle 
hand" will not be less gentle, because guided by knowledge, nor will the safe 
domestic remedies be less anxiously or carefully administered, Inseparably con- 
nected with the intelligent use of these remedies, there must be correct general 
ideas respecting the anatomical arrangements and physiological requirements of 
the human frame. This also has been objected to. I hesitate not to say, that 
it is such knowledge as ought to be in the possession of every responsible man. 
Making apparent the importance, and rational foundation of the means of pre- 
serving or of invigorating health, or of restoring it when impaired, it renders 
submission to the requirements of those means, a more sure and cheerful service, 
when rendered to the conviction of the understanding, rather than to the dictum 
of an adviser. Amid the humbler classes especially, the diffusion of such know- 
ledge is highly requisite as a counter-agent to the impudent quackery which 
preys upon the credulity and lamentable ignorance of the simplest principles of 
health, which pervade the mass of the people. 

But health will fail, either in old or young, and accidents will happen, in spite of 
the most careful precaution ; it then becomes a question, how far non-professional 
interference may go. In many of the emergencies and accidents of daily life, 
even in a settled country, but more especially in the thinly peopled colonies, 
ready information respecting what is best to be done, possessed by a neighbour 
or a bystander, is often of the most essential service ; indeed, every medical man 
must have witnessed how much mischief may result, either actively or passively, 
and in a very short time, from ignorance of even the most obvious and common- 
sense modes of treatment. The information upon these points, given in a popu- 






AUTHOR'S PREFATORY ADDRESS. 7 

lar work, can scarcely be too full or too accurate. In the requirements of House- 
hold Surgery, or of sudden emergency, such as poisoning, burning, &c, the 
question is, " What must be done ?" Generally speaking, little or no skill is 
requisite to determine the nature of the case, or of the injury, which is often too 
apparent: the anxious question, "What must we do?" is that which calls for an- 
swer ; and if, sometimes, it happens that the exact nature of the accident be not 
sufficiently evident, that is no reason why knowledge on the subject generally, 
aided by common sense, may not do much to relieve. Life may be saved, suffer- 
ing may always be alleviated. Even to the resident in the midst of civilization, 
the "knowledge is power" to do good; to the settler and the emigrant it is 
invaluable. 

We come to a point more liable to cavil — the actual treatment of disease, pro- 
perly so called, by the unprofessional, and how far it is well to afford information, 
which may tempt the rash to use that which education only can safely employ. 
It may be trite, but it is true, that in order to treat a disease safely, and with 
benefit, we must learn its nature. Now, when it is remembered how the nicest 
judgment that observation and experience can form, the most patient attention, 
aided by practised ear and eye, by microscope and test-tube, are frequently ne- 
cessary to enable the conscientious physician to judge of his case before he can 
apply the remedy, it is evident how great must be the responsibility of those who, 
in rashness or ignorance, venture upon the treatment of serious disease, either in 
their own persons or in those of others ; incapable of judging of its nature, still 
less capable are they of selecting the appropriate treatment. There is, however, a 
vast difference between the management of real disease and of ordinary ailment— 
between endeavouring to strike at the root, or only to relieve the symptoms. Any 
unprofessional man, or woman either, in this kingdom, who, with all the facility 
that there is for procuring skilled advice, ventures to take the medical manage- 
ment of a case of real illness, acts most unwarrantably ; but there are numbers of 
lesser ailments, many of the more painful incidents and symptoms, simply and 
easily removable by mccans which all may employ, and with which it is most im- 
portant that all should be acquainted j which the parent may use to the child, or 
the pastor recommend to his parishioners, without fear. 

One step further. If clanger may result from rash treatment, none can arise 
from a general acquaintance with the most prominent symptoms which herald 
the approach of dangerous sickness ; these, I think, should be made known -, while 
JJLl remarks upon the management, whether limited as for use in this country, or 
more extended for the sake of the dweller in remote or unsettled districts, I trust 
so to guard as to make them safe and useful guides. 

I know well what is said by a few, about injuring the medical profession by 
making the public their own doctors. Nothing will be so likely to make "long 
cases" as for the public to attempt any such folly; but people of moderate means 
— who, as far as medical attendance is concerned, are worse off than the pauper — 
will not call in and fee their medical adviser for every slight matter, and, in the 
absence of a little knowledge, will have recourse to the prescribing druggist, or 
to the patent quackery which flourishes upon ignorance, and upon the mystery 
with which some would invest their calling. And not patent quackery alone, 
but professional quackery also, is less likely to find footing under the roof of the 
intelligent man, who, to common sense and judgment, adds a little knowlege of 
the whys and wherefores of the treatment of himself and family. Against that 
knowledge which might aid a sufferer from accident, or in the emergency of sud- 
den illness, no humane man could offer or receive an objection. 



8 



AUTHOR'S PREFATORY ADDRESS. 



To resume. The information which it is proposed to offer in this Dictionary 
may be classed as Anatomical and Physiological, Sanitary or Hygienic, the 
Treatment of Accident and Emergency, and the Management of Illness. In 
some respects, perhaps, the adoption of this classification might be advantageous, 
but as a means of ready reference, the alphabetical arrangement of subjects will, 
it is thought, be found more convenient. 

SPENCER THOMSON, 

Haunton, JBurton-upon- Trent. 



PREFATORY NOTICE. 

As it would involve much repetition, to give the forms, doses, and mode of 
administration of the various remedies each time they are individually mentioned, 
the reader is referred, for the requisite information, to the individual articles them- 
selves, and to the article " Materia Medica," which will appear in its proper 
place, and under which all that is necessary for the purposes of the Dictionary 
will be fully given. When doses are mentioned in the general articles — unless 
otherwise specified — they are the average for an adult. S. T. 

[For Concluding Address of the Author, see page 581. — Ed.] 



. 



MEDICAL DICTIONARY. 



ABDOMEN.— Figs. i. and ii. The abdo- 
>men, or belly, the largest cavity of the body, 

Fig. i. 




is bounded above by the chest, (Fig. ii. 7 ;) 
and below by the pelvic bones, which are 
joined in front, (Fig. ii. 8.) These bones, 
which every one may feel in their own per- 
son, likewise enclose a cavity — the cavity of 
! the pelvis — which is sometimes described 
1 separately from the cavity of the abdomen ; 
but the two are so completely united, that 
they are better treated of together. The 
cavity of the abdomen is divided from that 
of the chest, by the midriff or diaphragm, 
(Fig. ii. 6;) posteriorly, it is supported and 
protected by the spine ; and it is enclosed by 
the short ribs and abdominal muscles. To 
facilitate description, medically, the abdo- 
men is mapped out into regions by imagina- 
ry horizontal and vertical lines, drawn as 
represented in Fig. i. The horizontal lines 
■ drawn across the abdomen divide it into 
1 three zones, which, by the vertical lines, are 
; divided into nine anterior regions, as fol- 
low:— 1, 1, Right and left Hypochondriac ; 
2, Epigastric ; 3, 3, Right and left Lumbar ; 



4, Umbilical ; 5, 5, Right and left Iliac ; 6, 
Hypogastric. In the upper zone lies the 

Fi<r. ii. 




liver, (Fig. ii. 1,) extending from under the 
right ribs across to the left. The stomach 
(Fig. ii. 2) has its small end situated in the 
epigastric, and its large end in the left hy- 
pochondriac region, where it is in contact 
with the spleen, or milt. The pancreas, or 
sweetbread, lies behind the stomach. The 
middle zone contains the large bowel, (Fig. 
ii. 3,) the omentum or caul, a portion of the 
small intestines, (Fig. ii. 4;) and, posterior- 
ly, lying close to the spine, the kidneys. 
The inferior zone also contains, centrally, a 
portion of the small intestines ; laterally, 
the extremities of the. large intestines or co- 
lon ; and, when it is distended, the superior 
portion of the bladder. All these parts, or 
viscera, are covered and supported by a 



ABL 



10 



ABO 



smooth, glistening, moist membrane, the 
peritoneum, which is also continued over the 
parts within the cavity bounded by the pel- 
vic bones. These are, more especially, the 
bladder, and terminating extremity of the 
bowels, named the rectum, and, in the fe- 
male, the womb and its appendages. Both 
bladder and womb, when distended, rise 
from their own proper cavity into that of the 
abdomen. The viscera of the abdomen are 
divided into solid and hollow : of the former, 
the liver is an example ; of the latter, the 
intestines and bladder. These, of course, 
give different sounds, when the covering of 
the abdomen, beneath which they lie, is 
slightly struck with the finger — a fact of great 
importance to the physician, in his examina- 
tion of this cavity. The contents of the ab- 
domen shift their position considerably ac- 
cording to posture. The diseases to which 
they are liable will be noticed under their 
respective heads. One of the most import- 
ant accidents to which this cavity is subject, 
is protrusion of a portion of its contents 
through its walls, constituting hernia, or 
rupture. Accidental wounds penetrating the 
cavity of the belly are very generally fatal, 
and, if they pierce any of the viscera, almost 
necessarily so. 

Refer to Diaphragm — Liver — Stomach — 
Intestines — Hernia — Navel. 

ABLUTION.— Washing the surface of the 
body regularly, is, happily, in this country 
at least, becoming daily more common ; but 
it is far from being so general a habit as 
it ought, particularly among the working- 
classes, who stand most in need of it : many 
go from January to December without even 
thinking it necessary to wash more than the 
face or hands. The skin ought continually 
to be throwing off, or excreting, gaseous, 
saline, and greasy matter, which it is neces- 
sary for the health of the body should be 
thrown off; but the skin cannot do this 
properly if caked over with perspiration and 
dirt, either its own, or the dust to which 
many are exposed in the performance of 
their employments. The consequence of 
neglect is, that much is retained in the sys- 
tem which ought not to be there ; an addi- 
tional load of duty is thrown upon other 
excreting organs, as the liver and kidneys, 
and if they have not the power to compen- 
sate for man's own carelessness, languor, 
low spirits, headaches, local accumulations 
of blood, gout, gravel, and other diseases are 
the result. Fortunately, complete neglect 
cannot entirely stop the skin's functions ; 
otherwise death itself must result. For the 
purpose of cleansing the skin, soft water 
ought to be used, if possible, with soap — 



good brown is quite the most effectual — and 
a thorough purification of the entire surface 
of the body should be effected at least once a 
week, with these materials ; along with this, 
washing over the surface with simple water, 
and rubbing well with a rough towel, every 
night or morning, as most convenient, will 
suffice to preserve a healthy state of skin. 
Those who are robust, and wash in the 
morning, ought to use cold water immedi- 
ately on rising, while heat is abundant; 
but delicate persons cannot sustain the de- 
pression and subtraction of animal heat, 
which this occasions — it leaves them chilled, 
languid, and with impaired digestion. There 
are some individuals, in whom cold sponging 
in the morning invariably produces heart- 
burn and indigestion after breakfast ; such 
ought to try the water slightly warm, or con- 
tent themselves with washing only a portion 
of the skin each morning ; if even this can- 
not be borne, dry friction with a rough towel 
or hair-glove may be substituted. After 
washing, it is always desirable to rub the 
surface thoroughly with a towel till a warm 
glow is produced. For washing at night, 
water slightly warm is always to be pre- 
ferred. The feet require very frequent 
washing. It is surprising how insensible 
even otherwise respectable individuals are 
upon this point ; were it not so, they would 
never expose themselves to medical men in 
the disgusting state of dirt they frequently 
do. Happy are those who can have the use 
of baths for the purposes of ablution, but 
any man who can command water and a 
towel need not dispense with the luxury. 
For the aged, frequent and thorough ablu- 
tion is most requisite ; the often shameful 
neglect of this by those who have the care of 
old people is visited upon them in queru- 
lousness and troublesome bodily ailments, 
which attention to the duty would have pre- 
vented. [Those subject to sore throat and 
cold in the head will generally derive benefit 
from washing the neck and back of the head 
daily in cold water.] 

Refer to Bath — Children — Skin. 

ABORTION— Miscarriage.— The terms 
abortion and miscarriage are applied to the 
expulsion of the human foetus from the 
womb of the mother, previous to the seventh 
month of pregnancy ; that is, before it is 
sufficiently developed to maintain its own 
independent existence. When the process 
occurs after that period, it is named prema- 
ture labour. Miscarriage involves pain and 
weakness, in addition to the loss of offspring, 
and is often a severe trial to the maternal 
constitution. It may occur at any period 
of pregnancy, but particular stages are more 



ABO 



11 



ABO 



liable to the accident than others. These are 
generally considered to be about the time 
of the first menstruation after conception ; 
again at the twelfth week, and toward the 
seventh month ; the liability is increased at 
those times, which correspond to the men- 
strual period. When abortion has once taken 
place, it is more liable to occur again ; and 
some have so strong a tendency to it, that 
they never go beyond a certain stage, at 
which they invariably miscarry. The cause 
of abortion may exist in the constitution of 
the female herself, and be the result of weak- 
ness and irritability, of over-full habit, or 
of a diseased condition of the womb ; the 
foetus may die, or be deficient in develop- 
ment, when it is cast off like a blighted 
fruit. Suckling, after conception has taken 
place, is not unfrequently a cause of mis- 
carriage. Active disease occurring during 
pregnancy, such as severe inflammation, fe- 
vers, eruptive fevers, &c, are almost cer- 
tain to occasion expulsion of the uterine 
contents. Continued diarrhoea, and the ac- 
tion of strong purgatives, particularly of the 
aloetic kind, are dangerous. This is a very 
cogent reason for those who are pregnant 
avoiding all quack aperient medicines ; they 
almost all contain aloes, and may be very 
injurious. All undue exertion or agitation 
of body or mind, sudden jerks or jumps, 
riding on horseback in the early, or in a 
shaking carriage in the latter stages of preg- 
nancy, may any of them bring on the mis- 
hap ; to these may be added, exertion of the 
arms in doing any thing on a level above the 
head; costive bowels and straining conse- 
quent thereon, sensual indulgences, and lux- 
urious habits. . Those who have once aborted 
ought to be extra careful in succeeding 
pregnancies, and all ought to bear in mind 
the possibility of the occurrence. 

The symptoms of threatened abortion vary 
with the constitution; in the strong and 
plethoric, it is often preceded by shivering 
and febrile symptoms, and by a feeling of 
weight in the lower bowels ; in the weak, 
there is languor, faintness, flaccidity of the 
breasts, general depression, and pains in 
the back and loins. Intermittent pains, and 
discharge of blood from the passage, tell 
that the process has begun. If miscarriage 
occurs within the first month or two after 
conception, the process may be accomplished 
with so little inconvenience as to escape no- 
tice, and be mistaken for a menstrual period ; 
more generally, however, the severity of 
the pain, and an unusual clotted discharge, 
render the case evident. The pain, the dis- 
charge, and at the same time the danger of 
an abortion, are in proportion to the ad- 



vancement of the pregnancy. When a mis- 
carriage goes on, the pains increase in force 
and frequency, and continue with discharge 
of blood, fluid, or in clots, until the ovum is 
expelled, after which, both become mode- 
rated, till they cease altogether, and the red 
flow gives place to a colourless one. It is 
very important that those in attendance 
upon the patient should examine every clot 
which comes away — if large, tear it in pieces 
— that they may ascertain whether the con- 
tents of the womb are expelled or not, for 
there is no safety or rest where miscarriage 
is progressing, till this has taken place, and 
every thing is cast off. When a medical man 
is in attendance, and in such cases he ought 
to be, all should be reserved for his inspec- 
tion. 

As soon as a female experiences threat- 
enings of abortion, she ought at once to retire 
to bed, upon a mattress, and keep perfectly 
quiet till every symptom has disappeared : 
sometimes this simple measure, promptly 
adopted, is sufficient to avert the threatened 
evil. If there is much feeling of fulness, 
and the patient is of full habit generally, 
eight or a dozen leeches may be applied to 
the lower part of the bowels ; if there is fe- 
ver, salines may be given, such as the com- 
mon effervescing draught of carbonate of 
soda and tartaric acid, or lemon-juice; or 
if the bowels are much confined, seidlitz 
powders, assisting the action by cold clys- 
ters if necessary. When the pains are se- 
vere, particularly in the weak and irritable, 
twenty or thirty drops of laudanum should 
be given, and may be repeated in a few 
hours if the symptom is unabated. In the 
case of profuse discharge, the patient should 
be kept very lightly covered, movement 
avoided, and every article of food or drink 
given cold, or iced if possible, provided the 
vital powers are not excessively reduced ; 
cloths dipped in cold or iced water should 
also b e applied to the lower part of the body, 
and frequently changed ; acid drinks, with 
cream of tartar, may be given freely. Ten 
or fifteen drops of diluted sulphuric acid, or 
of aromatic sulphuric acid, [elixir vitriol,] 
may be given in a wineglassful of water 
every two or three hours. Should slight 
faintness come on, it is better not to inter- 
fere with it, as it may be salutary : if it goes 
to an extent to threaten life, stimulants, (sal 
volatile or brandy and water,) must be had 
recourse to. But long before matters go to 
this extent, proper medical assistance should 
be sought. Profuse and continued discharge, 
though it may not threaten life, must occasion 
a weakness which is long in being overcome, 
and which may ultimately favour the deve- 



ABO 



12 



ABS 



lopment of fatal disease. The discharge 
may be kept tip solely by a state of mat- 
ters beyond the offices of domestic manage- 
ment, but to be speedily rectified by a little 
manual interference on the part of a medical 
man, who, by assisting the womb to cast off 
Jie already partially expelled contents, at 
once puts an end to further loss of blood. 
But even if matters be not sufficiently ad- 
vanced to admit of this interference, the use 
of measures or remedies which the unprofes- 
sional cannot or ought not to employ, may 
save life, and must save strength. Let no 
one think lightly of the loss of blood ; it saps 
the foundations of health. Should circum- 
stances occur in which medical assistance 
cannot be obtained, at least not speedily, 
and the flooding is profuse, and uncontrolled 
by the means already mentioned, one grain 
and a half of sugar of lead made into a pill 
with crumb of bread, may be given every 
two hours, and washed down with a draught 
of vinegar and water, to which, if there is 
much pain, from five to ten drops of lauda- 
num should be added. In addition, pieces 
of linen or calico, soaked in a strong solution 
of alum or decoction of oak-bark, and oiled, 
should be used to plug the passage, or the 
astringent fluid may be thrown up with a 
syringe. But, the unprofessional should 
never adopt these measures, if professional 
advice is to be had ; if not, it is better they 
should do so than matters go on uncontrolled. 
Both during the time, and after miscarriage, 
the general strength must be supported ; this 
is better done by strong animal soups, milk- 
preparations, with eggs and meat, when it 
is proper, than by much stimulant ; never- 
theless, wine or malt liquor may be requi- 
site. Convalescence is to be assisted by 
tonie medicines, those containing mineral 
acid, bark, or iron, are generally the most 
appropriate. The bowels will require atten- 
tion, as indeed they do throughout. Castor- 
oil is very suitable ; the cold or very cool 
water clyster is most useful ; a drachm of 
Epsom salts, dissolved in half a pint of wa- 
ter, either cold or slightly warmed, and 
fifteen drops of dilute sulphuric acid added, 
forms a most appropriate aperient, which 
should be taken before breakfast. 

Three principles of treatment are to be 
kept in mind in the management of miscar- 
riage. 

The first, to prevent it, if possible, by rest, 
opiates, &c. 

The second, to allay pain, moderate the 
discharge of blood, and save and support 
strength. 

The third, when abortion must take place, 
to expedite the separation of the ovum. 



The two first may be much assisted by 
judicious domestic management ; the third 
must be done by the medical attendant only. 

Refer to Pregnancy — Hemorrhage. 

ABRASION. — An abrasion, by which the 
outer or scarf skin or cuticle is forcibly 
removed, and the sensitive surface of the 
under true skin or cutis exposed, is a tri- 
fling, but sometimes a painful accident, and 
it may be, where the hands are necessarily 
subjected to the action of poisonous or irri- 
tating fluid, a dangerous one. Though the 
protecting cuticle is quickly restored, it is 
necessary to provide a substitute in the 
mean time. It must be an unirritating one. 
Persons often err by putting the common 
diachylon plaster on abrasions, and fre- 
quently much irritation and pain, or even 
ulceration, are produced by it. Court- 
plaster does not irritate, but is not useful 
for a large surface, in which case gold-beat- 
er's leaf will be the best application, if not 
exposed to moisture. Collodion has been used 
of late : it is not soon acted upon by water, 
but it causes severe smarting when first 
put on ; this may be prevented by putting 
gold-beater's leaf next the sore, and collodion 
over it. In the absence of the above, a little 
strong gum mucilage, with a piece of tissue- 
paper over it, is a good substitute. Isinglass 
plaster is also used, but those who are not 
in the habit of applying it, find a difficulty 
in making it adhere. The principle in treat- 
ing an abrasion, is to protect the sensitive 
true skin by some light, perfectly unirritating, 
dry application, till nature restores the na- 
tural covering. 

Refer to Collodion — Plasters — Skin. 

ABSCESS.— A collection of purulent fluid 
in a cavity, formed in the substance of any 
of the bodily tissues, is named an abscess. 
The contained matter, or pus, may be either 
of a healthy or of an unhealthy character ; 
if the former, it is of a yellowish-white co- 
lour, cream-like in consistence, and possesses 
a faint sickly odour ; in the latter case, it 
may resemble whey, with bits of curdy sub- 
stances floating in it, or it may be bloody, 
fetid, &c. 

Abscesses are either acute or chronic, and 
may occur in nearly every tissue of the body. 
The first symptoms of an acute abscess are 
heat and tenderness of the part, followed by 
throbbing pain. If the matter is deeply 
seated, no external marks may be visible for 
a time ; when it is near the surface, the skin 
quickly exhibits inflammatory swelling; this 
continuing, it becomes thinner with more or 
less rapidity, until, at last, it gives way, and 
permits the matter to escape. Such is the 
natural course of what we may call a, healthy 



ABS 



13 



ABS 



abscess; but this course is necessarily mo- 
dified by the position and coverings of the 
collection of matter. Abscesses do not al- 
ways discharge through the skin, they may 
do so internally. Generally, as soon as the 
contents of an abscess are discharged, the 
pain, which has previously been severe, 
ceases. Boils may be classed as abscesses ; 
they contain a distinct core, or slough. 
Chronic abscesses may continue for weeks 
or months without change and give com- 
paratively little pain : they occur in weak 
or scrofulous subjects, and very generally 
in glandular tissues. In addition to pain 
and swelling, the sense of fluctuation, as of 
fluid contained in a bag, which an abscess 
conveys to the finger, is a symptom valuable 
in obscure cases ; but when it is most valu- 
able, it requires the educated touch of the 
surgeon to discover it. On the first suspicion 
of an acute abscess, frequent fomentation 
with water, as hot as it can be borne, may 
succeed in preventing its formation, if purga- 
tive medicine be given at the same time ; but if 
it does not do this,it will then assist and hasten 
its progress, while it soothes the pain. When 
it is tolerably certain that matter has formed, 
thick, warm, soft poultices must be continu- 
ally applied to the part, the position of ivhich 
should be regulated with as much regard to ease 
as possible. It is sometimes the popular 
custom to apply irritants, such as honey, 
soap-and-sugar, and such like, to boils or ab- 
scesses, with the view of assisting or "break- 
ing" them : the practice is both hurtful and 
cruel, and ought never to be followed. For 
fomentation, cloths wrung out of simple 
water, and for poultice, bread or linseed 
are most generally applicable ; when there 
is much pain, decoction of poppy-heads may 
be used for either, with advantage. Medi- 
cal men are in the habit of opening abscesses 
or boils with the lancet or knife ; but as to 
do this safely in every case requires anato- 
mical knowledge, the unprofessional should 
be content with simply relieving and assist- 
ing the painful progress by the means men- 
tioned, till the matter is discharged natu- 
rally. [It is a bad practice to prick a boil 
with a needle or pin : if not freely opened, it 
had better be left to nature.] After this hap- 
pens, poulticing ought to be persevered in 
for a few days, and then exchanged for sim- 
ple water-dressing, which must be continued 
till the part is well. A little opening medi- 
cine should at the same time be given. 
Many persons are in the habit of squeezing 
abscesses after the matter discharges : the 
practice is useless and painful ; very gentle 
pressure only is admissible. A chronic 
abscess is serious, from the indication it 
B 



gives of a weak and unhealthy condition of 
body, and may also be so from size or posi- 
tion. The formation of an acute abscess is 
generally accompanied with more or less 
general inflammatory fever. In the chronic 
abscess, when there is fever, it has more of 
the hectic character, and is accompanied 
with night perspirations. A chronic abscess 
sometimes requires speedy evacuation arti- 
ficially, and constitutional treatment is al- 
ways called for ; the first ought always to 
be done by a medical man, and the latter 
also, to be effectually carried out. Good 
light nourishment, with a due proportion of 
animal food, is indispensable ; milk, if it 
agrees ; wine or malt liquor, if there is not 
much fever. Regulation of the bowels by 
simple aperients — iron, mineral acid, with 
infusion of bark, and cod-liver oil, are the 
most generally applicable remedies in the 
constitutional treatment of chronic abscess. 

Refer to Suppuration — Poultice — Water- 
dressing — Fever-hectic. 

ABSORBENTS.— Absorbents are minute 
vessels distributed throughout the body, the 
office of which is to take up nutritive mate- 
rial, and convey it into the current of the 
general circulation. The lacteal absorbents 
are those which take up the nutrient por- 
tion of the food, named chyle, from the ali- 
mentary canal ; they unite in one common 
trunk, which runs up in front of the spine, 
and joins the large vein going directly to 
the heart. Soon after a full meal, these 
lacteal absorbent vessels become distended 
with the milky-looking chyle, the essential 
nutriment, separated from the food by the 
first process of digestion. As this chyle 
has to pass through a set of small glands 
— the mesenteric — before it can reach the 
blood, it must be evident how much the 
health of the latter fluid, and the nutri- 
tion of the body generally, must be inter- 
fered with when these glands become dis- 
eased, as they frequently do in children. — 
See Tabes. 

The lymphatic absorbents are distributed 
throughout the body, and take up and con- 
vey back to the general circulation what- 
ever nutrient matter is fit to re-enter the 
blood. They also pass through glands, 
which are more particularly observable on 
the sides of the neck, in the arm-pits, 
groins, and insides of the thighs. These 
lymphatic glands are very apt to become 
enlarged, inflamed, and even to suppurate, 
particularly in weak constitutions, or when 
there happens to be a sore on a part of the 
body more distant from the heart than the 
gland. In some persons, even scratching 
the head with the comb will occasion the 



ABS 



14 



AC A 



glands of the neck to become swollen and 
painful. Popularly, these enlarged glands 
go by the name of "waxen kernels." When 
any of the lymphatic glands exhibit symp- 
toms of irritation, the first thing is to as- 
certain whether this be owing to some 
scratch, wound, or sore on the body. If the 
glands of the groin inflame, the genital or- 
gans and the whole lower extremity must 
be examined, even between the toes. If the 
glands of the neck, the head must be well 
looked over, for it is evidently useless to be 
treating the secondary effect, while the 
cause, such as an irritable or irritated wound, 
continues ; for they generally are, even 
though very small, irritable sores, which 
cause inflamed glands. If the exciting sore 
be soothed by rest, fomentations, poultices, 
&c, and a little simple opening medicine 
given, the irritated gland will generally re- 
sume its healthy condition ; if it seems in- 
clined to continue inflamed, it, too, must be 
soothed by the same means, and, if need be, 
one or more leeches applied, and the bowels 
more freely acted upon. Suppuration ought, 
if possible, to be prevented, especially in 
the neck, where it leaves an unseemly scar. 
In this situation, when matter has actually 
formed, the visible after-traces of the occur- 
rence will be much less evident if the ab- 
scess is opened at the proper time, and in a 
proper manner, by the surgeon. The lym- 
phatic glands, especially in weak or scrofu- 
lous persons, are apt to assume a state of 
chronic enlargement and slow suppuration. 
As the root of the evil is in the constitution, 
this must be invigorated in every possible 
way, by nourishing animal diet, with pro- 
bably wine or malt liquor, by early hours, 
regular exercise, and change of air, to the 
coast, if possible. Cod-liver oil, half nutri- 
ment, half medicine, is most useful, and 
may also be rubbed on the enlarged glands 
with advantage. [Washing the swellings 
with strong brine, or poulticing with corn- 
meal and brine, is also serviceable.] Iron, 
iodide of iron, bark, and tonic medicines ge- 
nerally, are all indicated. 

Refer to Mesentery — Tabes — Glands — Scro- 
fula. 

ABSORPTION.— Absorption is not per- 
formed by the "absorbents" alone; the 
blood-vessels take a considerable share, 
more particularly in the case of fluids ; 
neither is the process confined to the inte- 
rior of the body; it may take place through 
the skin, and thus a person who, from dis- 
ease or accident, is disabled from swallow- 
ing fluids, may have his distress partly re- 
lieved by warm or tepid baths. In cases 
of shipwreck, or want of fresh water, fluid 



may, without injury, be supplied through 
the skin, by wrapping the body in cloths 
soaked with the sea-water. 

ABSTINENCE.— Abstinence may be a 
great good or a great evil. In those who 
live fully and freely, eat much animal food, 
and drink malt liquor or wine, no remedy is 
more useful either in their peculiar ailments, 
or in general sickness, than abstinence. If 
the constitution be tolerably sound, nature 
will right herself if left unopposed ; many 
a dose of medicine may be omitted when 
such patients can be persuaded to "starve." 
More persons hurt themselves by excess 
than by the reverse, but not a few do them- 
selves much injury by too great abstinence. 
They are generally individuals of weak di- 
gestive power, who, finding that the less they 
give the stomach to do, the better they feel, 
run into the extreme, and consume barely 
sufficient food to support health; and the 
general system suffers; the stomach, the 
liver, the bowels, the blood, and circulating 
system are insufficiently supplied with sti- 
mulus ; they act and react on one another ; 
the general tone is permanently lowered, 
and perhaps organic disease originated. 
This error has been fostered by medical 
authorities, and the case of Cornaro and 
others held up as examples of the health 
and longevity to be attained by extreme ab- 
stinence. Undoubtedly some men will re- 
tain health and strength on much less 
nourishment than others ; but with most, a 
tolerably liberal supply of varied food is re- 
quisite, and they cannot permanently lower 
the standard without injury. Living mode- 
rately, instead of stinting the whole body to 
favour the stomach, they ought by exercise, 
relaxation, and other means — by medicine, 
if requisite — so to strengthen the organ that 
it may comfortably digest sufficient for the 
wants and support of the whole system. 
By acting on the reverse, nothing is gained 
eventually, for the stomach, partipipating 
in the general debility, becomes daily more 
unfit for its office. The effect of abstinence 
on those who practise it on religious 
grounds, is too often most injurious, and 
lays the foundation of organic disease of 
the stomach. [Fasting should never be 
practised for a length of time without con- 
sulting a medical man.] 

Refer to Digestion — Regimen, $c. — Starva- 
tion. 

ACARI. — Ticks or lice, generally the re- 
sult of filth, may show themselves upon the 
head or body during sickness, notwithstand- 
ing the most scrupulous care, and some 
kinds of cutaneous eruptions and sores are 
with great difficulty freed from them. Wash- 



AGO 



15 



ACI 



ing and cleanliness are the great counter- 
agents : after -washing, equal parts of sal 
volatile and water may be used to the part. 
[Free greasing with sulphur or mercurial 
ointment, and then a good washing with soft 
soap, is also serviceable.] The itch-insect 
is an acarus; also the harvest-bug. 

Refer to Itch — Harvest-bug. 

ACCLIMATION.— One of the most won- 
derful endowments of the human constitu- 
tion is its power of accommodating itself 
to the great varieties of climate which pre- 
vail over the surface of the globe — of be- 
coming acclimated. The Anglo-Saxon race 
appear to possess this power of constitution 
in an eminent degree, and, with comparative 
impunity, fix their habitations amid the 
snows of the Arctic regions or under a tro- 
pical sun. The constitution, it is true, on 
removal from a cold to a warm climate, may 
not all at once accommodate itself entirely 
to the change, but it is much more likely to 
do so quickly and safely if assisted by the 
judicious management of the individual. 
The ignorance and inattention which prevail 
upon the subject of acclimation are truly 
lamentable ; great numbers of young men 
yearly leave this country for hot climates, 
without one word being said, or idea 
given them, as to the reasons for, and im- 
portance of, certain rules for preserving 
health. Under the change of circumstances, 
the habits of their colder fatherland are 
continued, and fever or cholera puts an end 
to many a promising life, which a little ra- 
tional information and advice might have 
preserved. 

The air and its temperature are largely 
concerned in the process of acclimation ; 
the former is so much more rarefied in hot 
than in cold climates, that in the vital pro- 
cess of respiration, a comparatively much 
smaller quantity is habitually consumed ; 
less oxygen is taken in, and the process of 
oxidation or combustion, which is continu- 
ally going on within the body, is slower : 
we reasonably conclude that by this process 
of combustion, the animal heat, in part at 
least, is maintained; but, of course, in a 
hot climate, a less ^active condition is suf- 
ficient to keep up the average temperature. 
The process of oxidation or combustion 
effected on the one hand by the oxygen 
inspired, is supported on the other by some 
of the elements — carbon and hydrogen — of 
the food. It is evident, therefore, that if 
an. individual who has become resident in a 
hot climate, makes a practice of consuming 
as much nutriment as he used to do with- 
out injury to health in a cold one, he must 
take more than is requisite ; consequently 



the blood becomes overcharged with a load 
of noxious matter, which the rarefied air 
and inactive habits of warm countries do 
not tend to remove ; and if the course be 
continued, an attack of illness, probably of 
a biliary nature, is the consequence. Even 
in temperate climates, the difference be- 
tween the consumption of oxygen in winter 
and in summer is considerable. In Germany 
it has been calculated at one-eighth less in 
the latter.* How great must be the differ- 
ence to those who permanently settle in 
tropical heats ! certainly sufficient to re- 
quire much alteration in habits of living. 
The abundant animal diet, the fats and 
alcoholic drinks of the colder climes, all of 
which contain carbon and hydrogen in 
abundance, and assist materially in sustain- 
ing temperature, must give place to the fa- 
rinaceous and watery fruits of warmer re- 
gions ; vice versa, on going from a warm or 
temperate country to a colder, as the expe- 
rience of all arctic travellers testifies, a 
larger proportion of animal diet, and that 
of a more fat or oily character, is requisite 
to maintain health and strength, and those 
only who are capable of consuming and di- 
gesting this full allowance, are fit for en- 
countering the cold of the north. From what 
has been said, it is evident how important 
due regulation of the food is to safe and 
speedy acclimation ; it is the main element, 
and the one most under man's control. 
Modern science and discovery will render 
him much assistance, but study of the 
natural products of the soil and of native 
habits is essential. 

The great increase of the functions of the 
skin which takes place on removal to a 
warm climate requires attention. It ren- 
ders the constitution more susceptible to the 
influences of a damp or chill air, such as 
frequently occurs in evening. The above 
remarks apply to our own climate in sum- 
mer. The best preservative is woollen 
clothing of some kind, be it ever so thin, 
worn next the skin. Persons who, from a 
warm climate, of which they are either na- 
tives, or to which they have become accus- 
tomed, come to reside in a variable or cold 
country, are peculiarly liable to affections 
of the chest or lungs, and not unfrequently 
become the subjects of consumption. 

Refer to Air — Respiration — Diet — Cloth- 
ing. 

ACID. — The general characters of an 
acid are that it has a sour taste, reddens 
vegetable blues, and neutralizes alkalies. 
Acids are vegetable or mineral. The prin- 



* Lietog. 



ACN 



16 



ADV 



cipal vegetable acids used in medicine are 
acetic acid or vinegar, benzoic acid, citric 
acid, gallic and tartaric acid, and hydro- 
cyanic or prussic acid. The mineral acids 
are, hydrochloric or muriatic acid, nitric 
acid or aqua fortis, nitro-muriatic acid or 
aqua regia, and sulphuric acid or oil of vi- 
triol. They may be referred to under their 
respective heads. 

ACNE. — Acne is a disease of the skin 
which takes the form of what are popularly 
called pimples. Its seat is in the glands 
which secrete the oily matter. Pimples 
mostly occur on the face, or between the 
shoulders. They are more common in per- 
sons under forty years of age, are gene- 
rally dependent upon some derangement of 
the digestive organs, and will frequently 
continue to recur in spite of medicinal or 
dietetic treatment. At the same time they 
are much more likely to be got rid of by 
light and cooling diet than by the reverse, 
although they appear, and obstinately con- 
tinue, in the most abstemious. A smart 
dose of opening medicine is frequently fol- 
lowed by a crop of pimples in the predis- 
posed, but the bowels should be kept regu- 
lar. Local applications do comparatively 
little good. As good and safe a one as 
any is a lotion made with a little either of 
the flowers or milk of sulphur, rubbed up 
in a little soft water or rose-water, in the 
proportion of two drachms to a pint. 

ACONITE, or Monkshood, or Wolfs- 
bane, is a virulent poison, but in proper 
hands a valuable remedy. The most pro- 
minent symptoms of poisoning by monks- 
hood, following irritation of the mouth and 
stomach, are general paralysis and loss of 
sensation. Of course, on the suspicion of 
such an event, medical assistance should at 
once be sought. In the interval, vomiting 
must, if possible, be produced by the readi- 
est emetic, such as mustard or salt, or by 
a feather carried down the throat. When 
vomiting has come on, or been induced, it 
should be encouraged by copious draughts 
of thin gruel or warm water, a little spirit 
or wine being added if the depression be 
extreme. The extremities should be placed 
in hot mustard and water, and large mustard- 
plasters down the spine will assist to rouse 
the nervous system. [Powdered alum, in 
doses of a teaspoonful, or a little white 
vitriol, will also be found an active emetic] 
In this, and in other cases in which the na- 
tural sensibility of the skin is impaired, care 
should be taken that water is not used too 
hot, as the patient's feelings afford no guide 
in the matter. 

liefer to Emetics — Mustard-Plaster — Bath. 



ACUPUNCTURE.— Acupuncture is a mode 
of treating some diseases by the insertion 
of needles into the body, at or near the seat 
of the malady. The needles, which are 
about two inches long, are fitted into a small 
handle. The method has long been known 
and employed among the Chinese. In this 
country it is chiefly used in rheumatic cases, 
and the relief is sometimes instantaneous. 
The pain of the operation is very trifling, 
and such as none need shrink from. 

ACUTE. — Acute is a term used in contra- 
distinction to chronic, as applied to diseases, 
to denote such as are characterized by vio- 
lent symptoms. Inflammation of the lungs 
and erysipelas are acute diseases ; consump- 
tion and ringworm are chronic. 

ADIPOSE.— Adipose— Fatty. 

ADHESION. — Adhesion is the growing 
together of parts of the body which are or 
have been separated, either naturally or 
artificially. A common cut unites by ad- 
hesion, and when it does so at once, with- 
out the formation of matter, it is said to 
unite "by the first intention." It is evident 
how essentially valuable this property of 
animal bodies must be. It is effected, in the 
first place, by the exudation of a glue-like 
liquid, which soon becomes solid. For the 
exudation of this adhesive lymph, as it is 
called, some degree of inflammation in the 
parts is requisite. This tendency of certain 
inflamed parts to contract adhesions one 
with another, is often hurtful or inconve- 
nient. In some inflammations of the chest 
or abdomen it is especially so ; and in burns 
of the fingers, much care is required to pre- 
vent their being united in the progress of 
cure. 

ADVICE, MEDICAL.— When a medical 
man is consulted, it is a tacit acknow- 
ledgment of confidence ; that confidence 
should be implicit, or placed elsewhere. In 
the first place, care should betaken that the 
necessary directions given, are fully and 
accurately understood ; being so, they should 
be fully and accurately followed out, un- 
less some evident change in the condition 
of the patient, or in circumstances which 
the prescriber could not foresee, renders a 
departure from them necessary ; but of this 
he should have as early notice as possible. 
There is no greater folly than to call in a 
medical man, and then, either from wilful- 
ness or weakness of purpose, to controvert 
or neglect his prescribed rules. It is only 
equalled by that which conceals or deceives 
in the particulars of a case, and looks for 
benefit. It is too commonly the case, in 
illness, that officious persons are continually 
offering their counsel and opinions, disturb- 



ADV 



17 



ADV 



ing the mind of the patient or of the friends, 
and perhaps undermining the trust reposed 
in the attendant practitioner. If it is re- 
flected for one moment how worthless such 
counsel and opinions must be, they would 
be less attended to than they are. Again, 
if proper confidence is felt in the judgment 
of the medical attendant, his requirements 
should be submitted to without remon- 
strance or grumbling. When doubt and 
uneasiness respecting the progress or pros- 
pects of a case intrude themselves upon the 
mind of those most interested, and a second 
opinion is desired, the matter should be 
openly, at once, stated to the ordinary 
medical attendant, and his views and 
wishes heard ; but never should another be 
called in till this has been done. Still less 
even if a medical man can be found to de- 
mean himself so far, should a clandestine 
opinion be taken. Lastly, in sending for 
medical assistance, especially in country 
districts, as full an account of the symp- 
toms of illness, or accident, as possible, 
should be transmitted by written note. The 
precaution must save time ; it may save life. 

[The following extract from the Code of 
Ethics or rules of intercourse adopted by the 
medical profession in the United States, con- 
tains many points that should be remem- 
bered by every one requiring medical ser- 
vices, as they have always proved advan- 
tageous to patients : 

"Obligations of Patients to their Physicians. — 
$ 1. The members of the medical profession, 
upon whom is enjoined the performance of 
so many important and arduous duties to- 
ward the community, and who are required 
to make so many sacrifices of comfort, ease, 
and health, for the welfare of those who 
avail themselves of their services, certainly 
have a right to expect and require that 
their patients should entertain a just sense 
of the duties which they owe to their medi- 
cal attendants. 

\ 2. The first duty of a patient is to se- 
lect as his medical adviser one who has re- 
ceived a regular professional education. In 
no trade or occupation do mankind rely on 
the skill of an untaught artist ; and in me- 
dicine, confessedly the most difficult and 
intricate of the .sciences, the world ought 
not to suppose that knowledge is intuitive. 

\ 3. Patients should prefer a physician 
whose habits of life are regular, and who is 
not devoted to company, pleasure, or to any 
pursuit incompatible with his professional 
obligations. A patient should, also, confide 
the care of himself and family, as much as 
posisble, to one physician ; for a medical 
man who has become acquainted with the 



peculiarities of constitution, habits, and 
predispositions of those he attends, is more 
likely to be successful in his treatment than 
one who does not possess that knowledge. 

A patient who has thus selected his phy- 
sician should always apply for advice in 
what may appear to him trivial cases, for 
the most fatal results often supervene on the 
slightest accidents. It is of still more im- 
portance that he should apply for assistance 
in the forming stage of violent diseases : it 
is to a neglect of this precept that medicine 
owes much of the uncertainty and imperfec- 
tion with which it has been reproached. 

$ 4. Patients should faithfully and unre- 
servedly communicate to their physician the 
supposed cause of their disease. This is the 
more important, as many diseases of a men- 
tal origin simulate those depending on ex- 
ternal causes, and yet are only to be cured 
by ministering to the mind diseased. A pa- 
tient should never be afraid of thus making 
his physician his friend and adviser ; he 
should always bear in mind that a medical 
man is under the strongest obligations of 
secrecy. Even the female sex should never 
allow feelings of shame or delicacy to pre- 
vent their disclosing the seat, symptoms, 
and causes of complaints peculiar to them. 
However commendable a modest reserve 
may be in the common occurrences of life, 
its strict observance in medicine is often at- 
tended with the most serious consequences, 
and a patient may sink under a painful and 
loathsome disease, which might have been 
readily prevented had timely intimation 
been given to the physician. 

\ 5. A patient should never weary his phy- 
sician with a tedious detail of events or mat- 
ters not appertaining to his disease. Even 
as relates to his actual symptoms, he will 
convey much more real information by giv- 
ing clear answers to interrogatories, than by 
the most minute account of his own framing. 
Neither should he obtrude upon his physi- 
cian the details of his business nor the his- 
tory of his family concerns. 

\ 6. The obedience of a patient to the pre- 
scriptions of his physician should be prompt 
and implicit. He should never permit his 
own crude opinions as to their fitness, to 
influence his attention to them. A failure 
in one particular may render an otherwise 
judicious treatment dangerous and even 
fatal. This remark is equally applicable to 
diet, drink, and exercise. As patients be- 
come convalescent, they are very apt to sup- 
pose that the rules prescribed for them may 
be disregarded, and the consequence, but 
too often, is a relapse. Patients should 
never allow themselves to be persuaded to 
2 



AER 



18 



AFT 



take any medicine whatever, that may be 
recommended to them by the self-constituted 
doctors and doctoresses who are so frequent- 
ly met with, and who pretend to possess 
infallible remedies for the cure of every dis- 
ease. However simple some of their pre- 
scriptions may appear to be, it often hap- 
pens that they are productive of much mis- 
chief, and in all cases they are injurious, by 
contravening the plan of treatment adopted 
by the physician. 

g 7. A patient should, if possible, avoid 
even the friendly visits of a physician who is 
not attending him ; and when he does receive 
them, he should never converse on the sub- 
ject of his disease, as an observation may 
be made, without any intention of interfer- 
ence, which may destroy his confidence in 
the course he is pursuing, and induce him 
to neglect the directions prescribed to him. 
A patient should never send for a consulting 
physician without the express consent of his 
own medical attendant. It is of great import- 
ance that physicians should act in concert ; 
for, although their modes of treatment maybe 
attended with equal success when employed 
singly, yet conjointly they are very likely to 
be productive of disastrous results. 

$ 8. When a patient wishes to dismiss his phy- 
sician, justice and common courtesy require 
that he should declare his reasons for so doing. 

§ 9. Patients should always, when practi- 
cable, send for their physician in the morn- 
ing, before his usual hour of going out ; for, 
by being early aware of the visits he has to 
pay during the day, the physician is able to 
apportion his time in such a manner as to 
prevent an interference of engagements. 
Patients should also avoid calling on their 
medical adviser unnecessarily during the 
hours devoted to meals or sleep. They 
should always be in readiness to receive the 
visits of their physician, as the detention of 
a few minutes is often of serious inconve- 
nience to him. 

§ 10. A patient should, after his recovery, 
entertain a just and enduring sense of the 
value of the services rendered him by his 
physician ; for these are of such a character 
that no mere pecuniary acknowledgment can 
repay or cancel them."] 

AERATION.— Blood, during its circula- 
tion through the body, becomes impure in 
quality, dark in colour, and unfit for the 
support of the vital functions. Being passed 
through the lungs , by the powers of the 
heart, it undergoes purification, and the 
dark colour of the venous is exchanged for 
the bright red hue of the arterial fluid : it 
has undergone "aeration" — it has robbed 
the air drawn into the lungs of a portion of 



its oxygen, and given off carbonic acid. 
This aeration of the blood is essential to the 
maintenance of life ; if stopped entirely only 
for a few minutes, death is the result. This 
fact is obvious, and known to all; not so, 
the injurious, ultimately fatal effects of the 
imperfect aeration of the blood, to which 
thousands of our town population are daily 
and nightly exposed. Living in a contami- 
nated atmosphere, the vital fluid never fully 
purified, disease and shortened lives must be 
the result. 

Refer to Respiration — Blood — Circulation. 

iETHERS are volatile liquids used in 
medicine as stimulants. 

Refer to Chloric JEther — Nitrous JEther — 
Sulphuric JEther. 

AFFUSION.— Affusion of cold water over 
the body has been employed by medical men 
in febrile diseases, more especially in scar- 
latina. The patient is seated naked in a 
tub, and a pailful of cold water dashed over 
the surface ; he is then to be wiped tho- 
roughly dry, and put to bed. — The method 
is not much employed. 

AFTER-BIRTH.— In medical language, the 
placenta. It is usually discharged at a pe- 
riod varying from five to forty minutes after 
the birth of the child. There is always some 
little anxiety, both on the part of the pa- 
tient and of the medical attendant, until 
this concluding part of child-birth has been 
accomplished. Within the above time, in 
most cases, sometimes immediately after the 
child is born, the patient complains of an 
accession of labour-pain, caused by the con- 
traction of the womb, which casts off the 
after-birth ; at times expelling it entirely 
from the body, but generally propelling it 
so far toward the external orifice as to make 
its withdrawal perfectly easy. When all is 
as it should be, the business is concluded by 
the ordinary midwife without the least diffi- 
culty. At the same time, it must be remem- 
bered, that some of the most formidable 
accidents of the lying-in chamber are con- 
nected with the management of this part of 
its duties ; and if a female only be in at- 
tendance, not one moment is to be lost in 
summoning proper medical aid, should the 
slightest embarrassment occur. Above all 
things, let the attendants beware of any at- 
tempt to force matters by pulling strongly 
at the navel-cord — they can only do mis- 
chief. The chief danger to be dreaded when 
the after-birth is retained, is loss of blood 
or flooding. If this comes on to any extent, 
the patient must be kept as quiet and cool 
as possible ; gentle but firm pressure must 
be maintained over the bowels generally, 
and especially over their lower portion, by a 



AFT 



19 



AGE 



bandage, and by the hand ; cloths dipped in 
cold water are to be applied over the exter- 
nal parts and frequently changed ; should 
extreme faintness occur, a little wine, or 
brandy, or sal- volatile, may be given in wa- 
ter, but stimulants must not be too readily 
resorted to. The retention of the after- 
birth is at times the result of irregular con- 
traction, but often of adhesion to the womb : 
the possibility of such an occurrence should 
make those who are advanced in pregnancy 
careful to avoid any thing which may press 
upon any portion of the distended womb — as, 
for instance, the stays — and guard against 
habitually leaning, even gently, against any 
hard body. A careful attendant will always 
examine the after-birth : it ought to be 
nearly circular, about the size of a dinner- 
plate, and should not exhibit any signs of 
tearing on the surface which is next the 
womb. The membranes which line the in- 
terior of the womb during pregnancy are 
for the most part discharged along with the 
after-birth, and are more readily and neatly 
brought away by giving the latter body a 
slightly twisting motion as it is withdrawn. 
If they are very tender, a portion may re- 
main and pass off with the discharge ; it is 
well to be aware of the fact, as persons are 
often needlessly much alarmed at this oc- 
curring a few hours or more after delivery. 
Occasionally, the after-birth is so placed 
over the mouth of the womb, that it must 
necessarily be detached in the first stages 
of labour ; the case is always attended with 
danger, and cannot be too soon put under 
medical superintendence : it may generally 
be suspected, if, simultaneous with the occur- 
rence of labour pains, a free discharge of 
blood takes place, which is increased every 
time the pain recurs. In the event, as in 
the country, of any delay in procuring me- 
dical assistance, the measures recommended 
in the treatment of hemorrhage, in "Abor- 
tion," may be resorted to. 

Refer to Child-birth. 

AFTER-PAINS are the regularly recur- 
ring pains which women experience for a 
day or two after child-birth. They are 
rarely troublesome after a first confinement, 
but are apt to increase in severity at each 
succeeding one. After-pains are, in mode- 
ration, salutary, and are caused by the efforts 
of the womb to attain that properly con- 
tracted condition on which the woman's 
safety depends. If they are very severe, it 
is generally owing to the presence of clotted 
blood, which must be expelled before they 
moderate. A constant, unintermitting after- 
pain coming on very soon after the termina- 
tion of labour, is often symptomatic of inter- 



nal flooding, and should be attended to ac- 
cordingly. If after-pains are very severe, 
they can be advantageously relieved by the 
administration of twenty drops of laudanum, 
which may be repeated ; but if the amount 
of pain be moderate, this is unnecessary. 
If the discharge is not profuse, a hot flannel 
to the lower part of the abdomen affords 
comfort. After-pains are often kept up after 
the first four-and-twenty or six-and-thirty 
hours by the bowels being loaded ; a table- 
spoonful of castor-oil is at once a safe and 
effectual remedy. Too tight bandaging may 
aggravate after-pains. 

Refer to Child-birth. 

AGE, OLD. — Althougn the powers of life 
may have previously shown symptoms of 
decline, the period of incipient old age is 
usually fixed in women about the fifty-third, 
and in men about the sixtieth year. After 
this, it generally becomes evident that the 
vigour of prime is giving way, and that the 
powers of the constitution are no longer able 
to recruit themselves, or to sustain exertion 
with the same ease as formerly ; diseases, 
too, peculiar to this stage of life,begin to show 
their symptoms of approach — symptoms 
which can scarcely be too soon detected or 
too carefully watched. As time goes on, the 
individual becomes more dependent upon 
the affectionate care, and, what is equally 
important, the intelligent supervision of 
those around. The subject of the treatment 
of the aged has been a neglected one. A 
valuable work, by Dr. Day, has lately sup- 
plied the want of a special treatise upon it. 
With old age, increases the liability to such 
hereditary diseases as gout, gravel, rheu- 
matism, apoplexy, and paralysis, and in 
women especially, to cancer. Now the ef- 
fects of excesses L.nd dissipation in early 
life, which may have been unfelt during the 
vigor of manhood, too often add to the natu- 
ral infirmities. Whatever may have been 
the previous modes of living, it is always a 
dangerous experiment to make any material 
or sudden change in them; after age has 
begun to tell upon the constitution, it should 
not be done but for important reasons, and 
under direct medical control. The natural 
sensations will gradually guide the indivi- 
dual to those modifications of previous habits 
which accord with the altered structures 
and diminished powers, especially in the 
case of active or violent exertions, which 
the hardening and ossification of the various 
tissues, but more particularly of the coats 
of the arteries, render hazardous. The 
weakened digestion of advanced life should 
be considered in the food, which, while it is 
nutritious, ought at the same time to be 



AGE 



20 



AGU 



lightly cooked, and every thing like harden- 
ing avoided. Where the teeth are deficient, 
meat should be well divided, either by minc- 
ing before cooking, or by the knife after. 
[Hashes are therefore well adapted to old 
people.] The meals should be light, not at 
too long intervals. If the dinner be early, as 
it ought to be for the aged, who are not obliged 
to hurry off to business, supper, though a 
light one, should always be taken. The skin 
of old people is often most shamefully and 
disgustingly neglected, and no point in their 
management is more closely connected with 
their comfort and health ; it should fre- 
quently be sponged with tepid water, and 
well rubbed afterward with a rough towel 
to promote reaction. It ought at the same 
time to be carefully protected by woollen 
clothing: old people are most injuriously 
susceptible of the changes of external tem- 
perature, particularly cold ; indeed the 
change of a few degrees in the thermometer 
may be the immediate cause of death in very 
advanced life, and the average number of 
old people affected by apoplectic or paralytic 
seizures, is apt to be notably increased at 
the setting in of frost. Exercise by the old 
should be continued as long as they are able 
to take it, but never extended to fatigue. 
Sleeplessness, so frequently and loudly com- 
plained of by aged people, is, in some re- 
spects, natural; as life advances, nature 
would seem to require less of the soft re- 
storer. It is not well to endeavour to over- 
come it by narcotic medicines. If possible, 
the time of sleep should, by habit, be kept to 
the early hours of the night, and, in summer 
especially, the tedium of the early morning 
may be relieved by reading, knitting, sew- 
ing, or some other light employment, even 
in bed. In advanced life, the urinary or- 
gans require the greatest care ; the call to 
relieve them should never on any account be 
delayed ; on the slightest symptoms of de- 
rangement, proper medical advice ought to 
be taken at once ; it may prevent evils which 
too often render the latter years miserable. 
It is most important for old people to give 
themselves time to empty the bladder tho- 
roughly ; they do this with more difficulty 
than the young. The medicines prescribed 
for the aged should be, whenever it is possi- 
ble, of a warm character, to counteract the 
tendency to flatulent distension : large doses 
of mercurials, neutral salts, and strong pur- 
gatives, are_ all to -be avoided. Alkalies, 
even when given to counteract a tendency to 
the acid of gout or gravel, must be carefully 
watched, and not too long continued ; they 
may produce the opposite state from that 
which they are intended to correct — a much 



greater evil. Pills, especially if at all hard, 
are apt to pass through the bowels un- 
changed. When an aperient is required by 
an old person, none is more suitable than a 
moderate dose of infusion of senna, to which 
a little ginger, or a teaspoonful of bark or 
of gentian is added, [or a little of Warner's 
gout-cordial may be substituted.] Six to 
eight drachms of the compound decoction of 
aloes answers well, if there is no great ten- 
dency to piles. When the bowels are ha- 
bitually constipated, a clyster, of a pint to 
a pint and a half of warm soap-water, must 
be given occasionally as required : this 
counteracts the great tendency to fsecal ac- 
cumulation. The doses of medicine ought 
always to be diminished after the period of 
incipient old age. 

Refer to Diet — Purgatives. 

AGUE, or Intermittent Fever, is a 
disease which prevails chiefly in marshy 
districts ; the production of that condition 
of the atmosphere which originates it being 
generally associated with the presence of 
decaying vegetable and animal matter. To 
this peculiar atmospheric state the terms 
marsh miasma and malaria have been ap- 
plied. A certain degree of heat appears 
necessary for the origination of malaria. 
Ague is unknown in cold regions, and be- 
comes more virulent the nearer the tropics 
are approached. The malarious poison does 
not seem to extend to any great height 
above the surface of the marsh, and persons 
who are compelled by circumstances to 
sleep in a locality where ague prevails, are 
more likely to escape the effects by occu- 
pying rooms in the upper stories of the 
house. Moreover, marsh poison may be 
carried a considerable distance by the wind 
— the leeward side of a malarious district 
being always the most dangerous. High and 
thickly grown trees have the power of at- 
tracting and retaining marsh miasmata. 
Their vicinity, therefore, in malarious dis- 
tricts, at night, and especially as sleeping 
stations, is to be avoided. At the same time 
the fact is taken advantage of by the resi- 
dents in such districts: for if they can 
place their dwellings so that a belt of trees 
intervenes between them and the marsh, 
they are safe. Strangers are more likely to 
become the subjects of ague than those who 
are regularly resident in the district. The 
latter, however, if the district be a decidedly 
malarious one, even if they do not suffer 
from regular ague, are scarcely ever healthy. 
An individual should always consider well 
before placing himself within the influence 
of a malarious atmosphere ; no worldly ad- 
vantage can be a set-off against the mise- 



AGU 



21 



AGU 



rable condition of a man subject to periodic 
ague. The emigrant, in choosing the scene 
of his future labours, ought to make himself 
very certain upon this head, and when he 
is assured, should be very careful [especially 
in new districts of the United States] not to 
expose himself, even for a night, to the in- 
fluence of malaria, if he possibly can avoid 
it. One of the most remarkable features 
of intermittent fever is its tendency to re- 
turn upon those who have once suffered 
from it. An east wind, indiscretion in diet, 
any thing which lowers the tone of the ge- 
neral health, may bring back the enemy. 
When an attack of ague is about to come 
on, the person complains of general lassi- 
tude, oppression about the stomach, and 
general chilliness, which at last amounts to 
actual shivering, with chattering of the 
teeth, when the disease is fully established. 
By this time, the features are pinched and 
blue-looking, and the whole body seems 
shrunken, the pulse is feeble, the tongue 
pale, sometimes there is vomiting, and there 
may be stupor or convulsive action. Flying 
pains are felt throughout the head and 
limbs. After a certain time, this first (the 
cold) stage gives place to the second or hot ; 
transient heat-flushes become more frequent, 
till at last the coldness is entirely super- 
seded by a state of fever, with quick, full 
pulse, hot skin, furred tongue, and thirst, 
with high-coloured urine, generally throbbing 
headache. At length the third stage brings 
relief, by copious perspiration, the symp- 
toms of disease subside to the level of 
health, and the patient remains compara- 
tively well during what is called the remis- 
sion, that is, until the next attack, which 
may come on in twenty-four, forty-eight, or 
seventy-two hours, or at longer or less re- 
gular periods. The periodicity observed by 
the attacks of ague is one of the most 
marked features of the disease, and the 
terms quotidian, tertian, quartan, are ap- 
plied to denote the interval of return. The 
more frequent the paroxysms, the more se- 
rious the character of the malady, as a 
general rule. The marked features of ague, 
its occurrence in particular localities, and 
its tendency to return, render it one of the 
diseases most easily and certainly distin- 
guishable by the unprofessional, while, at 
the same time, the peculiar circumstances 
under which it often occurs, and the compa- 
ratively regular modes of treatment, per- 
mit of timely assistance being extended to 
the sufferer in the absence of regular medi- 
cal advice. When an individual is attacked 
with the cold stage of the fever, the appli- 
cation of external warmth is at once the 



most natural and beneficial remedy. This 
may be done either by means of bags of 
heated bran, salt, or any other convenient 
method ; or if a vapour-bath be at hand it 
may be used, or an extempore one made by 
seating the patient, wrapped in a blanket, 
on a chair over a bucket containing hot 
water, which is kept steaming by means of 
heated stones thrown in it from time to 
time. Warm diluent drinks may be freely 
allowed, as weak tea, barley-water, and 
such like ; only in a very few debilitated 
cases may a little wine be added. Emetics 
have been given at this stage, but are not 
advisable. A brisk purgative is, however, 
required at the commencement; none is 
more convenient than a pill containing one 
grain of calomel and three grains of the 
compound rhubarb pill. Of these, two may 
be given to an adult. [The compound ca- 
thartic or anti-bilious pill is also often ser- 
viceable, one, two, or three being taken at 
once.] During the hot stage, opium may 
be given. It may be administered as lauda- 
num, in one dose, averaging full five-and- 
thirty drops to an adult, the diluent drinks 
being freely allowed at the same time. The 
sweating stage is to be encouraged until the 
feverish symptoms are quite gone ; if it then 
continues, wiping the skin dry and changing 
the linen will put a sufficient check upon it. 
The individual paroxysm being over, the 
object is next to cure the disease and' 
prevent the recurrence. For this purpose, 
the one remedy, Peruvian bark, as formerly 
given, or its essence, quinine, as now admi- 
nistered, is generally sufficient. If the 
bowels are not thoroughly cleared by the 
calomel and rhubarb, this point must be 
insured by a full dose of castor-oil or some 
purgative, and two-grain doses of the sul- 
phate of quinine in solution, every five 
hours, immediately commenced with, and 
continued night and day, paroxysm or not. 
The dose may require increasing to three 
grains, or even more, but perseverance with 
the quinine will most generally succeed. 
The chief objection to this remedy is its 
high price, and others cheaper have been 
sought. [Sixteen grains divided into two 
doses, and taken when free from fever, will 
often prove more efficient than the smaller 
and oft-repeated doses just advised.] Arse- 
nic is the most to be relied on, but not 
in unprofessional hands. Sulphate of zinc, 
or white vitriol, may be given in six-grain 
doses twice or three times a day with safety, 
and often with success. The use of either 
of the remedies recommended must be con- 
tinued for a week or ten days after the 
disease appears to have ceased, as relapse 



AGU 



22 



AGU 



is apt to occur ; but in the case of quinine, 
should headache, deafness, or noise in the 
ears be complained of, the administration 
must be stopped or greatly moderated. 

Such are the principal general modes of 
treating ague which may safely be had re- 
course to by the unprofessional, and with 
them no one who is resident in a malarious 
district, or no intending emigrant, who may 
chance to find himself in such a district, 
should be unacquainted. At the same time, 
however useful a knowledge of these gene- 
ral principles may be, it will not be every 
thing in all localities. In each the disease 
assumes varied features, which can only be 
properly known and treated by the resi- 
dents. Ague may resist every remedy, or 
may frequently recur, so long as the pa- 
tient resides within the malarious influence, 
or having been contracted, it may be kept 
up by the air of another district, particu- 
larly a cold or damp one, although it could 
not be produced by it. In such a case, 
change to a dry and more genial climate is 
necessary, for though ague is not imme- 
diately fatal, its continuance undermines the 
constitution and originates serious disease. 
Ague is most general in spring and autumn, 
the latter being the more dangerous period 
of attack. Those who are temporarily or 
permanently compelled to reside in a mala- 
rious district, will do well to keep up the 
general tone of the system, by sufficiently 
generous living or a moderate use of fer- 
mented liquors. They should protect the 
skin by woollen clothing, avoid night air, 
or, if obliged to go into it, protect the nose 
and mouth by a handkerchief, [or veil ap- 
plied over the face,] and never go out in 
the morning without taking food, or better, 
some warm fluid, previously. A few doses 
of quinine should be taken occasionally. 

Refer to Quinine — Zinc. 

Ague — (Note on.) — Since the above was 
written, a paper has appeared in the Edin- 
burgh Journal of Medical Science, for Octo- 
ber, 1851, by Mr. Kerr, of Canada, strongly 
recommending, from his own experience and 
that of others, the use of a preparation of 
iron in the treatment of ague. The recom- 
mendation is well supported by evidence, 
and is a most important fact to all who re- 
side or are likely to reside in aguish dis- 
tricts. The salt of iron is named persesqui- 
nitrate of iron., Mr. Kerr gives the follow- 
ing method for its preparation, which is 
simple enough to be followed by any careful 
person: — "Take of iron wire, that known 
by the name of number 17, one ounce, 
nitric acid three fluid ounces, water one 



hundred and seventeen fluid ounces. Mix 
the nitric acid with fifteen ounces of water 
in an earthenware or glass vessel, put into 
it the iron wire broken into several pieces, 
and so tivisted as to extend into every portion of 
the liquid ; place the vessel in a moderately 
warm situation, and in eight or twelve 
hours the solution will be completed, when 
the liquid is to be poured off the remainder 
of the wire, which should always be in ex- 
cess. The residue of the water is now to 
be added, so as to increase the solution to 
one hundred and twenty ounces. The pro- 
cess may be carried on out of doors, if it 
be not cold weather, on account of the 
fumes, or at least placed where these may 
be carried off." Mr. Kerr lays down the 
following method of treatment :— " If the 
patient has paroxysms of ague, ten grains 
of sulphate of quinine, divided either into 
two or three portions, ought to be given 
before the accession of the paroxysm, say 
one portion the preceding night, and two, 
with two hours between them, the following 
morning, each along with a teaspoonful of, 
persesquinitrate of iron. This treatment 
will most probably prevent the accession of 
the paroxysm. The succeeding treatment 
consists in giving a teaspoonful of the per- 
sesquinitrate, thrice a day, about an hour 
before meals. In many individuals, quinine 
suspends a paroxysm of ague only for a 
fortnight or thereabout, the disease return- 
ing thereafter every second day as formerly. 
If this relapse be anticipated, by a few 
grains of quinine given as at first, ague will 
be again prevented. Patients who, from 
previous experience, know that the disease 
will return at the end of a fortnight, ought, 
therefore, to take quinine at the end of this 
period, and to persevere in the use of the 
persesquinitrate till they are restored to 
perfect health. Possibly five out of twenty 
may require a third quantity of quinine at 
the end of a second fortnight, when the 
patient's health ought to be so much im- 
proved by the persesquinitrate of iron that 
the disposition to relapse shall have alto- 
gether ceased." "If the state of fever in, 
or paroxysm of ague has commenced, two 
or three teaspoonfuls of persesquinitrate of 
iron will greatly abridge the duration of the 
distressing headache and pains in the back 
and limbs, and often remove vomiting. Be- 
sides using the medicine, the patient ought 
to avoid fatigue and exposure to rain, till 
his health and strength are re-established. 
Constipation must of course be removed." 

AGUE-CAKE.— The enlarged spleen 
which is frequently the result of repeated 



AIR 



23 



AIR 



attacks of ague. It forms a perceptible 
tumour in the left hypochondriac region of 
the abdomen. 

Refer to Abdomen. 

AIR and ATMOSPHERE.— The air in 
■which we live and breathe consists simply 
of a mechanical mixture of the two gases 
oxygen and nitrogen, in the proportion of 
twenty-three parts of the former to seventy- 
seven parts of the latter, by weight, in every 
hundred. The atmosphere not only consists 
of this air, but also includes various other 
substances. Of these, the principal are 
watery vapour and carbonic acid : ammonia 
and nitric acid exist in minute proportions, 
together with exhalations of various kinds 
and amount, according to situation and cir- 
cumstances. The weight of our atmosphere, 
amounting to fifteen pounds upon every 
square inch of surface exposed to it at or- 
dinary levels, exerts a pressure of nearly 
fourteen tons distributed over the surface 
of every grown man. We do not feel this, 
because it is counteracted by the aeriform 
elasticity of the fluids contained within our 
bodies. But when the pressure of the at- 
mosphere is taken off any portion of the 
surface, as by an exhausted cupping-glass, 
it is the elastic counteracting force within 
the body which pushes up the covered por- 
tion of the skin. The prime, essential con- 
stituent of the atmosphere is oxygen, the 
sustainer of animal life : its dilution with 
four parts of nitrogen exactly adapts it to 
our requirements. The proportions of oxy- 
gen and nitrogen in the atmosphere do not 
vary ; its quality is chiefly altered by the 
amount of watery vapour, carbonic acid 
and other gases, and exhalations, and by 
the rarefying or condensing effects of heat 
or cold. The importance to health of a 
due supply of pure air, and the knowledge 
of the principal sources of its vitiation, is 
becoming every day better understood and 
acted upon. 

The most constant and^ extensive source 
of impurity is animal respiration. Every 
breathing animal, man included, is conti- 
nually drawing air into the lungs, and the 
next moment giving out, instead of the life- 
sustaining oxygen, poisonous carbonic acid. 
It is evident from this, that if an individual 
or individuals are enclosed in a room which 
possesses no means of ventilation — in other 
words, which has not its air continually 
changed — the air contained in that space 
must become unfit to be breathed, health 
will suffer, and life may be extinguished. 
The headaches and uneasy sensations caused 
by close, crowded rooms are familiar to all. 
The tragedy of the Black-Hole of Calcutta, 



and that of the Irish steamer a few sum- 
mers ago, are notorious. In the latter, 
sixty persons, fastened down in a close, small 
cabin, perished in less than six hours. 
These individuals were actually poisoned 
by the carbonic acid gas they had them- 
selves expired. Such effects are too obvi- 
ous to require comment ; it is the gradual 
undermining of health, the slow poisoning 
of those who habitually breathe a vitiated 
air, to which attention requires to be drawn, 
and more particularly in the case of sleep- 
ing apartments. When it is considered that 
one per cent, of carbonic acid in the air 
will cause uneasiness, that ten per cent, is 
the probable limit where immediate danger 
to life commences, and that every adult man 
vitiates at least two hundred and sixteen 
cubic feet per hour of the pure element, it 
is needless to say more upon the necessity 
for proper ventilation. Moreover, exhala- 
tion from the surface of the bodies even of 
the healthy is constantly adding a consider- 
able proportion to the other sources of at- 
mospheric impurity. Notwithstanding facts 
like the above, people lie singly or in num- 
bers, for six or eight hours every night, 
breathing over and over again the same 
contaminated atmosphere : they sleep hea- 
vily, and rise in the morning wondering, 
perhaps, that they feel even more languid 
than when they lay down at night. 

The notorious cases of low lodging-houses 
and other such resorts are not now alluded 
to, but the less-suspected nurseries and 
well-furnished apartments even of the higher 
classes, many of which, with door, window, 
and chimney closed, and heavy curtains 
drawn round heavy sleepers, are perfect 
hot-beds of disease. It is time such igno- 
rant, culpable disregard of all the princi- 
ples of health should cease. We spend on 
an average one-third of our lives in our 
bedrooms for the purpose of refreshing the 
body, how important then to have them as 
airy as possible, with free entrance for the 
good air, free exit for the deteriorated. If 
the door of a room must be fastened at 
night, let it be by a chain-bolt ; or if it must 
be locked, let the upper panels be perforated, 
or the window fitted with a pane, of perfo- 
rated glass or zinc : at all events, let air in 
somehow. Keep the chimney open, that it 
may carry off the impure ; this it will do, 
particularly if fitted with an Arnott's venti- 
lator. Breathing the air in crowded assem- 
blies of people is only occasional, and ge- 
nerally for a short time — it can do compa- 
ratively slight mischief; the air we breathe 
for one-third of our lives cannot be vitiated 
without the most serious injury to health 



AIR 



24 



ALB 



and curtailment of life. Many a mother 
has mourned over the untimely grave of a 
child, little suspecting how the close, hot 
nursery had undermined the young consti- 
tution, before the fatal cold or epidemic 
snatched her treasure away. 

Diet, clothing, exercise, all claim serious 
attention : still more, for old or young, the 
purity and ventilation of the sleeping 
apartment. 

Burning candles or lamps vitiate air in 
the same manner as the respiratory process 
of animals. They consume oxygen and form 
carbonic acid, consequently they are unde- 
sirable in close rooms at night, or indeed at 
any time, if there is insufficient renewal of 
the air. A fire in the bedroom is recom- 
mended as a means of ventilation, and un- 
doubtedly is so as long as it is burning 
briskly, if kept well replenished, and if the 
chimney draws well ; but when, during the 
hours of sleep, the fire gets low, and the 
draught up the chimney is diminished, the 
air vitiated by the burning embers is very 
apt to become diffused through the apart- 
ment, and, with it, sulphurous and other 
fumes. This point is one frequently over- 
looked, and, from the very injurious conse- 
quences which may result, requires strict 
attention. Plants or flowers kept in a sleep- 
ing apartment are another not unfrequent 
source of impure air ; for although living 
vegetation under the influence of sunlight 
has the power of abstracting carbonic acid 
from the atmosphere, which in fact it con- 
tinually purifies from the effects of animal 
respiration, in darkness the case is reversed: 
not only do leaves cease to absorb carbonic 
acid, but they give it out. When it is re- 
membered, that in a school in which pupils 
had been taking lessons for three hours, 
with doors and windows closed, the amount 
of carbonic acid has been found to be eight 
times the average ; that much less than this 
causes uneasiness ; that a little more may 
cause death ; enough has been said to prove 
the necessity for preserving the air we 
breathe in a state of the highest possible 
purity, and of avoiding every known source 
of deterioration. In the room of sickness 
the necessity is increased tenfold ; both for 
the sake of the patient and of those around, 
the air must be kept pure. In the few cases 
in which ventilation cannot be had recourse 
to, Liebig recommends the use of slaked 
lime spread on a board ; this quickly ab- 
sorbs the carbonic acid of any closed space 
in which it may be placed, and fresh air 
must rush in through the crevices to supply 
the place of the former gas. It scarce re- 
quires mention that all decomposing sub- 



stances, in whatever situation, cannot fail to 
render the air impure — moist vegetable mat- 
ter particularly. Damp, decaying wood, 
sawdust, straw, &c, all exhale carbonic 
acid, and in close places may also originate 
serious disease. It is worthy of note that 
while decomposing dead animal matter does 
not seem so materially to affect health, the 
morbid exhalations from living animal bodies 
poison the atmosphere to such an extent as 
to occasion the most malignant fevers. 

Locality, it is well known, exerts much in- 
fluence over the purity of the atmosphere. 
The air of towns must of course be less 
pure, principally from admixture of sul- 
phurous vapour, the product of combustion. 
The air of the coast is stimulating and 
strengthening, probably in some measure 
owing to its containing minute portions of 
the sea constituents. The air of all damp, 
low situations is particularly unhealthy; 
doubly so if the situation is surrounded 
by elevations which prevent atmospheric 
changes. Intermittent fevers and diseases 
of a neuralgic character prevail in these 
places. The noxious influence is generally 
more potent near the ground, and those 
who are compelled to reside in such locali- 
ties may escape much evil by occupying 
rooms as elevated above the soil as possible. 

Dry air is generally good, but it may be 
too dry, and produce disagreeable effects 
upon the skin, as chapped hands, &c. Moist 
air, when combined with cold, is worst of 
all. The state of the atmosphere varies 
much in the twenty-four hours. The fresh 
air of early morning, salubrious to the 
strong and healthy, requires to be dried and 
warmed by the sun before it is suitable for 
the invalid. Even in summer, in this climate, 
this is scarcely the case before eight o'clock. 
Exposure to the damp air of evening and 
night must always be shunned by the weak 
in health. So noxious is it in some tropical 
or marshy regions, that one night's sleep 
within its influence is certain to be followed 
by an attack of illness. That a uniform 
temperature and unchanging climate is not 
so well adapted to maintain health as a va- 
riable one, is admitted on the authority and 
experience of Sir James Clark, Dr. Combe, 
and others. 

Refer to Oxygen — Carbonic Acid — Nitro- 
gen— Respir a Hon — Ven tila Hon — Perspiration, 
$c. 

ALBINO. — An individual in whom the 
usual colouring matter of the body is absent. 
The complexion is unnaturally white, the 
hair white, the eyes appear pink. White 
rabbits with red eyes are albino rabbits. 
Albinos are rare among Europeans, but are 



ALB 



25 



ALI 



found more frequently among the negroes. 
[When the person thus affected is a female, 
she is termed an Albiness.'] 

ALBUMEN.— One of the principal con- 
stituents of the animal body. The white 
of the egg is nearly pure albumen. In the 
serum or watery portion of the blood it 
exists in large proportion, and may be co- 
agulated from it by heat, like the white of 
an egg. When it is recollected that from 
the albumen of the egg (for the yelk is al- 
bumen also) the perfect chick is constructed, 
with its blood, muscles, bones, and nerves, it 
will be seen how great must be the nourish- 
ing power of this substance. Besides exist- 
ing in the blood, albumen forms a consider- 
able proportion of the animal solids : it 
also exists in the vegetable kingdom, more 
especially in the grains and pulses. Heat 
first coagulates, and then hardens albumen, 
thus impairing its digestibility — a reason 
for avoiding over-cooking meat, as well as 
eggs. 

ALCOHOL, the principle on which the 
characteristic properties of fermented and 
distilled liquors depend, is formed from 
grape sugar which has undergone the vinous 
fermentation. It is a limpid, colourless, 
highly inflammable liquid, of penetrating- 
smell ; it is rarely, if ever, used either as 
medicine or beverage uncombined. Distilled 
spirits, wines, malt liquors, and fermented 
liquors generally, owe their intoxicating and 
stimulating properties to the alcohol which 
they contain in more or less proportion. 
In medicine, alcohol is used to form tinc- 
tures, that is, to hold in solution certain ve- 
getable, and, in a few cases, animal sub- 
stances, which are most conveniently ad- 
ministered in this form. Some of these, 
such as camphor, will dissolve to the extent 
required only in strong alcohol or rectified 
spirit: for others a more diluted alcohol or 
proof spirit is sufficient. In addition to its 
solvent properties, alcohol is likewise valu- 
able from its power of preserving the infu- 
sions or solutions to which it is added. 
One ounce, by measure, of alcohol, mixed 
with a pint of water, forms a good evapo- 
rating lotion to be used when it desirable to 
reduce the external heat of any portion of 
the body. 

Refer to Tincture — Fermentation — Sugar. 

ALE and BEER contain more or less sac- 
charine matter, alcohol, and bitter principle 
of the hop ; they also contain, especially 
when old and hard, a proportion of lactic 
acid. As an ordinary beverage for most 
people, good table beer is particularly well 
adapted. It contains just enough spirit to 
afford gentle, almost inappreciable stimula- 
C 



tion, and its bitter undoubtedly assists to 
maintain the tone of the stomach, so apt to 
fail in the hard-working, anxious-minded 
citizen. Ale is too strong for ordinary 
every-day use for the robust, but in the de- 
licate, and in convalescence from illness, 
when it agrees, it is often admirably adapted 
to support the powers of the constitution. 
The India bitter beer agrees well with some 
persons, and the great amount of bitter it 
contains acts as a powerful tonic to weak 
stomachs ; [the same is the case with the 
lager-beer now so much employed in the 
United States.] But for this very reason, 
its use ought not to be persevered in long 
at a time. The amount of spirit it contains 
is not large, but the narcotic properties 
of the hop are apt to affect the head. Malt 
liquors never agree with those who are 
liable to gout or gravel ; and if their use be 
continued, they are almost certain to induce 
a paroxysm of either of the diseases, as the 
slightest degree of acidity or hardness ag- 
gravates their bad effects tenfold. A single 
glass of hard ale is sufficient to indiice an 
attack of gravel in the predisposed. Those 
who suffer from plethora, and consequent 
head symptoms, from chronic cough or 
oppression of breathing, from gout, gravel, 
or habitual acidity of the stomach, should 
never touch either ale or beer. Hard or 
acid malt liquor is always injurious ; some 
persons on this account habitually add a 
small portion of carbonate of soda to their 
malt liquor The practice is most hurtful, 
and rapidly debilitates the stomach and de- 
teriorates the blood. 

ALIMENT.— Whatever is capable of 
nourishing the body. A rough division is 
made into liquid and solid aliment. Amid 
the vast variety of nutrient materials with 
which man has been furnished by his Crea- 
tor, it is by no means a matter of indiffer- 
ence which he selects. The first point is to 
be certain that the aliment used contains all 
the principles required to support health and 
strength. In a mixed diet this is tolerably 
sure to be the case ; not so when the food is 
restricted to one or two articles, and griev- 
ous mistakes have occurred on this point. 

Some alimentary substances contain with- 
in themselves whatever is required for the 
nourishment of the animal body. Of these, 
albumen, milk, and bread, are examples ; 
others, such as jelly, arrow-root, sugar, con- 
tain only part of the elements required for 
proper nourishment, and could not of them- 
selves support life ; indeed, man or animal, 
fed upon them exclusively, would die of a 
certain kind of starvation. Children have 
actually been partially starved to death on 



ALI 



26 



ALI 



arrow-root mucilage, made with water and 
sugar alone, while those around considered 
them to be receiving full nourishment. At 
the same time, even in the case of a single 
nutrient compound, such as albumen, con- 
taining all requisite principles, experience 
has shown that it is unfit to preserve health 
and strength. The whole alimentary system 
requires the stimulus of change. Aliment, 
it has been said, is divided into liquid and 
solid, but before it can actually enter the 
system, it must all be reduced to the state 
of liquid. Some persons err in diluting 
their food too sparingly. Aliment may be 
very nutritious, but difficult of digestion. 
This question, however, falls more fitly under 
the head of Diet. 

ALIMENTARY CANAL.— The entire tube 
through which the food passes from the 

Fig. iii. 




mouth to the anus ; the total length in man 
averaging thirty-three feet. Its divisions 



are the mouth, the pharynx or throat, the 
oesophagus or gullet, the stomach, the small 
intestines, and the large intestines and rec- 
tum. The oesophagus (fig. iii. 1) extends from 
the throat to the stomach, which it enters to- 
ward its larger extremity, (fig. iii.,) passing 
down the posterior part of the chest. The 
shape of the stomach will be best under- 
stood from the figure, (fig. iii.) It has a 
larger extremity, 2, and a smaller, 3. From 
the smaller proceeds the first portion of the 
small intestine, (fig. iii. 4,) named the duo- 
denum, divided, however, from the stomach 
at 4, by the pyloric valve. The small intes- 
tines, 6, 6, divided nominally into two 
more portions, jejunum and ilium, extend in 
a continuous coil to the length of about 
twenty-five feet, and then enter the large 
intestine in the right iliac region. The 
opening of the small intestine into the large 
is slit-like, (fig. iv. C.,) and is protected by a 

Kg. iv. 




valve, D. The large intestine, or colon, (fig. 
iii. 9, 10, 11,) five feet long, ascends from 
where it is entered by the smaller gut, cce- 
cum, (fig. iii. 7,) as high as the under surface 
of the liver ; it then passes across the abdo- 
men, and descending, after making a pecu- 
liar turn, ends in the rectum or vent gut. 
The calibre of the colon is much greater 
than that of the small intestine, and it is 
thrown into sacculi or folds by three longi- 
tudinal muscular bands. As soon as food 
reaches the back of the throat, it passes 
from the power of the voluntary to that of 
the involuntary muscles, and is conveyed 
into the stomach by a regular wave-like 
action of the muscular gullet or oesophagus. 
AVhen persons eat too fast, and one morsel 
is passed into the throat too quickly after 
the other, this regular muscular action 
becomes spasmodic, producing a very pain- 
ful sensation. The mass of food from a 
meal, being collected at the larger end of 
the stomach, is there mixed with gastric 



ALK 



27 



ALO 



juice, and converted into a pulpy, gray- 
looking mass, the chyme, which, as it is 
formed, is propelled toward the pyloric or 
smaller extremity, by successive wave-like 
motions of the organ. At the pyloric valve 
all well-digested food is allowed to pass, 
but in the healthy stomach, any portions 
which are not thoroughly softened, are 
stopped, and passed back into the organ. 
The food, having passed through the pylorus 
into the upper part of the small intestine, 
quickly becomes mixed with the bile, which 
flows into the duodenum from the liver by 
its proper duct, (Fig. iii.,) and also with the 
pancreatic juice. The mass of chyme is now 
propelled forward by a worm-like motion 
of the small intestines, the nutrient portions 
being absorbed from it, as it passes onward, 
by the lacteal vessels. The lining membrane 
of the intestines is thrown into folds to in- 
crease the surface to which the chyme is 
exposed. Having traversed the small, the 
chyme is discharged into the large intestine, 
or colon, through the slit-like valve, and 
here the contents of the bowels, thought by 
some to undergo a kind of second digestion, 
assume the feculent character. After yield- 
ing up in the colon the remains of nutrient 
matter, the mass is discharged through the 
rectum and anus. The whole of these 
movements are effected by the muscular 
powers of the alimentary canal itself. The 
main object of the alimentary canal is, most 
undoubtedly, the digestion of food; but 
this is not its only office — it is one of the 
great and important drains and sewers of 
tSe body, and into it is cast a large propor- 
tion of the used-up material of our frames, 
which would be hurtful if retained, particu- 
larly so in illness, such as fever. The fact 
is a cogent one why at all times the bowels 
should be kept clear ; and will explain to 
people wherefore, during illness, even when 
food is not taken, and when they often think 
and say, " there can be nothing in a pa- 
tient," the medical attendant is so careful 
to keep this great drain, the alimentary ca- 
nal, clear of its noxious contents. 

Refer to Abdomen — Absorption — Digestion. 

ALKALI. — An alkali is a substance which 
neutralizes acids more or less perfectly, 
forming by the combination a salt which 
differs from either of its components ; thus, 
nitrate of potash or saltpetre is a compound 
of potash and nitric acid. Alkalies have also 
the general property of turning vegetable 
blues to green. Potash, soda, and ammonia 
are the three alkalies ; the two first are fixed, 
the last is volatile. 

Refer to Potash — Soda — Ammonia. 

ALMOND. — The sweet almond, as an arti- 



cle of food, is not digestible ; when triturated 
with gum and sugar, so as to form an emul- 
sion, it constitutes a pleasant demulcent ve- 
hicle for medicine, in affeotions of the chest 
or mucous membranes, and may be taken 
freely. The bitter almond is most decidedly 
unwholesome, unless in very small quantity 
as a flavour ; and some persons cannot even 
take it in that way with impunity. The es- 
sential oil of bitter almond contains, after 
distillation, prussic acid in sufficient quan- 
tity to act energetically as a poison. A sin- 
gle drop of the pure oil would be dangerous. 
Cases of poisoning from eating bitter almonds 
have occtirred : the symptoms and treatment 
are very similar to those in poisoning by 
prussic acid. The strong peculiar odour of 
the oil will in most cases betray the accident. 

Refer to Prussic Acid. 

ALOPECIA.— See Baldness. 

ALOES. — One of the most useful and ex- 
tensively used purgatives. It is seldom given 
alone, and is scarcely employed domestically 
except in its combinations, particularly in 
pills ; indeed, there are few active aperient 
pills into the composition of which aloes does 
not enter. The action of aloes is certain, and, 
except in peculiar cases, easy and safe. In 
pregnancy, and where any tendency to piles 
exists, its use had better be avoided. The 
action of the medicine upon the stomach is, 
in small doses, tonic ; but the principal ef- 
fect of aloes is upon the lower bowels, the 
movements of which it appears to excite, 
without increasing the discharges : it seems 
to act similarly to the bile, and when that 
is deficient, as a substitute for it. The prepa- 
rations into which aloes enters are general- 
ly better provided ready made. Of the pills, 
the simple aloetic, the compound rhubarb, 
and the compound colocynth, are the best ; 
the last is the most active. Of any of these, 
one or two pills, three grains each, may be 
taken at bedtime as an average dose. The 
compound decoction of aloes is a most ex- 
cellent form, and may safely be given when 
quick action is required, in one to two ounce 
doses. For old people, it often answers 
well, and is preferable to pills. It is made 
follows : — Take of aloes, saffron, and myrrh, 
bruised, of each one drachm and a half; ex- 
tract of liquorice seven drachms ; carbonate 
of potass three scruples ; water thirty fluid 
ounces. Mix the whole together, and boil 
down to twenty fluid ounces. Filter, and 
add compound tincture of cinnamon seven 
fluid ounces. Aloetic purgatives may be 
taken habitually for a long time without an 
increase of the dose being required ; the 
continued use, however, may induce piles. 

Refer to Purgatives — Pills, 



ALT 



28 



AM A 



ALTERATIVE is a rather indefinite term 
applied to certain medicines which are sup- 
posed to have the power of changing the 
various disordered actions of the body, with- 
out producing any sensible effect when taken. 
Mercury given in small doses, more particu- 
larly as it is in Plummer's pill, is perhaps 
the best example of a medicinal alteiative. 
There is, however, an alterative preferable 
to medicine — obedience to the laws of health. 
Temperance in eating and drinking, exercise, 
attention to the state of the skin, and to the 
ventilation of sleeping-rooms especially, are 
alteratives which every one may employ. A 
course of medicinal alteratives must be left 
to medical direction. 

ALUM is a compound salt of sulphuric 
acid, potash, and alumina. It is a powerful 
astringent, and is used as such in medicine. 
In bleeding, especially from the nose, lint 
dipped in a strong solution of alum, and ap- 
plied to the part as a plug, will often stop 
the flow, or, in the case of leech-bites, the 
powder of burnt alum may be sprinkled 
upon the puncture. Internally, alum is 
given in cases of protracted diarrhoea, and 
in hemorrhage from the lungs or stomach, 
&c. In case of an individual being attacked 
either with coughing up or vomiting of dark 
blood, in the absence of medical assistance, 
alum, which is generally easily procurable, 
may be given in doses of from five to twenty 
grains every two or three hours. In cases 
of that painful spasmodic affection of the 
bowels named painter's colic — to which those 
who work much among lead are liable — 
alum has recently been found of much ad- 
vantage, and might safely be given provi- 
sionally, by an unprofessional hand, to ame- 
liorate suffering — the dose is from ten to 
twenty grains every three or four hours. As 
an astringent gargle in relaxed sore throat, 
alum is most useful in the proportion of two 
drachms to half a pint of water. Alum may 
be given in pill, but better in solution, in 
distilled water flavoured with cinnamon or 
some aromatic. Alum whey, made with five 
grains of the salt to every ounce of [hot] milk, 
and the curd strained off, is a pleasant and 
convenient form : — a teacup ful to be taken 
three times a day. A few grains of alum, 
agitated with the white of an egg, form a 
coagulum which, put between two folds of 
muslin, is used with benefit to the bed-sores 
of the sick. [It is also useful in bringing a 
"sty" to a head. In croup, a teaspoonful 
of powdered alum, repeated every twenty 
minutes, is a certain emetic] 

ALVEOLUS.— The socket of a tooth. 

liefer to Hemorrhage — Croup. 



AL VINE.— Connected with the belly— as 
alvine discharges, concretions, &c. 

AMAUROSIS, the gutta serena of Milton, 
is total or partial blindness, depending upon 
disease of some portion of the nervous con- 
nections of the eye. . The retina, the brain, 
the optic nerve, may any of them be the seat 
of the disease. The appearance of the eye 
is unaltered beyond the dilatation of the pu- 
pil, which gives it a peculiar dark, deep 
look, but the expression is unmeaning. 
Persons who exercise the eyes much on mi- 
nute objects, or who are much exposed to the 
glare of intense light, are liable to become 
amaurotic ; but in such cases, the disease is 
mostly the result of some amount of inflam- 
mation going on within the eye itself, and 
if taken in time, is remediable. A person 
threatened with amaurosis, first observes, in 
the day time, dark motes or specks floating, 
as it were, before the sight, at first distinct 
from one another, but gradually becoming 
connected, and forming, as it were, a thicker 
and thicker veil as the sight becomes ob- 
scured. In the dark, the motes or specks 
frequently appear luminous. Sudden flashes 
of light appearing, is a symptom not unfre- 
quent ; there is usually pain in the eye and 
head. It must not be supposed, however, 
that every one who sees motes or specks is 
becoming amaurotic ; some persons have 
this peculiarity of vision, either habitually, 
or whenever the stomach is disordered. In 
addition to the causes above stated, amau- 
rotic blindness may be the result either of 
overfulness of blood or of the contrary con- 
dition, of disease of the brain, of indigestion, 
sexual excess, hysteria, gout, overnursing, 
&c. In such a disease, requiring the nicest 
discrimination of the medical practitioner as 
to cause, before he can adopt appropriate 
treatment, no unprofessional person is quali- 
fied to interfere. An individual threatened 
with amaurosis cannot too soon submit him- 
self to skilful advice, and should let no con- 
sideration stand in the way of his doing so 
as quickly as possible. Should distance, or 
any unavoidable cause, occasion delay, all 
exercise of the eye should at once be stopped, 
the general health and condition of the bowels 
attended to, and, unless there is evidence of 
extreme weakness, all stimulants avoided ; if 
the patient is a nursing female, the child 
must be weaned at once. Amaurosis, or 
blindness without obvious cause, coming on 
suddenly in a person of full habit of body, is 
always a grave symptom, and, as in such a 
case every minute may be valuable, if me- 
dical aid cannot at once be got, six or eight 
[European, or eighteen American] leeches 



AME 



29 



AMP 



may safely be applied to the temples ; an 
active purgative of twenty grains of jalap, 
and four or five of calomel, is to be given at 
once ; and after the leeches, cold should be 
applied to the head, and perfect quiet ob- 
served. All further treatment in this dis- 
ease must depend on the individual judgment 
of the medical attendant. 

Refer to Eye — Brain. 

AMENORRHEA.— See Menstruation. 

AMMONIA. — Volatile Alkali. — Spirit 
of Hartshorn. — A gas in its pure state : is 
used in medicine in solution, either in water 
or alcohol, or as a salt, in combination with 
carbonic acid or acetic acid. In the former 
case, it constitutes the common carbonate 
of ammonia ; in the latter, the solution of 
acetate of ammonia is known popularly as 
"spirit of mindererus." The solution of 
ammonia in water is used of two different 
strengths ; one very strong, generally em- 
ployed externally ; the other more diluted — 
"diluted solution of ammonia" — given in 
cases of fainting, depression of the system, 
or as a stimulant antacid in indigestion ; or 
in spasm, in doses of from five to twenty 
drops, in water or other simple fluid. In 
cases where a very rapid effect is required, 
ammonia is advantageous ; but when there 
is partial insensibility, care must be taken 
that choking is not produced in the adminis- 
tration. When combined with olive-oil, am- 
monia forms a most useful and general- 
ly used stimulant liniment, [volatile lini- 
ment.] Two parts by measure of oil, to one 
of the diluted solution of ammonia, is a con- 
venient strength ; or equal parts of each 
may be used if a stronger form is requisite. 
Poisoning by ammonia sometimes occurs, 
particularly by mistake : the best and most 
convenient antidote is vinegar, or any vege- 
table acid. 

Carbonate of ammonia* is an instance of 
two gaseous bodies forming, by their union, 
a firm solid. The actions and uses of this 
salt are the same as those of ammonia ; 
it may, however, be given in pill ; if in solu- 
tion, five grains dissolved in three table- 
spoonfuls of water is an average dose. 

The aromatic spirit of ammonia, or sal- 
volatile, is perhaps the best and most con- 
venient form for internal administration — 
certainly so for popular use. It keeps good 
any length of time in a stoppered bottle ; 
and the dose, which is from a half to a whole 
teaspoonful, in three parts of a wineglass- 
ful of water, is easily and readily adminis- 
tered. Solution of acetate of ammonia, 
popularly known as " spirit of mindererus," 
is a very certain and safe diaphoretic, pro- 
ducing free perspiration. In colds and slight 
c2 



febrile ailments, it may be given without 
fear, in tablespoonful doses, diluted with 
water, repeated every few hours, its effect 
being assisted by warm drinks and confine- 
ment to bed. 

AMMONIAC GUM.— A stimulant expecto- 
rant,used also in the form of stimulant plaster. 

AMPUTATION can never legitimately fall 
within the scope of unprofessional surgery, 
except when it is occasioned by violent acci-, 
dent, and when a longer or shorter time 
must elapse before surgical assistance be 
procured. The immediate danger in such 
cases is fatal hemorrhage, or bleeding ; but, 
fortunately, from the usual nature of the ac- 
cident, this does not occur to so great an 
extent as might be expected : the bruising 
or tearing which generally accompanies the 
severance of the limb acts as a preventive. 
The first thing to be done in such an acci- 
dent, if there is much bleeding, is to tie a 
handkerchief, a garter, or band of some 
kind, round the limb, between the bleeding 
points and the body, [twisting it tight,] and 
if a pad can be placed over the trunk of the 
main artery, so much the better. It is better 
not to attempt to wrap up the wound itself 
too soon ; it should be freely exposed to the 
air ; there is no better stauncher of blood 
than a cool breeze : above all things, the 
bathing with water, especially warm water, 
which is so frequently done, is to be avoided. 
In addition, the wounded member should be 
elevated above the level of the body. When 
the bleeding has ceased, which it will almost 
certainly do if these means are properly 
attended to, a soft linen cloth, or cotton, if 
there is no linen at hand, should be placed 
over the wound, the patient kept quiet in a 
recumbent posture, with the limb slightly 
but easily elevated, and nothing more done 
until the surgeon's arrival. No mention has 
been made of the method by which the sur- 
geon secures a cut artery by tying : it is not 
a procedure to be attempted by the unpro- 
fessional, except in most extreme circum- 
stances, such as the certainty of no medical 
assistance being procurable for many hours, 
it might be days. In such a case, it would 
be impossible to keep the tight band round 
the limb without mischief ensuing: by 
slightly relaxing it, after some reaction has 
come on, the situation of any arteries likely 
to bleed would be made evident by their im- 
mediately doing so. A slender but firm 
hook, or pair of small forceps, should be 
used to pull forward every bleeding point in 
succession, so far as to allow of a ligature 
[string] of silk or fine twine being tied 
around it by a second person. The cessa- 
tion of the flow of blood will indicate whether 



AN^E 



30 



ANG 



this has been done effectually ; at the same 
time, the band round the limb must not be 
removed, but only relaxed, and left so that it 
can be instantaneously tightened, should he- 
morrhage return. In such an extreme case, 
it might be almost a matter of necessity to 
detach a limb, the bone of which had been 
crushed through and the main artery severed, 
by a few strokes of a sharp knife. Of course, 
after such an accident, watch, with light, 
must be kept up during night. Should heat 
and inflammation come on, cloths dipped in 
cold water may be freely applied. 

Refer to Artery — Hemorrhage — Tourniquet. 

ANiEMIA. — Chlorosis. — A condition of 
constitution, in which the quality of the 
blood is deficient, in its red globules, or co- 
louring portions, more especially. It is 
common in young females, especially of scro- 
fulous habit. The pallor of all those por- 
tions of the body, such as the lips, which are 
usaally well coloured, sufficiently indicates 
the disease. Ansemia may arise from acci- 
dental causes, such as deficient nourishment, 
unhealthy situation, extreme loss of blood, 
or may be of constitutional origin. In the 
former case, it is generally quickly recovered 
from, if the constitution is a good one, under 
the use of iron and good living ; in the latter 
case, it often requires long and patient per- 
severance in these and other means to effect 
a cure. General languor and listlessness, 
very heavy sleep, headache, mental debility, 
impaired, capricious, or depraved appetite, 
constipated bowels, and swelling of the feet, 
are the general accompaniments of ansemia ; 
the monthly secretion is either absent or 
very pale. The primary cause of anosmia is 
still obscure, but the direct cause of the 
symptoms is undoubtedly poverty of the 
blood ; and to improve the vital fluid must 
be the great aim of treatment. The bowels 
should be kept open, not purged, by some 
mild aperient, such as the compound rhu- 
barb or colocynth pill, and ten drops of the 
muriated tincture of iron, or two grains of 
the ammoniated tartrate of iron, given in a 
wine-glassful of water twice or three times a 
day. If the appetite is deficient, and does 
not improve, a dose of tonic bitter, as quinine, 
salicine, or gentian, must be given along 
with or substituted for one dose of iron. 
Codliver-oil is also useful. The diet must 
be generous ; meat twice a day ; eggs if pre- 
ferred, puddings in small proportion, and 
bread partly substituted for vegetables. 
Malt liquor, especially porter, to the extent 
of one of the usual pint bottles, should be 
taken in divided portions daily, or a couple 
of glasses of port wine, if the former dis- 
agrees. An amende patient ought to retire 



to rest by ten o'clock, and to rise, as a gen- 
eral rule, by half-past seven, but ought 
never to delay breakfast beyond the mere 
time required for dressing ; going out before 
the meal is quite out of the question, and, 
indeed, in some cases, where there is a ten- 
dency to fainting, it is better to have a cup 
of coffee, or warm milk, before rising, and 
even to this, as a temporary remedy, it may 
be requisite to add a teaspoonful of brandy. 
The skin must be attended to, but by tepid 
sponging only. The bed should be a hair 
mattress. Exercise in the open air on foot 
or horseback must be regular, but not car- 
ried beyond comfortable fatigue. Change 
of air to the seaside, or to a chalybeate 
spring, is of great service. Mothers are 
often anxious about the non-appearance of 
the monthly discharge ; its absence is but a 
symptom of the disease, and it is better that 
the constitution should not be drained even 
by it, until it is able to support it. Such 
are the general rides respecting ansemia, but 
a confirmed case should always be submit- 
ted to the medical man : causes may be ag- 
gravating, or effects, such as consumption, 
springing from the disease, which he only 
can detect. Moreover, in extreme cases of 
this disease, sudden death has occurred. 

Refer to Chalybeates — Iron, $c. 

ANAESTHESIA.— Loss of sensation. 

ANALYSIS.— The art of separating and 
distinguishing the various constituents of a 
compound body, either as regards quality 
or quantity. In judicial inquiry it is most 
important, and were its power and perfec- 
tion more generally known, the dread of al- 
most certain discovery would tend to check 
the too common crime of poisoning. It is 
possible for the chemist to make the thou- 
sandth of a grain of arsenic demonstrable. 

ANASARCA.— See Dropsy. 

ANATOMY. — The science which treats 
of the structure of organized beings. It is 
divided under the heads of General Anato- 
my, which regards the general features and 
relative position of the various portions of 
a body, and [Special Structural] Anatomy, 
which regards the intimate and microscopic 
structure of the various textures. 

ANCHYLOSIS.— Stiffening of a joint: 
it may be complete or partial. In the for- 
mer case it is best let alone ; in the latter, 
much may be done to restore the motion of 
the part by friction with oleaginous sub- 
stances, codliver-oil, &c, by bathing the 
joint with warm sea-water, and by daily, 
constant, gentle attempts at movement. 

ANEURISM.— See Artery. 

ANGINA PECTORIS, or Spasm of the 
Heart, is one of the most formidable and 



ANG 



81 



ANI 



painful of the affections which terminate 
human life. It occurs more generally after 
middle age,and is more frequent in men than 
women. The attack is characterized by the 
sudden onset of agonizing pain, referred to 
the centre of the chest, or a little to the left 
side of it, passing through to the spine, up 
to the left shoulder, and down the arm of 
the same side even to the extremities of the 
fingers. Sometimes both arms are affected. 
Along with the pain, which is always said 
to be agony beyond description, there is a 
sensation as of instant impending death. 
The paroxysm ceases as suddenly as it 
comes on. Angina pectoris may be pre- 
ceded by warning symptoms, palpitation, 
shortness of breathing, indigestion, or it 
may come on unheralded by any of these, 
generally during some slight exertion, as 
walking up hill, or during strong mental 
emotion, but not unfrequently in the night, 
after the first sleep. An attack of angina 
pectoris is an emergency affecting life, 
to which there are few equal ; full, in- 
stant stimulation is demanded, and the first 
agent of the kind at hand must be used, 
till other remedies and proper assistance 
can be procured. A glass of spirits and 
water, as hot and strong as it can be swal- 
lowed, and with it (if procurable instantly) 
sixty- drops of laudanum, must at once be 
given. A strong mustard poultice is at 
once to be applied to the front of the chest, 
the same being placed between the shoulders, 
and hot applications made to the feet. If the 
paroxysm be not subdued in a quarter of an 
hour, the stimulant is to be repeated with 
half the quantity of laudanum, and this 
again, after the same interval, if requisite. 
Spirits have been mentioned, as being the 
most readily procurable, but when ether 
and sal-volatile, either^ one or other, or 
both, are at hand, they are preferable, and 
must be given in just so much water as will 
permit of their being swallowed ; a teaspoon- 
ful of each, with sixty drops of laudanum. 
A person who has once suffered an attack 
of angina should never be without these 
three requisites, laudanum, or (better, Batt- 
ley's sedative solution,) ether, sal-volatile. 
It is needless, perhaps, to say, that all these 
measures of an emergency in which not a 
moment is to be lost, are while waiting the 
arrival of the medical attendant, and that 
to him must be intrusted the direction of 
that regulated mode of life, which : must 
ever be adopted after an attack of this dis- 
ease. The treatment of the emergency it 
may be highly important for an unprofes- 
sional person to be acquainted with ; that 
of the interval, which may with care ex- 



tend to months, or even years, must be left 
in the hands of educated skill alone. 
ANIMAL HEAT— Is the temperature which 
every animal body is enabled to sustain, 
independent of surrounding media. In 
healthy men the average temperature of the 
body is 98° or 99°, in some diseases it rises 
considerably. Whether our animal tempera- 
ture is sustained in part from other sources 
or not, it is generally now considered to be 
chiefly due to the continual union of the 
carbon and hydrogen derived from the food, 
and from the bodily tissues, with the oxy- 
gen conveyed to every portion of the living 
frame from the lungs by the blood. One 
great fulfilment, therefore, of the food we 
digest is to keep us warm, by the continual 
combustion of elements going on within us ; 
consequently, persons who can consume and 
digest large quantities of food have much 
greater power of resisting cold than those 
who cannot, and chilliness is one very con- 
stant symptom of impaired digestion ; the 
stomach being unable to keep the system 
supplied with fuel. The point is one of con- 
siderable importance in the selection of 
crews for arctic expeditions, and ought to 
have some influence with intending emi- 
grants in their choice of a future home. An 
individual who suffers from habitual weak- 
ness of digestion, ought to choose a warm 
or genial climate, in preference to a cold one. 
Fats and oils especially, which contain 
much carbon and hydrogen, afford great 
protection against severe cold ; accordingly, 
all northern people, like the Esquimaux, 
consume them in large quantity, and Euro- 
peans travelling in northern latitudes have 
always copied the natives in this respect. 
Alcoholic fluids, like fat and oil, contain 
much carbon and hydrogen, but their sti- 
mulant properties and more evanescent in- 
fluence render them unfit for ordinary con- 
sumption to sustain animal heat, although 
on extraordinary occasions they are invalu- 
able. When from illness or any other cause, 
sufficient food cannot be taken to keep up a 
due temperature, fuel is supplied at the ex- 
pense of the bodily tissues, more especially 
of the fat, as is the case in hibernating ani- 
mals ; and if illness, such as fever, continues, 
even the supply within the body threatens 
to fail, and the person is actually in danger 
of dying of cold. It then becomes impera- 
tive to get into the circulation as much 
"respiratory food," as much nourishment 
as possible, simply as fuel. Much may be 
done by strong animal broths, but alcohol 
is the great resource, in whatever form it is 
most advisable ; it passes readily into and 
mingles with the blood, and affords an im- 



ANI 



32 



ANK 



mediately available supply of carbon and 
hydrogen to keep the animal temperature 
going. The regular, steady supply of wine 
when required in fever, must be kept up, and 
this cannot be too strongly impressed upon 
the mind of the attendant. Half an hour's 
nap on the part of the nurse may lose a life. 

But internal heat cannot do all in our cold 
climate, and with artificial modes of living. 
It is of the utmost importance, especially in 
the young and delicate, to maintain the full 
temperature of the surface by proper cloth- 
ing. The subject is one respecting which 
much carelessness and ignorance prevails 
in all classes of society in this country ; and 
children, half clothed for the sake of ap- 
pearance, with bare chests and limbs, and 
exercise not sufficiently active to counteract 
the effects of the chill, are exposed to all the 
evils resulting from internal congestions of 
the blood repelled from the surface. Warm 
clothing is in some respects a substitute for 
food, and either man or animal requires less 
nourishment when protected from cold. It 
is well known to agriculturists, that sheep 
or cattle will fatten more quickly under 
cover, in winter, than if exposed to the 
weather. The reason is obvious : they are 
able to store up in their bodies that which 
otherwise must have gone to keep them 
warm. When it is considered, that abstrac- 
tion of animal heat by cold and wet is one 
of the most fertile sources of fatal disease, 
the importance of maintaining the full tem- 
perature of the body is manifest. It is well 
known that exercise is the best antagonist 
to cold : it is so by quickening the respira- 
tion, and thus increasing the supply of oxy- 
gen taken in by the blood, which is also 
circulated more rapidly. In fact, to use the 
simile which compares the body to a stove, 
exercise gives a free draught for the process 
of combustion. Continued exposure to an 
extreme degree of cold, which carries off 
the animal heat more quickly than it can 
be generated, it is well known, gives rise 
to overpowering drowsiness, which, once 
yielded to, is death. It must be resisted, 
and when one of a party thus exposed is in- 
clined to yield, the others must resort to 
every means calculated to rouse, even, as 
has been done, by threshing him along : 
the temper which is excited is a most ex- 
cellent resistance to cold. 

Refer to Aeration — Blood — Lung — Circu- 
lation — Food. 

ANIMATION SUSPENDED— Is the term 
applied to that condition in which the life 
of the body is threatened in consequence 
of respiration having been stopped or im- 
peded, but in which there still exists a 



possibility of life being preserved. The 
chief causes of suspended animation are 
drowning, hanging, immersion in choke- 
damp or irrespirable gas, and intense cold. 
These maybe referred to under their proper 
heads. [See Drowning, Hanging, Choke- 
damp.] 

ANISE. — An aromatic and carminative, 
which is used, chiefly in the form of the 
distilled water, to correct flatulence in chil- 
dren, but is not so generally liked by them as 
dill-water, which is equally efficacious. The 
dose is a teaspoonful. The essential oil of 
aniseed is used to flavour mixtures, and is 
given in doses of five or six drops, for an 
adult, upon lump-sugar. 

Refer to Carminative. 

ANKLE — Is the joint connecting the foot 
with the leg, (fig. v.;) it belongs to the class 

Fig. v. 




of hinge joints, and is formed by the ex- 
tremities of the large and small bones of 
the leg, [tibia and fibula,] (fig. v. 1 and 2,) 
on the one side, and the smooth, " articula- 
ting" surface of a bone of the foot, named 
the " astragalus," on the other, the whole 
being kept in place by means of strong liga- 
ments, 4 and 5. The position of the ankle 
joint renders it peculiarly liable to injury — 
strain, dislocation, or fracture of the leg 
bones close to their extremities. Whenever 
the least suspicion exists that violence to 
the ankle has caused more than a sprain, 
no time should be lost in submitting it to 
the examination of the surgeon: such inju- 
ries are often extremely obscure, and there 
is much difficulty in making out their exact 
nature after swelling has come on. A sim- 
ple sprain of the ankle is to be treated in 
the mode directed to be followed in these 
injuries generally. [See Sprain.] In cases 
of dislocation, occurring at a great distance 
from medical aid, and when, from the ex- 
treme distortion of the foot, the accident is 
distinctly apparent, some attempt ought to 
be made by those near .to replace the parts : 



ANO 



33 



ANT 



for this purpose, the sufferer being laid 
down, one individual should grasp the leg 
firmly just below the calf, whilst another, 
grasping the heel with his left hand, and the 
lower part of the instep with his right, en- 
deavours, by extension in the first place, 
and slight turning of the foot toward its 
proper position, to reduce the dislocation. 

The ankles in children are very apt to 
become gradually distorted from general 
weakness, or from relaxtion of the ligaments. 
As the deformity is often not discovered 
until it has considerably advanced, the 
bones become altered in shape, and even 
the spine affected, from the habitual mal- 
position of the body. The best constitu- 
tional remedies are attention to the general 
health and strength of the child, as directed 
in the article "Children," the prohibition of 
long ' standing, and enforcement of regular 
but moderate exercise. The ankles ought 
to be bathed every morning with cold salt 
water, and well rubbed afterward with a 
rough towel. Many contrivances, boots of 
various kinds, &c, are and have been used 
in cases of weak ankles ; unless in extreme 
cases, they are better avoided, and the case 
left to the gradual strengthening measures 
above recommended. If artificial supports 
supply the place of the natural ones, the 
latter will not regain the proper tone and 
strength essential for permanent cure.,. One 
of the many forms of elastic sock or stock- 
ing may, however, be worn with advantage. 
In addition to the above means, consider- 
able mechanical power may be exerted by 
making the inner or outer margin of the 
sole of the boot (for cloth boots should al- 
ways be worn in such case) thicker or thin- 
ner, according to the nature of the deform- 
ity ; thus, if the ankle be inclined to pro- 
ject inward, the sole should be raised on 
the inner side, and vice versa. Regular 
perseverance in the above mode of treat- 
ment will, in most cases, effect a cure 
without the more complicated contrivances 
often used. Attention, too, ought always 
to be paid to the habits of standing prac- 
tised by the child. Children are some- 
times born with ankles distorted. See Club- 
feet. 

Refer to Dislocation — Joint — Sprain, $c. 

ANODYNES — Must be regarded as consti- 
tuting one of the most benevolent provisions 
of the Creator for the relief of his crea- 
tures. The removal of pain by an anodyne 
is like a breath of heaven. The more gene- 
rally used anodynes are opium, belladonna, 
aconite, conium, hyoscyamus, lettuce, hop, 
camphor. 

ANOREXIA.— Loss of appetite. 



ANTACID — In medical language, means 
! whatever directly neutralizes acid secre- 
j tions, more especially of the stomach and 
1 bowels. The principal antacids are potash, 
} soda, ammonia, lime, chalk, and magnesia. 
I The use of antacids can only be palliative, 
and their continued regular use is produc- 
tive of serious mischief ; they inevitably 
destroy the tone of the stomach, and aggra- 
vate permanently the evil they may tem- 
porarily relieve. "Whenever antacids are 
frequently called for, it is a sign that there 
is other disorder, though perhaps less pro- 
minent, which must be looked for and cor- 
rected. 

Refer to Dyspepsia — Digestion. 
ANTHELMINTICS— Are medicines which 
remove the different species of worms found 
in the alimentary canal. See Worms. 

ANTIMONY— Is the metallic base of our 
antimonial preparations : of these, the most 
useful are tartarized antimony or tartar 
emetic, antimonial wine, antimonial or 
James's powder, and the compound, Plum- 
mer' spill. Of these, tartar emetic, the most 
powerful, is a remedy which stands without 
a rival as the controller of some forms of 
inflammation. A compound salt of anti- 
mony, potash, and tartaric acid, it is formed 
in crystals, but usually sold as a white 
powder. It is sufficiently soluble in water 
to be conveniently administered in that 
fluid, whith should always be used soft or 
distilled : a simple solution of the medicine 
is preferable in most cases. In large doses, 
tartar emetic acts as a powerful irritant 
poison, causing intense nausea, vomiting, 
severe pain in the bowels, purging, bloody 
stools, and extreme general depression ; and 
even in comparatively small doses, these ef- 
fects are sometimes liable to be developed 
in degree, especially in children. Great 
caution, therefore, is required. In case of 
a poisonous or overdose of tartar emetic 
having been swallowed, the best remedy is 
some astringent infusion, Peruvian bark, 
nutgalls, or strong tea. There is consider- 
able variation in the strength of the dose 
of tartar emetic given by medical men: 
when, under necessity, it is dispensed by 
others, the sixth to the eighth of a grain 
only should be given to an adult. A con- 
venient form is to dissolve two grains of 
the salt in half a pint of soft water slightly 
warmed, and of this, to give a tablespoonful 
every three or four hours, so as to keep up 
continued nausea. Vomiting may follow 
the first dose or two, but after that, in most 
cases, the stomach becomes tolerant of the 
remedy. By giving tartarized antimony 
dissolved in a moderately small quantity of 



ANT 



34 



A OR 



water, its irritant effects are less liable to 
be exerted upon the bowels, and should they 
come on, a few drops of laudanum, if other- 
wise admissible, must be given in some de- 
mulcent, barley or rice water, and the de- 
mulcent alone continued as common drink. 
To children, tartarized antimony must be 
administered with great caution, and is 
better avoided by the unprofessional, except 
in the extreme cases of croup or severe 
inflammation of the lungs plainly existing, 
and occurring at a distance from proper 
medical assistance. In the former alarm- 
ing disease, tolerably full doses are required 
to make a quick impression upon the 
system, and to induce speedy vomiting. 
For a child of six or seven years, a single 
grain must be dissolved in an ounce of 
water, and a teaspoonful of the solution, 
given, either alone or in a little water as 
drink, every quarter of an hour, till free 
vomiting is produced. In inflammation of 
the lungs, half the dose must be given ; 
but this advice, let it be remembered, ap- 
plies only to the severe diseases above men- 
tioned, when occurring at a distance from 
medical aid. The practice of administering 
antimony to children, generally, is not well, 
unless under medical sanction, and in those 
of weak constitution may be productive of 
serious or fatal results. 

For a simple emetic, antimony is seldom 
well adapted, and should not be used when 
others are obtainable. 

ANTIMONIAL WINE— Is a solution of 
tartar emetic in wine, two grains to the fluid 
ounce. In many cases, it is a convenient 
preparation, but of course liable to the 
same dangers as the watery solution ; it is 
much — too much used popularly, especially 
as an emetic. In inflammatory diseases, 
the amount of wine which must be given 
with each dose is objectionable. It is 
most useful as a simple diaphoretic, given 
at bedtime, in doses of from ten to thirty 
drops, and combined with half an ounce of 
spirit of mindererus. 

James's powder, although a secret pre- 
paration, is comparatively so mild and 
certain in its operation as a diaphoretic, 
that it is very generally prescribed by medi- 
cal men ; dose, three to eight grains. The 
pharmaceutical imitation — antimonial pow- 
der — is not to be depended on. 

Plummer's pill contains antimony in small 
proportion. See Plummer's Pill. 

ANTISEPTIC— A substance which coun- 
teracts the tendency to fermentation or 
putrefaction in organized bodies. Chlorine, 
mineral acids, salt, alcohol, volatile oils, 
cold, &c.j all act as antiseptics, [The es- 



sential oil of camphor is an excellent anti- 
septic and disinfectant.] 

Refer to Fermentation. 

ANTISPASMODIC— That which allays 
pain arising from muscular spasm, or in- 
deed any severe pain unconnected with in- 
flammation. Anodynes, therefore, are anti- 
spasmodics, but there are others of the class 
which are stimulants, and which do not ap- 
pear to possess any anodyne effect. The 
principal stimulant antispasmodics are 
ether — which may also be regarded as ano- 
dyne — ammonia, valerian, asafoetida, musk, 
and the various forms of spirit, brandy, &c. 
The anodyne antispasmodics are quite the 
safest for unprofessional administration : 
they cannot do mischief, which the stimu- 
lants certainly will, in the event of inflam- 
mation being present. Heat is, however, 
one of the best, and certainly the safest 
antispasmodic for general use : in spasm of 
the stomach, in colic, in gravel, in gall- 
stone, indeed, in pain generally, the con- 
tinued application of heat — as high a tem- 
perature as can be well borne — acts certain- 
ly, safely, gratefully. The antispasmodics 
above enumerated are more directly appli- 
cable to the treatment of painful spasm ; 
those which are employed in the treatment 
of spasmodic diseases, such as St. Vitus's 
dance, hooping-cough, &c, are many of 
them more properly tonic remedies : chloro- 
form, as a general antispasmodic, is emi- 
nently serviceable, [when given by the 
mouth. Its inhalation is dangerous.] 

Refer to Anodynes — Spasm — Heat, §c. 

ANUS. — The fundament, or terminating 
outlet of the alimentary canal. Itching in 
this situation is at times extremely trouble- 
some : it will generally be allayed by slight 
relaxation of the bowels, effected by a few 
doses of sulphur and magnesia, half a 
drachm of each taken every night, and by 
the use of a lotion composed of two or three 
grains of acetate of lead in the ounce of 
water. Fissure of the anus is a most pain- 
ful affection, which requires the care of the 
surgeon. Prolapsus of the bowel, " falling 
of the body," piles, and fistula, all occur in 
this situation. The anus is kept closed by 
a sphincter muscle which surrounds it. 
When this muscle loses its power, as it does 
in some diseases, involuntary discharges 
occur. 

Refer to Fistula— Piles — Prolapsus. 

AORTA. — The main artery of the body, 
which arises directly from the heart, and 
from which all the secondary arteries have 
their origin except one, the pulmonary. 
See fig. vi. The aorta is divided into an 
ascending portion A,- an arch B, and a de- 



APE 



35 



APH 



gcending portion C, the latter being sub- 
divided into a thoracic portion C, and abdo- 
minal C 2. The origin of the aorta from 
the heart is just opposite the junction of 
the fourth rib with the breastbone. The 
passage from the heart into the aorta is 
closed by three "semilunar" valves, which, 

Fig. vi. 




when perfect, effectually prevent any regur- 
gitation of blood. 

Refer to Artery — Heart. 

APERIENT.— Whatever opens the bowels 
gently — a laxative, in contradistinction to 
purgatives and cathartics, which act strongly. 
See Laxative. 

APHONIA. — Loss of voice may be owing 
to inflammatory swelling, either acute or 
chronic, or to ulceration of the lining mem- 
brane of the larynx, to paralysis, or to 
hysterical affection. Coming on suddenly, 
accompanied with fever, pain in the larynx 
and upper part of the throat, increased on 
swallowing, with difficulty of breathing, the 
above symptom must be regarded with some 
apprehension, as one of the concomitants of 
a rapidly fatal disease, acute laryngitis. 
Loss of voice, however, frequently occurs 
quite unconnected with the other symptoms 
mentioned, and is then not to be so seriously 
regarded. Many persons are liable to it 
after exposure to night or foggy air, or 
after much or loud talking. Persons living 



in damp houses suffer from this form of 
aphonia, which is probably owing to the 
thickening or great susceptibility of the 
laryngeal membrane. When it continues, 
nothing affords greater relief than antimo- 
nial ointment, or croton oil, rubbed over the 
forepart of the neck so as to produce a free 
eruption. Blisters maybe used, but are not 
so efficacious. A hot bran poxiltice [or a 
small mustard-plaster] applied to the throat 
at night, and a teaspoonful of paregoric, 
taken along with twenty drops of ipecacuan 
wine, will often remove a threatened attack. 
In the more chronic form, twenty drops of 
tincture of squills may be substituted for the 
ipecacuanha. A sirup made with infusion 
of horseradish is popularly and sometimes 
beneficially employed. Persons who are 
liable to loss of voice ought never to expose 
themselves to damp, cold, or night air, with- 
out protecting the mouth by means of a light 
shawl or respirator of some kind, and should 
keep the feet well protected, not so much 
on account of the system itself, though that 
is troublesome enough, but because of the 
indication it affords of general delicacy of 
the bronchial membrane. When along with 
loss of voice, there exists hoarse cough, 
pain, and expectoration of thick mucus, 
ulceration is to be suspected, and the case 
as soon as possible put under proper medical 
care. Aphonia from paralysis or hysteria 
must fall under the general treatment of 
these diseases. 

Refer to Larynx — Laryngitis — Expectorants 
— Respirator. 

APHTHA. — Thrush is more especially a 
disease of eafly infancy, affecting the mouth 
and fauces, the lining membrane of which, 
in this disease, appears as if sprinkled over 
with bits of milk curd. Recent researches 
have discovered that upon these patches a 
filiform description of minute fungus is de- 
veloped, which probably finds a congenial 
habitat in the disordered secretions which 
are the main feature of the disease ; excess 
of acid, and irritation of the mucous lining 
of the bowels always existing. The disease 
is not generally serious : it is accompanied 
by slight fever and drowsiness, and passes 
off in eight or ten days ; during the time, 
however, it interferes with the child taking 
the breast properly. Aphtha is very often 
the result of improper feeding with bread 
and other things unfit for the infant stomach. 
The first thing to be done when an infant is 
affected with thrush is to correct the acid 
state of the bowels by a few grains of cal- 
cined magnesia — in this case preferable to 
the fluid form — or if the bowels be relaxed, 
by chalk, following the antacid by a mild 



APN 



36 



APO 



dose of castor-oil. This may be repeated 
every second day. The quality of the milk, 
and state of the nipple of the mother is to 
be examined, and the food, if any be given, 
regulated; milk and water, two parts of the 
former to one of the latter— in which a 
little isinglass should be dissolved if there 
is diarrhoea — is to be the sole addition to 
the mother's supply; all saccharine matters 
being avoided. If the state of the bowels 
be corrected, the thrush will generally get 
well, but it is expedient to assist the cure 
by the use of a solution of borax in water — 
one drachm to half a pint — used to wash 
the mouth. The common system of mixing 
borax with honey is not advisable, as the 
saccharine matter may favour the fungoid 
growth. When the case is mild, the aphthge 
separate in seven or eight days, leaving a 
healing surface below, and the mouth soon 
gets well ; that is, if it be not injudiciously 
scrubbed (''cleaned") dairv by the nurse. 
In children of weak constitution, or who 
are exposed to unhealthy influences, thrush 
may assume a malignant character ; the 
aphthous specks become black, and ulcera- 
tions form on their site, diarrhoea increases, 
and the belly becomes tender, the child is 
drowsy, or it may be convulsed. In such 
cases, the chlorate of potash, internally, 
and saturated solution of sulphate of cop- 
per applied to the sores, as recommended 
by Dr. West, [England,] are most useful, 
the strength being at the same time sup- 
ported by a teaspoonful of strong broth, in 
which isinglass has been dissolved, given 
frequently. When, however, the disease 
assumes this dangerous character, medical 
assistance must be procured at once. Chil- 
dren past infancy, and even adults are some- 
times affected with aphtha. Regulation of 
the bowels by a mild aperient — castor-oil — 
chlorate of potash internally, and borax 
wash, are the best remedies. Bismuth is 
sometimes useful. The diet should be mild 
and unirritating, chiefly milk and farina- 
ceous articles. 

APNCEA. — Imperceptible breathing, such 
as occurs in fainting, and in some nervous 
affections. 

APPETITE.— The instinctive desire for 
food which is periodically, and, in health, 
regularly experienced, is a real blessing 
given to us by God, and its temperate en- 
joyment is a sign of a sound mind in a 
sound body. The sensation of hunger doubt- 
less originates in the system at large, and 
its removal by the presence of food upon the 
stomach must be due to the sympathetic 
connections of that organ with the system. 
All that is required for the immediate ap- 



peasement of hunger is the presence of a 
substance, it may be of very small nourish- 
ing power, in the stomach: the unctuous 
earth consumed by the American Indians, 
and the berg meal of Norway, act in this 
way. Taste has nothing to do in satisfying 
the appetite. Mr. Beaumont, who experi- 
mented in the famous case of St. Martin, 
found that appetite was quite as well ap- 
peased by food passed into the stomach by 
the external opening, as if it had been swal- 
lowed. A regular appetite is generally a 
symptom of a healthy state of system ; as 
soon as disorder occurs, the appetite flags, 
nature herself stops the supplies, which, 
instead of nourishing the body, would only 
increase the embarrassment of the func- 
tions; but this is not understood, and the 
sick are too often tempted and pressed by 
anxious attendants to take nourishment, to 
their own hurt and discomfort. Even then 
nature asserts her right, and the stomach 
rejects what it did. not desire. The longings 
of appetite sometimes appear to be almost 
instinctive, especially in illness, particularly 
where there has been much or obstinate 
vomiting. The patient will express a strong 
desire for some article of food or drink 
which our preconceived ideas or theories 
would certainly forbid, but which, being 
permitted, seems at once to agree. When 
the various morbid deviations from natural 
appetite are considered, such latitude re- 
quires of course great caution ; but the fact 
should not be lost sight of: — a variable ap- 
petite, at one time deficient, at another mor- 
bidly active, is scarcely consistent with 
health. In children it is often indicative 
of worms. Depraved appetite consists in 
the longing for or devouring substances not 
intended for food, such as chalk, slate, pen- 
cils, cinders, earth, &c. : the symptom is not 
unfrequently a concomitant of the chlorotic 
diseases of young females. The " dirt-eat- 
ing" of tropical climates is another form of 
depraved appetite. 

APOPLEXY — Is an affection of the brain, 
during the continuance of which, sense and 
voluntary motion are wholly or partially ex- 
tinguished ; the patient lies unconscious, as 
if in deep sleep, and cannot be roused by 
any ordinary means. More generally the 
face is flushed, and the vessels of the head 
and temples appear over-filled; there is 
snoring, or stertor, as it is called ; the mar- 
gin of the upper lip is partially or entirely 
blown forward at each expiration, and the 
skin is covered with profuse perspiration : 
if the eyes are examined, they appear blood- 
shot and glassy-looking. In some cases, 
while the symptoms of insensibility, per- 



APO 



87 



APO 



spiration, &c, are present, the face is pale, 
and the appearance is one of general de- 
pression ; the weak pulse contrasting with 
its full, hard condition in the former case. 
If a person be found in a state of apoplexy, 
as he can give no account of himself, it is 
important for others to ascertain whether 
there is any assignable cause for the circum- 
stance. The head should be examined for 
signs of violence ; the breath for the odour 
of alcoholic drink ; any circumstances likely 
to give occasion to poisoning searched out ; 
but whatever the condition, no time should 
be lost in procuring medical advice ; in the 
mean while, much is to be done by well-di- 
rected attentions. Few attacks of apoplexy 
come on without previous warning; the pa- 
tient, if of full habit, has suffered from 
headache or giddiness, especially on stoop- 
ing, or has slept much and heavily ; the 
mental faculties have been sluggish, the 
memory affected, or vision impaired ; there 
may have been numbness or pricking in a 
limb, or in a finger only ; to others, the face 
and eyes have looked full and red ; — if of 
spare habit, there may also have been head- 
ache, giddiness, impaired vision, and confu- 
sion ; but there has been, also, marked de- 
bility of the mental powers, memory affected, 
the power of following a consecutive train 
of thought impaired, articulation indistinct, 
while with these the face has been pale, the 
pulse weak, the whole manner inanimate, 
rather than oppressed. Individuals of san- 
guine temperament, with short necks and 
large heads, particularly if they live well, 
are the subjects of the first set of symptoms ; 
those of spare habit, and weak, leuco-phleg- 
niatic constitution, of the second. When in 
an individual, at any time of life, but more 
especially after the age qf fifty, such symp- 
toms show themselves, they should not be 
neglected for a day. It is evident, however, 
that depending on two very opposite condi- 
tions of body, the treatment for each must 
be very different. The extent and gradua- 
tion of this treatment ought to be intrusted 
to the medical attendant ; in the mean time, 
if interval must elapse before that can be 
done, the man of full habit should at once 
reduce his diet, cut off entirely, or nearly 
so, his stimulants and spices, and animal 
food, eschew supper, take exercise moderate- 
ly,, and rise early. He should purge the 
bowels freely by a couple of calomel and co- 
locynth pills, taken nightly for a few times, 
and by salines, such as Seidlitz powders or 
Epsom salts, a couple of teaspoonfuls of the 
latter in half a pint of water, every morning. 
Mental excitement is to be avoided, the head 
kept well raised in bed, any thing (either 



handkerchief or shirt) round the neck worn 
perfectly easy. The man of spare habit 
must follow a more negative plan. Rest 
and quiet of body and mind are for him 
essential ; any thing likely to tax the nervous 
power, particularly of a sexual character, 
must be avoided ; over -fatigue is dangerous ; 
while the bowels are kept regular, they 
must not be purged ; the diet, easy of di- 
gestion, ought to be nourishing ; and stimu- 
lants, if habitually taken, must not — unless 
found directly to cause uneasiness in the 
head — be discontinued, without medical 
sanction ; spices, however, should be avoid- 
ed. The temperature of the skin generally, 
and of the extremities, should be sufficiently 
preserved. When an individual is seized 
with symptoms denoting apoplexy, it being 
ascertained that they neither proceed from 
violence to the head, from intoxication, nor 
narcotic poison — (see Head — Intoxication — 
Poison) — during the longer or shorter inter- 
val which may elapse before the medical man 
can arrive, much is to be done. The patient 
should be laid on the back, the head and 
shoulders well raised, the neck bared, and 
a free current of air permitted to the head. 
If there is much redness and congestion of 
the face and head, with full, hard pulse, in 
a person of full habit, if, as may happen, 
medical aid is far distant in point of time, 
and if there is any one present competent to 
bleed from the arm, it may be done to the 
extent of from sixteen to twenty-four ounces ; 
it may not do good, but in such a case it can 
scarcely do harm. If leeches are to be had 
in the case now supposed, from one to two 
dozen of them may be applied over the head, 
temples, and behind the ears, either as an 
adjunct to, or substitute for bleeding from 
the arm. The amount of blood taken in this 
way, must be left a little to the discretion of 
an intelligent lay adviser. In addition, free 
purging should be resorted to. As the power 
of swallowing is lost or impaired, medical 
men usually effect this by means of a drop 
of croton oil placed on the tongue, and re- 
peated if requisite ; but in the circumstances 
now supposed, this can scarcely be obtain- 
able, and instead of it, a clyster containing 
salt or soap-water, Epsom salts, turpentine, 
castor-oil, or whatever purgative is most 
readily available, must be given ; the warmth 
of the feet must be preserved, but not ex- 
cited, by hot water, mustard, &c. All at- 
tempts at giving nourishment must be sus- 
pended for many hours. In the event of the 
attack presenting the opposite symptoms, 
those of depression, all attempts at depletion 
are to be avoided ; indeed, it may be requi- 
site, in an extreme case, to get a few spoon- 



AQU I 

fuls of wine swallowed ; purging must be let 
alone, but the extremities should be kept 
well warmed, and mustard poultices may be 
freely applied to the legs, thighs, or between 
the shoulders ; liquid nourishment, such as 
meat broth, must be got down in teaspoon- 
fuls at a time. To the medical attendant 
must be left all beside. An attack of apo- 
plexy may either disappear or be removed, 
and leave the patient apparently in perfect 
health, or it may leave him paralyzed in 
body and weakened in mind, the man, but 
not the same man — changed ; strength has 
been exchanged for weakness in every way, 
for weakness which increases as time goes 
on, loss of memory, irritability, childish de- 
sires, and childish weeping, till in all proba- 
bility one or more attacks of the disease 
close the scene. Lastly, apoplexy may pass 
on to deeper and deeper insensibility; no 
sign of consciousness is ever given, the 
breathing becomes more laboured, the na- 
tural offices are performed involuntarily, the 
sweat becomes the cold one of death, which 
takes place with or without convulsions. 

Apoplexy may come on suddenly; the 
person is struck by a blow, but this form is 
less to be dreaded than that which creeps on 
more insidiously. An individual becomes 
giddy and faint for a few minutes, perhaps 
vomits, but seems to recover ; shortly after, 
however, he becomes dull, the eyes heavy, 
and insensibility gradually comes over him. 
The first form is most probably owing to 
sudden congestion in the head, or to rapid 
effusion of blood ; the latter to slower effu- 
sion ; in this case, the first shock is felt at 
the instant the vessel gives way, but it re- 
quires the further gradual effusion to com- 
plete the attack. An individual who has 
once suffered an attack of apoplexy, and re- 
covered, cannot too carefully avoid every 
possible exciting cause. A momentary im- 
prudence, the stooping to tie a shoe, look- 
ing at objects much above the level of sight, 
&c, a warm bath, may be sufficient to induce 
serious symptoms. Especially must the 
bowels be kept so easy that straining at 
stool is never required. The system of diet 
and regimen should be strictly laid down by 
the medical attendant, and as strictly ad- 
hered to by the patient ; the mind carefully 
kept from excitement. In no disease, with 
exception, perhaps, of that of the heart, 
does the man who possesses habitual self- 
control, in body and-mind, possess more ad- 
vantage, than in apoplectic tendency, over 
the slave of passion or of temper. 

Refer to Paralysis. 

AQUA-FORTIS.— Nitric Acid.— Refer to 
Nitric Acid. 



3 ARE 

AQUA-REGIA.— Nitko-Muriatic Acid. 
— Refer to Niiro- Muriatic Acid. 

AREOLA. — A term applied medically to 
the inflamed circle which surrounds a vesi- 
cular or pustular elevation, such as that of 
the vaccine vesicle. Also applied to the 
coloured circle surrounding the female nip- 
ple. Generally, not invariably, previous to 
pregnancy, this areola is light in colour, but 
in the majority of cases, soon after concep- 
tion, it begins to darken, and in some indi- 
viduals, especially in those of dark com- 
plexion, it becomes of a deep brown. The 
change of colour in the areola, is, therefore, 
classed amid the more certain signs of preg- 
nancy ; but as it has been known to exist in 
the virgin, and is not universally developed 
in the pregnant female, it can never alone 
be taken as a decisive proof, but only as a 
corroborative, along with other symptoms. 

Refer to Pregnancy. 

ARM-PIT.— See Axilla. 

ARNICA MONTANA.— Leopard's-bane 
is a plant bearing a composite flower, found 
in mountainous regions. It is scarcely, if 
ever, prescribed internally in this country ; 
as an external application, however, it is 
much and beneficially used in the treatment 
of wounds and contusions. From one • to 
two drachms of the tincture in half a pint 
of water forms a convenient lotion. The 
homoeopathic practitioners claim arnica as 
one of their own remedies, and their chemists 
ask for their tincture an extravagantly high 
price. The drug itself has long been used 
externally, on the Continent, and the tincture 
may be procured equally good, and much 
cheaper, at many respectable chemists. Like 
every thing else, there is much spurious 
tincture sold. When the pure tincture is 
dropped into water, it gives it a milky or 
opalescent appearance. 

AROMATICS.— Stimulants derived from 
the vegetable kingdom, possessing a more or 
less powerful and generally agreeable odour, 
a warm and agreeable taste. They are for 
the most part products of warm climates, 
and appear specially adapted to the relaxed 
constitutions of the natives. A free use of 
aromatics is said to counteract the effects of 
malaria in tropical countries. Some stimu- 
lant is certainly requisite in those climates, 
and the native productions bestowed by Pro- 
vidence are evidently much better adapted 
to fulfil the indication than alcoholic ex- 
citants. Mace, cloves, cinnamon, are all 
aromatics. Angelica is one of the few aro- 
matics of temperate climates, and perhaps 
the best. 

ARROW-ROOT— Now so well known, is 
procured of the best quality from the West 



ARS 



AKS 



Indies, especially from Bermuda, whence it 
is imported in soldered tin cases. It is now 
also imported from East India, and an infe- 
rior kind is brought from Tahiti. Arrow- 
root is subject to much mixture and adulte- 
ration, but generally — as with potato-starch, 
&c. — of a harmless character as regards the 
consumer. The "Lancet" periodical has re- 
cently, by means of its "Sanitary Commis- 
sion," thoroughly investigated the subject 
of these adulterations. The best arrow-root 
ought to be pure white, slightly glistening 
in the mass, and the powder of which it is 
composed, collected together in small crumbs 
or lumps, which break down with a slight 
crackling sensation beneath the finger. Ar- 
row-root is pure starch, and forms a pecu- 
liarly stiff j elly. As an article of sick-cookery 
it is invaluable, where mild support is re- 
quired without stimulation, and in convale- 
scence and chronic disease. There are few 
stomachs with which it disagrees, and infants 
both like and do well with it. At the same 
time, it is proper to caution against the too 
common error of trusting too much to the 
nutritive powers of arrow-root alone, espe- 
cially for children. It may give support 
indirectly, that is to say, by supplying mate- 
rial for respiration and animal heat, it may 
save the tissues of the body, or it may even 
go to build up some of these tissues, but 
alone it can never make bone or muscle, for 
the simple reason that it does not contain 
the elements necessary for these constitu- 
ents of the frame. A child fed exclusively 
on arrow-root, water, and sugar, and such 
has been the case, must become unhealthy, 
and, without fail, rickety. The case is 
abundantly altered, when milk is combined 
with arrow-root. In this fluid exists what- 
ever is requisite for the animal frame, nitro- 
gen for its muscle, phosphorus for its nerve, 
earthy salts for its bone. The combination 
of arrow-root with milk is one of the best 
which can be given to a child, or to an adult 
in the early stages of convalescence from 
illness. 

ARSENIC is a metal. The substance which 
usually goes under the name, and which is 
also called white arsenic, is an oxide of the 
metal ; it is a too well-known poison, and is 
perhaps more universally used than any 
other for destroying life. Its tastelessness, 
cheapness, and the culpable facility with 
which it has hitherto been obtainable have 
combined to make it familiar. Much con- 
troversy has at times taken place respecting 
the effect of arsenic upon the palate ; it is 
certain the taste is very faint, but extreme 
irritation of the portions of the lining mucous 
membranes of the mouth and other parts 



quickly follows its contact. The length of 
time after arsenic has been swallowed that 
symptoms take to show themselves varies 
much, depending in all probability upon the 
state of the stomach as to emptiness, or the 
reverse. Sometimes they appear in a few 
minutes, at other times not for hours. Poi- 
soning by arsenic is distinguished by faint- 
ness, nausea, intense burning pain at the pit 
of the stomach, and vomiting of its ordinary 
contents, followed by that of a turbid brown 
fluid, and mucus, often streaked with blood; 
intense burning heat in the throat, and 
thirst ; purging ensues, cold sweats, con- 
vulsions, death. The eyes may become in- 
flamed, but this is more general when the 
case is prolonged, as it may be, in conse- 
quence of the small dose, or from other 
circumstances ; in this case an eruption on 
the skin is not unfrequent. The symptoms 
of course vary, particularly that of pain, 
which occasionally has been almost entirely 
absent. It must, too, be remembered, that 
the symptoms of cholera morbus and those 
of arsenical poison very closely resemble 
one another. When poisoning by arsenic is 
suspected, of course the first measure is to 
procure efficient medical aid. In the mean 
time, it is requisite to get as much of the 
poison as possible evacuated from the sto- 
mach ; it is seldom necessary to produce 
vomiting, that most generally comes on soon ; 
but if it has not done so, five-and-twenty 
grains of white vitriol, (sulphate of zinc,) if 
procurable, should be given at once, in a 
little water ; if this is not done, a table- 
spoonful of mustard in water, (or pounded 
alum, ) or tickling the throat with a feather, 
should be resorted to ; milk, [or white of 
egg,] which by its coagulation may envelope 
the poison, or thick mucilagious drinks, olive- 
oil, alone or mixed with lime-water, may, 
any or all, be given, and with them mag- 
nesia. The great object must be to clear 
the stomach of the poison as thoroughly and 
speedily as possible, for, unlike many other 
poisons, there is no chemical antidote to 
arsenic which can be relied on. A prepa- 
ration of iron has been vaunted, but it is 
of doubtful efficacy : if either this or the 
stomach-pump is used, it will be in medical 
hands. In following the directions already 
given, the friends or neighbours of the poi- 
soned person will be doing good service. 
Should the patient survive, and pass on to 
the second stage of arsenical poisoning, in- 
flammation of the stomach, nervous symp- 
toms, &c, will perhaps end life, or recovery 
may follow; but these changes must neces- 
sarily be attended to under medical guidance. 
White arsenic is not the only preparation of 



AET 



40 



AET 



the metal by which poisoning occurs ; the 
colouring substances known by the name of 
King's yellow and Scheele's green are both 
compounds of arsenic, and being frequently 
and culpably used in confectionary, have 
proved fatal. Similar symptoms occur and 
similar treatment is to be followed as after 
poisoning by white arsenic. Whether in 
poisoning by arsenic, or by any other agent, 
the vomited matters should always be care- 
fully preserved in a vessel by themselves, 
for medical inspection ; and if there is any 
suspicion of foul play, some responsible per- 
son should place them under lock and key. 
Did those who perpetrate the crime of poi- 
soning by arsenic know beforehand with 
what certainty the chemist can separate, for 
exhibition in a court of justice, the instru- 
ment of their wickedness from the body of 
the victim, perhaps years after it has been 
buried, selfish fear, if no other considera- 
tion, might stop the deed. 

ARTERY. — An artery is a vessel which 
invariably conveys blood away from the 
heart, the blood, with one exception — in the 
pulmonary, or artery of the lungs — being 
bright red, "arterial," and flowing in waves 
or pulsations, corresponding with the beats 
of the heart. "When red florid blood flows, 
or is spirted from a wound in jets, an artery 
is certainly wounded, and the case is most 
probably serious. Blood from a vein is dark 
and black-looking, and flows in a continuous 
stream. 

From the aorta (see fig. vii. 1, 1) the main 
artery of the body, directly connected with 
the heart, various secondary vessels are given 
off, to supply the head and upper extremi- 
ties, and the viscera of the chest and abdo- 
men. Low down in the latter cavity, the 
aorta itself divides or bifurcates into the two 
large vessels which supply the lower limbs 
(fig. vii. 2, 2.) From the secondary arteries 
other branches are given off, until, at last, 
by division and subdivision, the vessels be- 
come " capillary," hair-like in their minute- 
ness, forming an intricate network, in which 
the arteries end and the veins begin. Ar- 
teries consist of three separate coats — an 
outer or protective, an inner or lining, and 
a middle, partly elastic and partly muscular. 
It is the thickness and firmness of this mid- 
dle coat which chiefly distinguishes the ar- 
tery from the vein. 

As a general rule, the main arterial trunks 
run upon the anterior and inner surfaces of 
the body ; some knowledge of their posi- 
tions, and especially of those points in their 
course at which they can be most easily felt 
and compressed, may at times be useful to all. 
It is no uncommon thing for medical men to 



be called to accidents in which immense and 
injurious loss of blood has taken place from 

Fig. Tii. 




a wounded artery, which might have been 
saved to the sufferer by any one possessed 
of sufficient knowledge and presence of mind 
to put his thumb on the main trunk of the 
vessel. In figure vii. the portions of the 
main arteries most easily found and com- 
pressed are marked black, and any one, 
unless very corpulent, may verify the posi- 
tions by examination of his own person. 
Wherever the finger is placed upon an ar- 
tery, pulsation is felt. 

In wounds of arteries of the head, such 
as upon the temples, there is the advantago 
of the bone, against which it is possible di- 
rectly to compress the bleeding point, and 
when this can be done; it is the best method; 



ART 



41 



ART 



otherwise, pressure may be exerted accord- 
ing to the position of the wound, at A in 
front of the ear, or just behind the ear; or 
at B, where the pulsation of an arterial 
branch may be found, as it winds over the 
edge of the lower jaw. 

In wounds of the large carotid arteries of 
the neck, pressure is unfortunately of little 
avail ; there is no point to press against : it 
is impossible to compress the artery without 
at the same time compressing the large vein, 
and from the size of the vessel and its prox- 
imity to the heart, the current of blood has 
much power. The vessels may be felt beat- 
ing on each side of the windpipe. 

In wounds of the large arteries about the 
shoulder and arm-pit, pressure must be 
made with the thumb, or handle of a mode- 
rate-sized key wrapped in a few folds of a 
handkerchief, upon the large vessel, at the 
point D, just behind the middle of the collar 
bone, and where it passes over the first rib. 
In the event of a wounded artery lower down 
in the arm, the compression may be exerted 
over any portion of the course (E) just in- 
side the large muscle. At the bend of the 
arm, the artery divides into two main 
branches, one of which (F) the pulse ar- 
tery, runs toward the thumb ; the other (S) 
toward the little finger, in which courses 
both may be felt ; from the free intercom- 
munication of the arteries of the hand, press- 
ure is more certain to arrest hemorrhage if 
exerted upon the single trunk of the arm (E). 
In case of arterial bleeding from wounds of 
the lower extremity, it is most certainly and 
easily arrested by pressure on the large ar- 
tery of the thigh, at the point H, in or just 
below the groin. In all these cases, press- 
ure may be exerted by means of the thumb, 
or by some convenient body, such as the key 
above named. To compress arteries in the 
limbs, surgeons use the tourniquet, specially 
adapted for the purpose ; but as a tempo- 
rary substitute, a handkerchief tolerably 
firmly tied round the member, between the 
body and the wound, will answer well ; if 
any one has knowledge enough to place a 
pad — a rolled-up stocking will do — over the 
course of the main vessel, so much the bet- 

ARTERIAL HEMORRHAGE— May also 
be arrested by compression directly upon 
the bleeding point, and this should be tried 
until the surgeon's arrival, but it must be in 
positions, such as the hand, foot, &c, where 
pads can be firmly bound over the wound. 
, These pads must be graduated, that is, a 
small firm one is to be placed directly over 
the bleeding vessel, over the first pad a 
larger, and one still larger over that, and 
d2 



the whole to be firmly bound with a bandage 
or ribbon — or strip of cloth of some kind; at 
the same time, the site of the wound is to be 
raised above the level of the body. Above 
all things, loose wrapping up is to be avoided: 
the wound had better be exposed to the air 
than enveloped in a hot poultice of clotted 
blood, which only causes it to bleed the 
more. Two cases which recently occurred 
in the writer's practice will illustrate the 
above directions: — 1. A girl, when cutting 
some bacon off the flitch, slipped the knife 
and plunged it into her hand, dividing one 
of the arteries ; it bled fast, and when she 
was seen by the author some time after, a 
large quantity of blood had been lost ; com- 
presses and a bandage being at once applied, 
not another drop of blood was lost ; the 
wound was undisturbed for a good many 
days, and quickly healed. 2. A man, when 
sheep-shearing, had the shears driven into 
his hand by a plunge of the animal, and the 
artery which ruus between the thumb and 
forefinger severed ; he had to come three 
miles to the author's house, and must have 
lost above a quart of blood. In this case 
the vessel was tied, but in either of the 
cases, if, instead of the wound being loosely 
covered, and the hand kept down, some one 
had been sufficiently informed to tie a firm 
pad over the wound, until proper assistance 
was obtained, it could not fail to have saved 
either of these individuals a considerable 
amount of blood — and to a poor man, blood 
is money : he must pay the butcher some 
hard days' work, to make up a pound of the 
vital fluid. Various styptics to arrest bleed- 
ing are recommended, such as alum, mati- 
co, fungus, &c. ; but in arterial hemorrhage, 
pressure is more to be trusted to. Surgeons 
arrest hemorrhage from a cut artery by 
tying the ends with a ligature of silk or firm 
twine. This might be done in emigrant life 
under necessity. The bleeding point being 
distinctly seen, is by one person to be pulled 
forward, either by a pair of forceps, or by a 
hook-tenaculum (see Instruments) made for 
the purpose, sufficiently far to allow of 
another individual tying it securely. The 
sailor's reef-knot is the proper one for the 
purpose. The end of the vessel next the heart 
is to be tied ; but should the lower end bleed, 
as it may do, especially in a few hours after 
the accident, it must be tied also. The ends 
of the ligature must not be cut off, but the 
wound should be covered with a cloth dipped 
in simple water, till the surgeon's assistance 
— as it must be — has been procured. After 
arterial hemorrhage, a person should always 
be watched, with light, during the night, 
and a handkerchief, which could be tightened 



ABT 



42 



ART 



at any moment, kept closely round the limb. 
The application of water, unless it be ice- 
cold or nearly so, to a bleeding artery, is 
better avoided — free exposure to the air is 
preferable. In severe hemorrhage or flood- 
ing after delivery, compression of the aorta 
(fig. vii. 1) may be of much avail in prevent- 
ing further loss of blood until the arrival of 
the medical man. The hand of an attendant 
must be firmly pressed into the centre of the 
abdomen, until the pulsation of the aorta is 
felt, and felt to be acting against the com- 
pression, but not beyond it. The pressure 
must not be relaxed for an instant. 

ARTERIES are liable to the disease of 
aneurism, in which one or more of the coats 
become distended at some particular point, 
into a sac or pouch filled with blood. The 
progress of the disease is for this sac to grow 
larger, while its coverings become thinner 
and thinner, until at last they give way, and 
the individual dies from loss of blood. In 
many cases, surgical interference can save 
life by arresting the disease, and the sooner 
this is done the better. Aneurism may be 
suspected when a tumour is felt, which dis- 
tinctly pulsates, conveys to the finger a thrill- 
ing sensation, and becomes smaller and less 
tense when the current of blood through the 
artery leading to it is interrupted. In such 
a case the surgeon should at once be con- 
sulted. It is not, however, every tumour 
which pulsates that is aneurism, for proxi- 
mity to a large artery may give the appear- 
ance of its doing so. 

ARTICHOKES— Whether the vegetable 
properly so called, or the root, Jerusalem 
artichoke — are not adapted for persons of 
weak digestion, for those liable to flatulence, 
or for the aged. On some persons, the ar- 
tichoke proper acts as an aperient. 

ARTICULATION.— See Joint. 

ARTISAN, (a Workman.)— The diseases 
to which workmen are liable in consequence 
of the nature of, or materials employed in, 
their respective businesses, always a subject 
of great interest, is too extensive to admit 
of being otherwise than very briefly entered 
into in the present work. Legislation and 
invention have of late years done much to 
screen the various classes of artisans from 
many sources of injury to health to which 
they were formerly exposed ; much more 
remains to be done, and would perhaps be 
done more quickly, were it not for the apa- 
thy, and sometimes' even contradiction, of 
those who were chiefly to be benefited. It 
is useless to supply miners with Davy lamps, 
and fork-grinders with magnetic respirators, 
when the means of safety are so constantly 
and carelessly neglected. One immense 



source of evil— now happily ameliorated— 
has been exertion too prolonged, especially 
in the young ; nutriment which should have 
gone to build up the growing frame, is con- 
sumed in mere physical exertion ; the powers 
of the brain are used up in the same, and 
if not deformity of body, at least great weak- 
ness, and with it mental inaptitude, are the 
consequences. Many of those who are liable 
to disease in consequence of the materials 
they work in, owe much to their own want 
of cleanliness: this is the case with regard 
to the metals, especially lead; and a striking 
improvement has taken place in the health 
of workmen who have been compelled to ob- 
serve certain rules of cleanliness, such as 
washing the hands before their meals. 
Workers in quicksilver are liable, in addi- 
tion to affections of the teeth and gums, to 
a species of shaking palsy, or tremour of 
the limbs. Modellers in coloured wax, ma- 
kers of wax-flowers, &c, are in danger of 
suffering injury from absorption through 
the skin of the hand of the poisonous co- 
louring ingredients, and should be extremely 
careful. Workers in lead, such as plumbers, 
type-founders, or painters who use it in the 
form of white or carbonate of lead, are apt 
to suffer from paralysis, more particularly 
of the muscles of the forearm ; their more 
usual disease, however, is the "painter's 
colic," or dry belly-ache. See Colic. Cop- 
per-smiths, smelters, lucifer-match makers, 
all have their peculiar affections, that of the 
latter being a disease of the j awbone. Those 
who are employed in filing or dry-grinding 
substances which give off a hard dust, are 
peculiarly liable to chest diseases, from the 
mechanical irritation caused by the particles 
continually inhaled. So much is this the 
case in some trades — such as the Sheffield 
fork-grinders — that most, if not all, their 
members die before reaching the age of 
forty. Millers, and those employed among 
fine dust of a softer quality, are not so likely 
to become consumptive as the former class, 
but have a greater tendency to asthma ; they 
also suffer from the consequences of the cu- 
taneous pores and functions being clogged 
and hindered by the dust. Grocers and 
bakers, who are in the habit of handling 
flour, sugar, &c, suffer frequently from a 
disagreeable skin disease affecting the fin- 
gers, well known by the name of " grocer's 
itch." Housemaids who kneel at work have 
their peculiar swelling, which forms, and 
sometimes suppurates, (gathers,) over the 
knee-cap : this may be prevented by kneel- 
ing on a soft substance. Thatchers who 
press their knees against the steps of the 
ladder are exposed tothe same thing. Cler- 



ASS 



43 



AST 



gymen, actors, and public speakers have 
their peculiar throat affection ; in short, 
there is scarcely a trade or profession which 
does not expose its follower to some pecu- 
liar ailment; but there is scarcely one of 
these ailments which may not be prevented 
or much ameliorated by proper care — by 
cleanliness more especially, but also by at- 
tention to the various other prophylactic 
means which are now so generally known 
and provided. 

Refer to Colic — Consumption — Lead — Skin, 

ASCARIDES.— See Worms. 

ASCITES.— See Dropsy. 

ASPARAGUS— When young, well boiled, 
and not overloaded with melted butter, is 
wholesome and digestible ; it gives a pecu- 
liar odour to the urine. Its peculiar vege- 
table principle, asp ar agin, contains ni- 
trogen. 

ASPHYXIA. — Suspension of sensible vital 
phenomena, in consequence of the blood not 
having undergone the proper change by re- 
spiration. In this condition, the brain, the 
lungs, the organs of the body generally, all 
suffer from the circulation of blood not be- 
ing duly arterialized ; the heart is less and 
less excited, until, at last, it ceases to act, 
and death ensues, unless the cause of the 
asphyxiated condition, such as hanging, &c, 
be quickly removed, and suitable measures 
adopted for removing the suspended anima- 
tion. See Animation suspended. 

ASS'S MILK— According to Dr. Paris, 
" bears a stronger resemblance to human 
milk than any other;" it contains much su- 
gar and curd. It is a most excellent dietetic 
article and restorative in all cases of debi- 
lity. Drank too freely, it acts upon the 
bowels. 

ASSAFGETIDA — A gum resin and power- 
ful antispasmodic, is useful in hysterical 
cases, and in flatulent distension of the 
bowels ; in the latter case, especially, given 
as a clyster, (injection,) it is the most effica- 
cious agent we possess. Two teaspoonfuls 
of the tincture of assafoetida may be added 
to a simple gruel clyster, or to one of the 
purgative clysters, if requisite. When assa- 
foetida is given by the mouth, it is best used 
in the form of pill. The compound galbanum 
pill, of which it forms an ingredient, may be 
given in three-grain doses three times a day. 
Where aperient action is required, especially 
in deficient menstruation, the aloes and as- 
safoetida pill is a most excellent combination, 
and may be given, three grains, twice or 
three times a day. The — to most people — 
disgusting smell of assafoetida is a great 
obstacle to its employment ; and yet in 



some countries it is used as a condiment, as 
we use onion. 

Refer to Clyster. 

ASSIMILATION.— The first process of nu- 
trition in animals, by which the nutrient 
portion of the food is rendered fit for absorp- 
tion by the veins and lacteal vessels, which 
convey it into the general current of the 
circulation. 

Refer to Digestion. 

ASTHMA — Is an affection of the chest, 
characterized by distressing inability of the 
person suffering from it to inspire sxvfficient 
air to fill the lungs. The term, although 
applied by medical men to a defined disease, 
is used popularly to denote any difficulty of 
breathing, from whatever cause occurring, 
whether from disease of the heart, or any of 
the varied affections of the lungs. Asthma, 
although a nervous or spasmodic affection, 
is very frequently connected with actual 
changes in the lungs themselves. Asth- 
matic fits, or paroxysms, come on at irre- 
gular intervals; for several days, or rather 
nights, successively, the patient is attacked, 
and a considerable time may then elapse 
before he again suffers : not that a regular 
asthmatic is in the intei'val entirely free from 
uneasiness, for there is generally some slight 
oppression of the breathing, liable to be ag- 
gravated by slight causes. Changes in the 
weather, peculiarity of situation, errors in 
diet, anxiety, fatigue, mental excitement, 
may any of them induce a paroxysm of asth- 
ma in the predisposed. The attack itself is 
premised by feelings of indigestion and flatu- 
lence, frontal headache, chilliness, languor, 
and drowsiness. After having experienced 
these sensations during the day, the asth- 
matic individual is probably awakened from 
his first sleep by a distressing sensation of 
constriction of the chest; he is forced to sit 
up in bed, labouring for breath, or, it may 
be, to seek an open window. The distressed 
state of the breathing, if not relieved by 
remedies, continues for some hours, and at 
last gradually subsides ; the characteristic 
wheezing becomes less ; the cough, almost 
impossible before, is now brought out, and 
sleep, never more welcome, comes on. The 
latter stage of the paroxysm of asthma is 
generally accompanied with expectoration 
of mucus — sometimes it is not; and upon 
this a distinction into di-y and humid asthma 
is founded. Confirmed asthmatics have a 
distressed cast of countenance, and acquire 
a peculiar rounding or elevation of the 
shoulders, perfectly characteristic. Asthma 
may occur at any period of life, but is more 
general about the middle ; and men are more 
commonly the subjects of it than women. 



AST 



44 



AST 



The disease, in itself, though most distress- 
ing, is not dangerous, further than as it 
tends to lay the foundation of other affec- 
tions of the lungs or of the heart. 

No one can witness a paroxysm of asthma 
■without distressing anxiety to relieve the 
suffering individual, and not without alarm, 
if it is the first time of seeing the attack. 
The patient seems as if he must die for 
want of air in the lungs, but death rarely 
if ever occurs. In a disease of so long 
standing and of so peculiar a character as 
asthma, those who are the subjects of it 
generally have their own remedy, to which 
they habitually have recourse. The reme- 
dies are very various, and indeed happily 
so, for what gives immediate and full relief 
to one person totally fails in another. The 
practice of smoking the leaves and stems of 
stramonium or thorn-apple is now exten- 
sively and popularly resorted to ; with some 
it succeeds admirably, to others it seems to 
be hurtful; it may be tried. Antispasmo- 
dics and stimulants, as might be expected, 
are frequently beneficial. iEther and lau- 
danum is a favourite combination ; half a 
teaspoonful of the former along with twenty 
drops of the latter being given in a wine- 
glassful of water. A teaspoonful of sal- 
volatile may be substituted for the sether, 
but is scarcely so efficacious. Twenty grains 
of powdered ipecacuanha, given in half a 
wineglassful of water, to act as an emetic, 
may be of service, particularly if the attack 
has come on after a full meal, or if there is 
any suspicion of the stomach being loaded. 
Some experience much benefit from strong 
coffee, drank without milk or sugar. The in- 
halation of chloroform, a few drops sprinkled 
on a pocket-handkerchief, has lately been 
found to afford relief; but this remedy, in 
the first instance, must not be tried without 
medical sanction. Dr. Watson recommends 
the fumes of burning nitre (saltpetre) dif- 
fused through the air of the apartment, by 
means of pieces of blotting-paper dipped in 
a saturated solution of the salt, and dried. 
One of these, about the size of the hand, 
ignited and placed upon a plate or tile in 
the room, quickly diffuses its fumes through- 
out the apartment. When there is great 
dryness and deficient expectoration, steam, 
inhaled either simply or with a few drops 
of sulphuric tether, is worth a trial. If there 
is much acidity of stomach, ten or fifteen 
grains of carbonate of soda with a teaspoon- 
ful of sal-volatile in a little water should be 
given. Indeed, when an attack of asthma 
is threatened or has come on, care must be 
always taken as far as possible to remove 
any existing disordered action. A basin of 



warm tea and retirement to a warm bed 
will remove the chilly sensation. Consti- 
pated bowels ought to be relieved by a 
gentle dose of castor-oil, or of rhubarb and 
magnesia ; flatulence or acidity corrected. 
Flatulence particularly must be obviated, 
and all sources of it avoided. Effervescing 
draughts, soda-water, and such-like, are 
almost always hurtful. The effects of situa- 
tion and of atmospheric peculiarity upon 
asthmatics are most varied; some can 
breathe freely in clear dry air, which drives 
others into a damp cellar for temporary re- 
lief; a close, warm room which suits one 
will be unbearable to another. Individuals 
who are never free from asthma in some 
situations lose their attacks as soon as they 
remove. These are peculiarities of which all 
should be aware. Certain odours produce 
asthmatic breathing in the predisposed ; 
the powder of ipecacuanha is notorious for 
this effect ; and the smell of new-made hay, 
so pleasant to most, produces hay-asthma 
in a few unfortunate individuals. 

The habitual asthmatic soon becomes 
aware how much his freedom from pa- 
roxysms of the disease depends on the state 
of the general health, particularly of the di- 
gestive organs. He may not be altogether 
able to command situation, he cannot avoid 
atmospherical vicissitudes ; but he can, by 
temperate living, exercise, attention to the 
bowels and to the functions of the skin in 
particular, pass long intervals without an 
attack. Sponging the chest and shoulders 
every morning with cold or salt water, fric- 
tion being afterward made with a towel or 
hair-glove, is a practice to be recommended, 
provided no other predisposition forbids. 
Asthma is one of those diseases long con- 
tinued, marked in character, and not imme- 
diately affecting life, for which much may 
be done by well-timed and well-directed 
domestic management, while the frequent 
recurrence of the attacks renders the at- 
tendance of a medical man a serious con- 
sideration in the case of limited income. 
Nevertheless an asthmatic patient ought, 
from time to time, to be examined profes- 
sionally, especially should there occur any 
change in the nature of the paroxysm, which 
may be indicative of other and serious 
disease. 

ASTRINGENTS— Produce contraction and 
condensation when applied to living tissues 
capable pf such effects. In cases of relaxa- 
tion or debility, in hemorrhage, either ex- 
ternal or internal, in increased and injurious 
secretions from glands or mucous surfaces, 
astringents are the chief remedy. The 
amount of astringent action, however, de- 



ATM 



45 



AXI 



pends greatly upon the mode and circum- 
stances of its application. The astringent 
principle in the vegetable kingdom, in the 
form either of tannic or of gallic acid, is 
very widely diffused. The principal vege- 
table astringents used in medicine are oak- 
bark, galls, kino, catechu, tormentilla, uva- 
ursi or bear-berry, logwood, &c. The mineral 
astringents are the acids, alum, salts of.iron, 
particularly the muriate, sulphates of cop- 
per and zinc, and nitrate and oxide of silver, 
and salts of lead. Cold, in any form, is 
astringent. Refer to the individual heads. 

ATMOSPHERE.— See Air. 

ATONY. — Deficient tone of the system, 
characterized by debility and laxity of the 
muscular fibre generallv. 

ATROPHY, (Wasting)— May be either 
general or local. General atrophy is in one 
sense natural to advanced life, when the 
powers of nutrition being diminished, the 
muscles, the brain, and the organs generally, 
shrink. There may be fat, but at the same 
time much atrophy of the other bodily com- 
ponents. Atrophy occurring earlier in life, 
without obvious cause, ought to be regarded 
suspiciously. "When an individual, without 
departing from ordinary habits, begins to 
lose flesh, the cause ought to be looked for ; 
and, if the change continue, the person 
should be submitted to a thorough medical 
examination, and the existence of incipient 
disease ascertained if possible. In young 
children atrophy occurs as a consequence 
of faulty digestion, most frequently from 
improper feeding; it also is the result of a 
diseased condition of the glands of the belly 
through which the nutrient portion of the 
food passes on its way to the general circu- 
lation. For this condition, codliver-oil is 
the remedy, given in teaspoonful doses twice 
a day, to an infant of six or eight months 
old, and the same quantity well rubbed into 
the skin of the abdomen night and morning. 
Some medicines, such as iodine, have the 
power of causing local or even general 
atrophy. 

Local atrophy is liable to occur from 
various causes. Whatever diminishes the 
supply of blood to a part, will cause it to 
waste. Pressure on the main artery of a 
limb, obliteration of the smaller vessels of 
a part by previous inflammation, disuse of a 
member from paralysis or any other cause, 
are all followed by diminution in size of the 
part affected. 

Refer to Age — Infancy. 

AUSCULTATION.— The application of 
the sense of hearing to the detection of 
disease. This art is most extensively useful 
to the medical man in affections of the chest, 



j but it is also of great assistance in diseases 
of the abdomen. Indeed, it is applicable 
to all cases, especially affections of the 
blood-vessels, fractures, &c, in which mo- 
tion makes a sound audible. When the 
medical man by tapping on the body with 
his fingers, or by any other means, elicits va- 
rious sounds, it is called percussion ; and the 
present meaning of auscultation is the prac- 
tical knowledge of those sounds which are 
produced by the movements within the living 
body. Probably no addition to the science 
and practice of medicine has more extended 
the power of detecting the existence and 
nature of diseased action than the practice 
of auscultation. The stethoscope, now so 
well known from its universal use by me- 
dical men, is but a conductor of sound, used 
for obvious reasons of delicacy, convenience, 
and in some cases to prevent unpleasant 
contact with the uncleanly, but the sounds 
are equally well heard by the unassisted 
ear. Some medical men affect to despise the 
aid of auscultation and of the stethoscope, 
but it can only be such as want either the 
capacity or industry to learn its proper use. 
The stethoscopic examination of females 
may always be conducted with perfect deli- 
cacy and sufficient nicet}', through a cover- 
ing of linen ; and never, as sometimes is 
done, though rarely, should this means of 
investigation be denied to the attendant 
practitioner. 

AXILLA. — The armpit is an important 
region of the body, on account of the large 
blood-vessels and nerves which occupy its 
space. A wound of the large artery in this 
situation, unless efficient means are speedily 
adopted to control the bleeding, must be 
quickly fatal. When, from the copious flow 
of florid blood from a wound in or near the 
armpit, such an accident is supposed to 
have occurred, a bystander should with all 
speed exert pressure by means of his thumb 
upon the artery as it passes over the first 
rib, just behind the middle of the collar- 
bone, until the effusion of blood ceases. 
This pressure of course must be kept up, but 
as to do so with the thumb simply would be 
too fatiguing, some solid body — the handle 
of a moderate-sized key is generally recom- 
mended^-must be wrapped in a few folds 
of handkerchief and used for the purpose. 
While this is done, if medical assistance be 
many hours distant, as an additional safe- 
guard, firm graduated pads should be tightly 
fixed into the hollow of the axilla, and 
firmly retained by a handkerchief or small 

j shawl crossed over the opposite shoulder; 
but this must be a supplementary aid until 

I the artery is properly secured by the sur- 



AXU 



46 



BAN 



geon. The pressure behind the collarbone 
cannot be relaxed for one moment without 
risk to life. 

Kefer to Artery. 

AXUNGE, (Hog's-lard) — Is used as the 
principal component of various ointments, 
but is often injurious in consequence of 
being slightly rancid, in which case, instead 
of soothing, it has an extremely irritating 
effect, especially upon abraded or blistered 
surfaces. Even when applied fresh, if al- 
lowed to remain too long unchanged, it will 
become a source of irritation. 

AZOTE, (Nitrogen.) — One of the gaseous 
components of the atmospheric air, of which 
it forms 77 per cent, by weight. It is one 
of the most abundant and widely distributed 
of the elementary bodies. With oxygen it 
forms various compounds, of which nitric 
acid is the best known. Combined with 
hydrogen it forms ammonia. Nitrogen is 
regarded as the characteristic element of 
animal substances ; it is also present in 
vegetables, but in smaller proportion. 

BACK. — Pains in the back may be owing 
to an affection of the spine itself, or of the 
kidneys ; to rheumatism of the muscles, 
(lumbago,) or to sympathy with disorder in 
some distant organ : in females they are 
often owing to disorders of the uterus. 

Refer to Spine — Kidneys — Lumbago, $c. 

BACON.— The flesh, or rather fat and 
flesh of the hog, salted and dried, and some- 
times smoked, [which forms a prominent 
article of diet, especially in the Southern and 
"Western portions of the United States.] As 
an article of food, it is undoubtedly a relish- 
ing, convenient, and in some degree nutri- 
tious addition to the general fare ; at the 
same time, it is a question whether it does not 
in some districts form too large a proportion 
of the ordinary nutriment consumed, and 
whether an advantageous exchange might 
not be made, in part at least, for a more fa- 
rinaceous diet. Owing to the great propor- 
tion of fat in bacon, there is comparatively 
little of those elements of food which go to 
build up the constituent tissues of the ani- 
mal body, and which are contained so 
abundantly in the grains and pulses. Where 
the choice lies between bacon and bread, or 
bread and milk, or oatmeal and milk, there 
is no question that much more real nourish- 
ment will be obtained from the vegetable 
grain and milk, which contain whatever is 
requisite for every portion of the frame, 
than from that of which simple fat forms 
so large a share, and which cannot do more 
than afford respiratory food, or, at the best, 
add fat to the body. To full-grown men 
this may be of comparatively little import- 



ance, but to growing children and youths 
it must of necessity be a consideration 
whether, in consuming the amount of nu- 
triment circumstances permit, they consume 
that which really will afford them strength 
and substance or not. [Where it is eaten 
with corn-bread, much of this objection is 
removed, and Southern labourers often live 
upon it alone for weeks.] Bacon, used as 
a dietetic, as is usually done, with break- 
fast, is often of much service in cases of 
biliary disorder. It is the fat alone, toasted 
in slices before the fire, which must be 
eaten : the lean is hurtful, and must be 
discarded by the bilious dyspeptic. W 7 hen 
used in this way, a slight aperient action is 
exerted, and it is to this, gently carrying off 
its daily proportion of bile, that the benefi- 
cial effect is to be attributed. 

BALDNESS.— See Hair. 

BALSAM. — The term is derived from two 
Hebrew words, signifying the "prince of 
oils." It was formerly applied to many 
more substances than it is at present. The 
balsams of Peru, Tolu, and Copaiba are 
those most generally known medicinally. 
The two former are used popularly as ex- 
ternal applications. Tolu balsam is used to 
impart a pleasant flavour to lozenges, cough 
mixtures, &c, &c. ; at the same time, it 
undoubtedly exerts a beneficial expectorant 
action. Quarter of an ounce of gum acacia 
powder, an ounce of Tolu syrup, one drachm 
and a half to two drachms of ipecacuanha 
wine, and sufficient water to make up six 
fluid ounces, forms a pleasant and good 
cough mixture for children," to be given in 
from teaspoonful to tablespoonful doses, 
according to age. When fever is absent, 
and the cough getting loose, a drachm of 
tincture of squill may be added with advan- 
tage to the above. 

BALSAM OF COPAIBA acts decidedly 
upon the mucous surfaces of the body, and 
is employed in bronchitis, and in irritation 
of the urinary passages. It is extremely 
nauseous, and liable to disagree with the 
stomach. These properties are endeavoured 
to be overcome by enclosing the medicine 
in gelatine capsules, and by preparing it in 
various ways, as by covering the taste 
with aromatics, such as cinnamon or pep- 
permint-water. When active inflammatory 
or febrile action is present, copaiba must 
not be used. 

BANDAGES — Are strips of calico, linen, 
flannel, or of any other convenient material, 
employed in rolls, to envelop any portion 
of the body requiring artificial support, or 
upon which it is requisite to produce press- 
ure, or to retain dressing. The art of 



BAN 



47 



BAN 



applying a bandage well, that is, both neat- 
ly and efficiently, requires some practice 
and attention, but it is often a most useful 
accomplishment ; for a bandage, if required 
at all, must be properly applied, otherwise 
it is worse than useless ; if, therefore, none 
but the surgeon can undertake the task, it 
necessitates a much more frequent attend- 
ance on his part than might otherwise be 
requisite. In general, the first few appli- 
cations of a bandage will be made by the 
medical attendant himself, and ought to be 
in the presence of the individual to whom 
the duty may be afterward deputed. By 
careful attention on the one hand, and kind 
explanation on the other, much may be 
learned and taught, but not all, as the in- 
experienced bandager will discover on the 
first attempt. By all means, therefore, let 
the first attempt be made on some one in 
health, before the call is made to the invalid. 
Attention to the following directions will 
facilitate the application of the previous 
practical lesson, or in some measure supply 
its place, if from circumstances it has been 
wanting. Whatever the material, the width 
of the bandage or roller must be propor- 
tioned in some degree to the size of the part 
to which it is to be applied ; if too narrow, it 
is apt to be stringy, and to cut; if too broad, 
it does not adapt itself readily to the ine- 
qualities, and the pressure is unequal. For 
an ordinary sized adult male leg, a bandage 
of two and a half inches broad is a good 
proportion; for the arm of the same person, 
one of two inches ought to be sufficiently 
well adapted. The material for bandages 
must neither be too strong nor too weak ; or- 
dinary "shirting calico" is a very convenient 
texture. The length, of course, must vary 
according to what is required, but rollers are 
usually put up in six or eight-yard lengths ; 
they are better torn in one continuous strip, 
free from joinings and without selvage edge. 
The strip, when prepared for use, must be 
rolled up as firmly as possible, either into a 
single or double head, (fig. viii.;) the former 



Fig. viii. 




is much the most generally employed. If 
the bandage is a new one, of calico or linen, 
the loose th»eads of the roll at each end 
must be roved off; otherwise they become 
troublesome when the roller is applied. 
Bandages may be applied in simple circles, 
(fig. ix. B.,) in spiral, &c., or in reverses, 



(fig. ix. C; They are also applied in va- 
rious other forms to suit the different por- 
tions of the body. In applying a bandage, 
the rolled-up strip being held in the right 
hand, the end which is commenced with is 
secured by the first turn. If it be the sim- 
ple circular bandage, round the trunk of the 
body, or round a limb of nearly equal girth 
throughout, either naturally or from swell- 
ing, the roller is carried round and round, 
each succeeding turn slightly overlapping the 
one before it ; if the spiral bandage be re- 
quired, the rolls are carried up very oblique- 
ly ; but if, as most likely, it is the reversed 
bandage, then, wherever the inequality of 
the parts prevents its being laid on flatly 
and evenly, the band must be turned upon 

Fig. ix. 




itself, (fig. ix. C,) so as to become reversed, 
the surface of the cloth which was next the 
skin being turned outward, and vice versa. 
It is difficult to describe the manoeuvre, and 
it is a little difficult at first to execute it 
neatly and well ; but when practised, it be- 
comes perfectly simple. This is by far the 
most useful form of bandage, and a person 
who can put it on well will have but 
little difficulty in accomplishing the other 
varieties. 

Fig. x. 



BAN 



48 



BAN 



For the purpose of retaining dressings upon 
the head, nothing answers better than a close- 
fitting calico cap ; a handkerchief will often 
serve every purpose, or the split cloth (fig. x.) 
may be used ; applied as in fig. xi. by the up- 

Fig. xi. 




per tails being brought beneath . the under 
ones and fastened under the chin, the under 
tails being carried to the back of the head. 
When it is desirable to retain the head in one 
position, it may be done by bands attached 
to a cap, and fastened as required to a band 
going round the chest. When for this pur- 
pose, or to fix a broken rib, such a band is 
required, it ought to be from eight to ten 
inches wide, made of tolerably strong double 
calico, and sewed firmly round the body. 

To retain a pad or poultice in the arm-pit, 
a good-sized handkerchief answers better 
than any bandage, the middle being placed 
at the arm-pit, the ends crossed, at the side 
of the neck opposite, carried under the cor- 
responding arm-pit, crossed and brought 
and tied on the shoulder. Slinging the arm, 
a very simple business, is often very badly 
done ; in almost every case the forearm 
should be supported throughout its entire 
length, and it is generally well to include 
the hand, especially in children. The simple 
sling handkerchief may be put on, as at 
fig. xii., but a much more confining sling is 

Fig. xii. 




made by enveloping the elbow in the long 
side of a triangular handkerchief, fastened 
up into a little pouch at the centre, and the 
point, including the hand, being fastened 
up to one of the ends going round the neck, 
(fig. xiii.) 

Fig. xiii. 




Upon the trunk of the body, dressings, 
blisters, &c, may be retained by means of 
a broad band of any convenient material, 
fastened round and prevented from slipping 
down by braces over the shoulders, (fig. xiv.) 



Fig. xiv. 




For bandaging the abdomen, a broad 
band, of any material that is suitable, is 
generally made, the ends split for conve- 
nience of fastening either before or behind, 
and a triangular piece cut out of either 
edge at the centre, and the edges joined, in 
order to fit the shape of the region. In 
order to retain poultices, &c, at or near 
the groin, a piece of cloth is to be shaped 
to fit the region, (fig. xv.,) a band long 
enough to go round the bedy, cross and 
fasten in front, is to be sewed to one end, (1,) 
and to the opposite point another small 
band (2) is attached, which, passing between 
the legs, is brought up to the band behind. 



BAN 



49 



BAN 



Fig. xv. 




To retain dressings, &c. between the legs 
or nates, the double T bandage (fig. xvi.) 
is used. For the groin and parts adjacent, 
the spica or figure of 8 bandage is also used. 

Fig. xvi. 




■///// ////s/s. - 




A roller eight yards long is taken, the end 
secured by one or two turns round the pel- 
vis, and then the bandage is brought down 
across the front of the thigh, carried evenly 
between the legs, and again brought up and 
carried round the pelvis- — this being repeat- 
ed at each turn till the roller is exhausted, 
(fig. xvii.) 




For the Extremities, the simple roller, ap- 
plied in reversed turns, is generally used. 
Bandaging from above downward may be 
required, but generally it is upward. There 
are various methods of commencing the ap- 
plication of the roller at the foot. The heel 
is covered by laying the end on the inner 
E 



ankle, bringing the roller under the heel, 
then round the ankle so as to secure the 
end, from thence going down to the toes, 
and carrying the bandage up from that point 
round the foot and leg, reversing where re- 
quired. The arm is to be bandaged, with 
the requisite modifications, by the reverse, 
like the leg. As a general rule, leg band- 
ages, habitually worn, ought to be put on 
before the individual gets out of bed in the 
morning. A bandage which gives pain after 
its application, without obvious cause, ought 
to be taken off and reapplied. If there is 
reason to suspect inflammatory swelling 
beneath, it will be well to try the use of 
cold water before disturbing matters. There 
is some little management required in tak- 
ing off a roller as well as putting it on : 
as each successive turn is unrolled, it 
should be gathered in a bunch in the hand, 
and not, as is often done, three or four yards 
of bandage at full length pulled round the 
limb every time. A many-tailed bandage 
(fig. xviii.) is used to bandage the leg where 



it is an object to avoid the slightest move-* 
ment. It is formed of a number of short 
strips of bandage, long enough each to go 
once and a half round the limb. They are 
placed obliquely, and overlapping one an- 
other ; they may, or may not be joined by 
a central strip, (1.) Upon these arranged 
strips the limb is laid, and each strip in 
succession is brought round the limb, every 
succeeding securing the previous one. The 
advantage of the many-tailed bandage is 
that it can be changed, either partly or en- 
tirely, if soiled, without the slightest dis- 
turbance. It is only necessary to attach a 
fresh strip to that which is to be removed, 
and pull the one away, and the other into 
its place. When, from movement, a bandage 
is liable to become displaced, the incon- 
venience is in great measure prevented by 
brushing a weak solution of starch or gum 
over the turns as soon as applied. This is 
different from the starch bandage which is 
so useful in many cases — fractures, &c. For 



BAR 



50 



BAR 



this bandage, the roller is thoroughly satu- 
rated, as it is put on, with strong starch or 
flour paste, and, if requisite, brown paper 
pasted on the top of the first bandage, and 
another dry one put over all. In thinly 
settled countries, where it might be requi- 
site to move a person soon after a fracture, 
the foregoing application would prove sim- 
ple, safe, and efficacious. It must not, 
however, be put on till inflammation has 
subsided. In many cases, in which band- 
ages used formerly to be applied, they have 
been superseded by elastic materials, of 
which stockings and belts of all kinds are 
fabricated : elastic rollers are also manu- 
factured. The flannel bandage unites at 
the same time support and protection to 
the surface. It is useful in rheumatic cases, 
and also when applied over the abdomen in 
diseases of that cavity. 

BARBADOES LEG.— SeeELEPiiANTiAsis. 

BARK. — The term, used alone, is always 
applied to the bark of the cinchona, also 
called Peruvian or Jesuit's bark, which was 
introduced into Europe from South America 
about 1640, and at first was enormously ex- 
pensive. Many marvellous tales are told of 
the way in which the virtues of cinchona 
bark were first discovered by the natives of 
the country, but they have been proved er- 
roneous. The remarkable power of bark in 
curing, not only intermittent fever and ague, 
but periodic diseases generally, and its effi- 
cacy as a general tonic, has rendered it one 
of the most valuable drugs possessed by 
man. The varieties of cinchona have been 
classed as pale, yellow, and red barks, but 
there are many more than these, and some 
^f them are almost worthless as medicines. 
The kind of bark has now, however, since 
the discovery of quinine, become almost a 
matter of indifference to the general pur- 
chaser. When the drug itself, either whole 
or in powder, is required, the only security 
is to procure it from a respectable chemist. 
The powder, which was formerly given so 
largely, is scarcely ever now prescribed, but 
the infusion, decoction, and tincture of bark 
still retain their places. The infusion may 
be made by pouring a pint of boiling water 
upon an ounce of coarsely powdered bark, and 
allowing it to stand near the fire, in a covered 
vessel, for five or six hours ; the dose is a 
wineglassful twice or three times a day. The 
decoction is made by adding double the quan- 
tity of water to the same quantity of bark, 
and boiling down to one-half. The dose is 
about the same as the infusion. A favourite 
domestic method of administering bark is to 
steep an ounce of the powder for a week in 
a bottle of port wine, and give of this a small 



wineglassful once or twice a day. Where 
the stimulant is admissible, the form is a 
good one. If the tincture is required, it is 
better to buy it. The characteristic proper- 
ties of bark are concentrated in the alkaloid 
substances, quinia and cinchonia. The for- 
mer of these is much the most widely known 
and used, but the latter is considered by 
many equally efficacious. Quinia or quinine 
is used in medicine, in the form of sulphate, 
or rather disulphate. Pure white in colour, 
it is in the form of silky crystals, and has a 
most intensely bitter taste. Its high price 
renders it liable to much adulteration: it 
ought, therefore, always to be procured from 
respectable parties. The dose of quinine is 
one grain twice a day, as a general tonic, 
but as an anti-periodic in ague, neuralgia, 
&c, much larger and more frequent doses 
are required — [usually 16 grains between 
each chill. ] It may be given in pill, made up 
with bread crumb and honey, or dissolved, by 
the addition of five or ten drops of dilute 
sulphuric acid in a small wineglassful of 
water, or it may be taken in a glass of 
sherry, if stimulants are admissible. 

As a curative agent in ague, and in dis- 
eases generally of an intermittent or periodic 
character, bark, either in its original state, 
or in the form of quinine, is quite unrivalled 
— as a tonic, in diseases of debility, in the 
advanced stages of fever, or at its very com- 
mencement in weakened digestion, it is 
equally efficacious. In some persons, qui- 
nine, even in small doses, is apt to occasion 
headache and other uncomfortable symp- 
toms, and to disorder the bowels. When 
given as a stomach tonic it cannot be long 
continued with advantage. Where there 
exists inflammatory action, or tendency to 
head affection, quinine must never be given, 
except by medical sanction. Quinine in 
combination with iron (the citrate of quinine 
and iron) forms an admirable tonic in cer- 
tain cases, in one-grain doses. The use of 
quinine in various diseases will be found un- 
der the separate heads, such as Ague, Neu- 
ralgia, §c. 

BARLEY, when prepared as pearl-barley, 
is one of the most useful additions to sick 
cookery; its decoction, "baidey-water," be- 
ing a pleasant and extremely beneficial de- 
mulcent in all affections of the mucous mem- 
brane, and forming a grateful and nutritious 
beverage in fever ; it ought, however, to be 
made considerably thicker in the former case 
than in the latter. To make plain barley- 
water, two and a half ounces of pearl-barley 
are to be well washed in cold water, half a 
pint of boiling water is then to be poured 
upon the grain, the whole boiled for a few 



BAT 



51 



BAT 



minutes, and the water strained off, a couple 
of quarts of boiling water must then be 
poured on, the quantity boiled down one-half 
and strained. This process does not quite 
exhaust the barley, and another portion of 
water may be boiled upon it, by those to 
whom the saving is an object. A little lemon 
or orange peel is a pleasant addition to the 
beverage. A compound and very pleasant 
drink is made by adding to a quart of simple 
barley-water, figs sliced, and raisins stoned, 
of each two and a half ounces, liquorice-root 
sliced five drachms, and a pint of water, the 
whole to be boiled down to a quart and 
strained. This compound decoction is not so 
well adapted for a fever drink as the simpler 
form. 

In irritation of the urinary passages, from 
gravel, or after the application of a blister, 
or from any other cause, barley-water is 
most valuable ; its soothing properties are 
still further increased by the addition of an 
ounce of gum arabic to each pint of liquor. 
In catarrh, and irritable cough, or simply 
as an article of mild unstimulating nourish- 
ment, it is serviceable. The late Dr. A. T. 
Thomson recommended equal parts of barley- 
water and milk, sweetened with a little refined 
sugar, as a good food for infants brought 
up by hand. It may act upon the bowels. 

BAROMETER.— The instxmment by which 
the amount of atmospheric pressure is deter- 
mined. Late observations would indicate 
that during the prevalence of epidemic dis- 
ease, such as cholera and influenza, the in- 
dications of the barometer are more than 
usually affected. 

BARRENNESS.— Sterility of the female 
may be the result of defect of structure in 
some portion of the generative organs, or of 
functional disorder resulting from local or 
constitutional causes. Such cases always 
require the care and consideration of a me- 
dical attendant. 

BASILIC VEIN.— Frequently opened in 
the operation of bleeding from the arm. — See 
Blood-letting. 

BASILICON OINTMENT, or Resin Oint- 
ment — Is made with three parts of resin, 
three of wax, and four of olive-oil. The 
resin and wax are melted together, the oil 
added, and the whole squeezed through linen. 
It is a stimulant ointment, not as much used 
at the present day as formerly. 

BATH. — Applications to the surface of 
the body, either general or partial, in the 
form of liquid, vapour, or gas, are now com- 
prehended under the term bath. 

Water baths may be simple or medicated. 

As regards temperature, they may be 
cold, tepid, and hot. 



As regards application, they may be 
general or partial, shower, cold affusion, 
douche, sponge, wet sheet. 

Vapour and hot air are both used as baths. 

The extreme vascularity, the nervous sen- 
sibility and sympathies of the skin, and its 
important functions as an excreting organ, 
all render it a most important medium 
through which to impress and act upon the 
system generally. The subject, till of late 
years, has been strangely neglected and 
overlooked by medical men. Brought promi- 
nently forward under the name of Hydropa- 
thy, or the Water-cure, by Preissnitz and his 
followers, it has unfortunately been carried 
far beyond its legitimate lengths, and be- 
come associated, in name, with quackery and 
undue pretensions. That much good is to 
be done by the use and application of water 
simply, in the treatment of disease and dis- 
order, there can be no question ; neither 
can it be doubted, that much and serious 
evil has resulted from the indiscriminate 
and ignorant employment of its powerful 
agency. With the medical profession it 
rests to place the subject upon its legitimate 
basis, by taking it into their own hands, and 
employing it rationally and scientifically. 

The cold bath may be of any temperature 
up to 80° or 85° Fahr., the effect upon the 
system varying, of course, according to the 
temperature, the length of time it is endured, 
and the amount of muscular movement ex- 
erted during that time. A single plunge 
into ice-cold water may depress less than a 
longer continued bath of a higher tempera- 
ture. As a rule, individuals of weak nerv- 
ous and circulatory powers do not bear 
well the effects of cold bathing : it robs them 
of an amount of animal heat which they 
cjfhnot readily again make up ; it produces 
nervous exhaustion, and perhaps internal 
congestion, unrelieved by reaction to the 
surface. 

When an individual, after the cold bath in 
any form, remains chilled, the fingers and 
lips blue, the countenance pale, and when 
languor and drowsiness succeed, he may be 
certain that more harm than benefit is being 
derived from the custom, and that it must 
be modified or given up. 

In such a case, if the bath has been usually 
taken before breakfast, the hour should be 
altered to a couple of hours after that meal. 
This with some will be quite sufficient to 
make the difference between agreeing or 
not: indeed, it requires a person of very 
good vital power to derive real benefit and 
comfort from bathing before breakfast. If 
the change in hour does not alter the effects 
of the cold bath, something may be due to 



BAT 



52 



BAT 



its low temperature; or the bather, espe- 
cially if he be not a swimmer, may expose 
himself too long to the depressing influence : 
he may be in the habit of going into the wa- 
ter after his powers have been exhausted by 
much exercise, or when he is in too chilled 
a condition. All these points require con- 
sideration, before either the undoubted good 
effects or the comfort of bathing are given 
up as unattainable. The last point men- 
tioned is one on which particular caution is 
required ; many persons, in dread of going in 
to bathe too hot, run to the other extreme, and 
allow themselves to become so chilled that 
reaction will not come on. After coming out 
of a cold bath, the skin ought to be well 
rubbed with a rough towel, till a glow is 
felt ; or the hair glove, now so well known, 
may be used. The above remarks apply 
to the application of cold water generally 
to the skin, in whatever form. Few old 
people can take cold baths with advantage, 
and the perseverance in their use may lay 
the foundation of rheumatic, urinary, or 
other disease. Those who are liable to head 
affection should not take the general cold 
bath ; for them the shower bath is prefera- 
ble. Females should not bathe in cold wa- 
ter during the menstrual period. Some 
persons who cannot bathe in fresh water, 
can do so in the sea, the saline ingredients 
producing a more stimulant effect upon the 
skin ; sometimes, however, the stimulation 
goes so far as to produce a painful rash, 
which forces the person to give up the cus- 
tom. The restorative and tonic effects of 
cold bathing are undoubted in many cases, 
if the mode of taking it be properly regu- 
lated. As a, general rule, five or six minutes' 
immersion is sufficiently long. [In winter, 
or with delicate persons, two minutes or ltss 
will suffice, unless the reaction is perfect.] 

Sea-water undoubtedly exerts a more tonic 
influence upon the bather than fresh ; more- 
over its temperature is more equable, and 
seldom so low as that of the latter. From 
the beginning of June to the end of Septem- 
ber, according to weather, may be considered 
the sea-bathing season, during which the 
temperature of the water on our shores 
averages from 55° to 70° Fahr. When a 
bath is either ordered as a remedy or de- 
sired as a comfort, and if when cold it does 
not agree — 

The tepid bath, of a temperature varying 
from 85° to 94° may be used ; about 88° is 
an agreeable and convenient standard. Of 
course the tepid bath involves the use of a 
receptacle for the water. It does not produce 
the shock to the system like the cold bath, 
and the person may remain in it from a 



quarter of an hour to twenty minutes. The 
tepid bath relaxes and purifies the skin, and 
promotes the insensible perspiration. For 
the purposes of cleanliness and comfort it 
is most generally applicable. After fatigue 
from travelling, hunting, shooting, &c, in 
irritable states of the system, with dry or 
chafed skin, the tepid bath is at once grate- 
ful to the feeling and salutary. Neither the 
tepid bath, nor any other, is useful or safe 
if taken soon after a full meal. 

The warm or hot bath is, or ought to be, 
a remedial agent only, not one for general 
use. Its temperature ranges from 95° to 
102° Eahr. ; 96° is the most general stand- 
ard. The warm bath is used to promote 
reaction, to allay spasmodic or inflammatory 
pain, to soothe convulsive action, or is car- 
ried to its fullest extent, to cause faintness. 
The time for remaining in the warm bath is 
generally from twenty to five-and- twenty 
minutes, but this must be regulated some- 
what by the effect required. The hot bath 
of the temperature of 100° Fahr. is a power- 
ful stimulant agent, to be used cautiously, 
and rarely without medical advice ; in dis- 
ease characterized by extreme depression, 
coldness, &c, it is useful. In the employ- 
ment of these baths generally, persons who 
are the subjects of any organic disease, 
or have a tendency to acute attacks of func- 
tional disorder, such as determination of 
blood to the head, &c, must be very cau- 
tious, and ought if possible to have medical 
advice. The regulation of the temperature 
of baths ought never to be left to the sen- 
sations ; the thermometer is the only trust- 
worthy guide, and, indeed, is an article 
which no house ought to be without. The 
price of the instrument is now extremely 
low, and whether for the bath, the temper- 
ature of the room, or the instruction of a 
child, it is equally useful. Baths are made 
either to contain the whole person, as in the 
"slipper bath," (fig. xix.,) the hip bath, 
(fig. xx.,) or the foot and leg bath, (fig. xxi.) 

Fig. xix. 




In choosing a bath, it is well to have one 
which will answer the desired purpose with 



BAT 



53 



BAT 



K*. xx. 





as small a quantity of water as possible. 
Every house where it can be afforded should 
have the means of providing a bath, and 
every village ought to have its movable 
"Parish Bath," for the use of the poor. 

Mode of Application of Bat n. — The Shower 
Bath, whether of fresh or salt water, whether 
quite cold or tepid, is a valuable agent in 
the treatment of many nervous affections ; 
it will suit some whom the general bath will 
not. It is well for persons of weak habit, 
or who suffer from the head, to have a thin 
layer of warm water put in the bottom of 
the shower bath before getting in. Useful 
hand shower baths are now manufactured 
for children. 

Cold Affusion. — See Affusion. 

The Douche Bath consists of a compact 
stream of water, either warm or cold, al- 
lowed to impinge forcibly upon any portion 
of the body. In some bathing establishments, 
especially in Europe, the douche stream is 
of great force and bulk. Domestically, the 
most familiar douche instrument is the pump, 
and a most efficient one it is to strengthen a 
limb which remains weak after an accident, 
such as fracture or sprain ; it must be used 
till aching is produced. The most convenient 
domestic douche is a watering-pot without a 
rose, but a jug will do ; in short, whatever 
will send a stream of water upon the part 
required. Additional force is obtained by 
the person administering the douche stand- 
ing upon a chair. 
E 2 



Sponging the skin with water is used in 
lieu of a bath, for purposes of cleanliness 
and comfort. It may produce depression if 
employed before breakfast. Partial spong- 
ing, sponging with tepid water, changing 
the hour, or having a cup of coffee on rising, 
may obviate the effect. Rough friction 
should be employed afterward. 

The wet sheet bath is sometimes, by mis- 
nomer, called the cold wet sheet. It is, in 
fact, a warm bath, or rather a large warm 
poultice, kept warm by the animal heat. It 
is formed by enveloping a person in a sheet, 
wrung out of cold or tepid water, and cover- 
ing or packing him up with layers of blan- 
kets ; very free perspiration is the result. 
It is a most useful remedy, and might with 
advantage be more generally used. Spong- 
ing with cold water after the use of this 
bath is occasionally practised. 

The vapour bath produces free perspira- 
tion, and may be used whenever that is re- 
quired, as in incipient cold. It is very re- 
laxing. Many different forms of vapour 
bath have been invented. A small kettle to 
place on the fire, with a tube to convey the 
steam underneath the blanket or cloth in 
which the person is enveloped, forms a good 
vapour bath. A simple extempore vapour 
bath may be made by placing a vessel of 
boiling water underneath the coverings of 
the patient, and keeping up the steam by 
means of hot stones or metal ; [or by wrap- 
ping him in a blanket wrung out of hot wa- 
ter, and covered with other dry blankets to 
prevent the evaporation.] 

The hot air bath is used for the same pur- 
poses as the vapour bath, but is more sti- 
mulating. Apparatus of various kinds for 
this bath may be had at the manufac- 
turer's. 

Medicated baths are used, but only under 
medical direction. 

Hip baths and Foot baths are used where 
a full bath is unnecessary. The former, 
either cold, tepid, or warm, is extremely 
useful in affections of the loins, hips, &c. 
The foot bath, generally used as a deriva- 
tive, ought to be of as high a temperature 
as can be borne and ought to redden the 
skin after the immersion. If a stronger ef- 
fect is requisite, an ounce of mustard, and a 
couple of handfuls of salt may be put in the 
water. To reap the full benefit of the foot 
bath, the extremities should either be clothed 
in woollen stockings, or wrapped in flannel 
immediately on coming out of the water. 
The fact must always be kept in mind, in 
using the foot bath in cases of insensibility, 
that it may be so hot as to scald, and yet 
cannot be complained of. The best mode is 



BAT 



54 



BED 



to use the thermometer, and not to raise the 
heat above 110°. 

Fomentations, poultices, &c, may all be 
regarded as partial baths, but will be treated 
of under their separate heats. 

BATH — City, celebrated for hot springs, 
the only ones in England. The waters are 
used for bathing, and are drunk. They are 
found useful in gout, rheumatism, paraly- 
sis, liver and stomach affections. Persons 
who suffer from impaired health, in conse- 
quence of long residence in a hot climate, 
frequently derive considerable benefit from 
the use of the Bath waters. A pint of the 
water is said to contain — 

Muriate of lime 1-2 

Muriate of magnesia 1-6 

Sulphate of lime 9-5 

Sulphate of soda 0-9 

Silex 0-2 

Oxide of iron 0-01985 

Loss ..0-58015 

Saline ingredient 14 grains. 

Carbonic acid 1*2 cubic inches. 

BATTLE Y'S SOLUTION OF OPIUM— 
Is a secret preparation, but one largely pre- 
scribed by medical men on account of its 
•efficacy. It is more purely sedative than 
the other preparations of opium, and is said 
to be twice the strength of laudanum — but 
this it is not. Twenty drops of the sedative 
solution are almost equal to thirty-four of 
laudanum. It more certainly produces sleep 
than the latter, and excites less. 

BEAN. — The various species of bean are 
most nutritious to those whose stomachs 
can digest them : they are used either young 
and fresh gathered, or old. The nutriment 
they afford, as shown in the case of the 
miners in South America, who live almost 
exclusively upon them, is calculated to sus- 
tain a high condition of muscular develop- 
ment and vigor. Garden-beans, as brought 
to table in this country, must be avoided 
by those of weak digestion. They are 
less likely to disagree if deprived of their 
skins. 

BEBEERINE.— A recently introduced sub- 
stitute for quinine. A powerful bitter, and 
slightly stimulant tonic. 

BED —Bedroom — in health — in sick- 
ness. — The fact that civilized people spend 
on an average about one-third of their lives in 
their bedrooms, is quite conclusive as to the 
importance of their salubrity being a first 
consideration with every one. Whatever 
the public rooms, bedrooms should be as 
spacious, lofty, and well-aired as circum- 
stances will permit. Unfortunately the 
reverse of this is the general rule, and we 



have close, small sleeping apartments, 
crowded and ill-ventilated nurseries, and 
bad health. Good ventilation will do much, 
but it will do far more if aided by plenty 
of space. During the day-time, there is 
much less danger of persons generally suf- 
fering from want of fresh air than during 
the night, when, in sleep, they are many 
hours confined to one place. Every respi- 
ration of the sleeper contaminates a cer- 
tain amount of air, and, as a matter of 
course, the smaller the space around, the 
sooner will the contamination of the whole 
body of air contained in that space be 
completed ; it will become loaded with 
an amount of carbonic acid injurious to 
health. The room must be sufficiently 
large — and this is rarely the case in mo- 
dern houses — to supply pure air for respira- 
tion during six or eight hours, or some 
means must be provided for carrying off the 
impure atmosphere. This, certainly, is not 
to be effected by closed doors and windows, 
and blocked-up chimneys, assisted in their 
injurious operation by closely-drawn cur- 
tains, which might be contrived for the 
special purpose of enveloping sleepers in 
their own exhalations, rendering sleep un- 
refreshing, and waking a painful rather 
than a pleasurable operation. It cannot be 
otherwise, after the poison of carbonic acid 
has been regularly inhaled for the last few 
hours of slumber. 

If the door of a sleeping apartment must 
be locked, the upper panels ought to be per- 
forated for the admission of air, but the 
purpose is much better answered by the 
door being left ajar, while it may be render- 
ed equally secure by means of a chain-bolt. 
There is an advantage in admitting the 
fresh air by this channel, for it must be 
warmed in some degree inits passage through 
the house. 

Air may be admitted directly from with- 
out, through the window, left slightly open 
at the top, or better, by means of a barred 
glass, or perforated piece of zinc or tin. 
Some of these plates are made so that 
the perforations may be opened or closed at 
pleasure. 

It is not sufficient to let in pure air — the 
impure must have some means of escape, 
and for this, the chimney — and no sleeping- 
room either for rich or poor should be with- 
out one— is the most ready channel, and 
perhaps the best, if under proper arrange- 
ments. In former times, when fire-places 
were ample and lofty, the chimneys were of 
themselves sufficient to carry off bad air ; 
but since, by change of fashion, the open- 
ings have been lowered and contracted, they 



BED 



55 



BED 



cannot do this. The air, warmed by respi- 
ration, ascends to the top of the room, where 
it must remain till it becomes cooler, but 
not more wholesome. It descends to be 
rebreathed, and reaches the level of the 
breather's nostrils before it can pass up an 
ordinary chimney. All this may be obviated 
by making a proper opening for the escape 
of the impure warm air into the chimney. 
Dr. Neil Arnott's chimney ventilator (fig. 
xxii.) is contrived for this purpose. A 

Fig. xxii. 




brick is taken out of the wall at the top of 
the room, so as to make an opening into 
the shaft of the chimney, the opening being 
kept closed, and smoke prevented during 
the use of fires, by means^ of a balance 
valve, b. Thus, a bedroom, to be healthy, 
must have a sufficient entrance for good air; 
must have a proper exit for that which has 
been rendered impure ; should have space 
if possible. The greater the number of 
sleepers, the more requisite the fulfilment 
of these conditions. It must also be borne 
in mind, that a light, and especially a gas- 
light, equally with the lungs, contaminates 
the air. It is advisable when a light is 
burned in a sleeping-room, to place it so 
that the fumes may pass up the chimney : 
if a gas-light, it ought to be provided with 
a special tube to carry off its fumes. With- 
out this, it must be a source of evil ; with 
it, of good ; for in the latter case it increases 
the current of air through the room gene- 
rally. 

Fires in bedrooms are frequent sources 
of impure air, uncomfortable sleep, and 
morning headaches. During the first hours 
of night, when burning briskly, the fire 
promotes ventilation ; but when, as often 
occurs toward morning, it smoulders down, 



and becomes choked with ashes, it has not 
sufficient power to create a draught. The 
current of air is reversed — instead of pass- 
ing up the chimney, it passes down, carry- 
ing with it into the room a very deteriorated 
atmosphere, perhaps loaded with sulphur- 
ous gases. — None who regard health will 
have curtained beds. It is difficult to con- 
ceive what other purpose the huge masses 
of drapery around a "four-post bed" can 
serve than to collect dust, and when 
drawn, to confine impure air around the 
sleepers. 

For the young and middle-aged, hair, or 
where these cannot be afforded, firm wool 
mattresses should always be used : feather 
beds, never. The cotton mattress requires 
more frequent dressing and cleaning than 
the hair. For the aged, who are deficient 
in natural warmth, a feather bed is quite 
admissible. However perfect the provision 
for ventilation of a bedroom during the 
night may be, it must require additional 
purification in the morning. As a rule, the 
window should be opened as soon as the 
occupant is about to leave the room, or 
even before, in summer, and the bed clothes 
turned down over the end of the bedstead, 
or thrown entirely off, for at least an hoxir 
before the bed is made up for the day. In 
this way perspiration, and emanations which 
take place from every animal body, are 
evaporated and got rid of. Turn-up beds, 
box-beds, and all enclosures of the kind, 
are perfect abominations. Slops of all kinds 
should be removed from sleeping-rooms as 
early as possible. Children even more than 
adults require fresh, pure air during sleep ; 
yet how often are nurseries crowded and 
shut close up during the night — the beds 
made as soon as left vacant, and the little 
creatures confined to the room in which 
they have slept for a great part of the day. 
This ought not to be, nor would it be, but 
for the generally prevailing ignorance upon 
all points connected with health and the 
rules for its preservation. There are few 
parents but would make sacrifices to give 
their children a change of room, were they 
sufficiently aware of the importance of so 
doing. Even self-interest would dictate the 
course, could they know how often the first 
cause of illness, and all its expenses, has 
originated in the badly-aired nursery. 

It is much to be regretted that in the 
houses of the poor, crowding at night is so 
frequently compelled by circumstances. If 
it must be so, its evils ought'to be counter- 
acted by the means of ventilation already 
pointed out, and by strict cleanliness. At 
the same time, floors should not be washed 



BED 



56 



BED 



in damp weather, and when they are wash- 
ed, it should he done early enough in the 
day to permit of their being thoroughly dry 
before the room window is closed for the 
night. Rooms which are at all crowded at 
night ought to be whitewashed at least 
twice a year. 

The chamber of sickness requires all the 
provisions for health to be attended to with 
increased care, more especially if the illness 
be of an infectious character. In this case, 
as free ventilation with cool pure air as the 
case will admit — the window, if possible, 
being open during the day — must be continu- 
ally preserved ; and all superfluous furniture 
or clothing, of cotton or wool especially, and 
bed hangings, removed ; dirty linen must be 
taken away at once, and excretions — kept, 
as they should be, for the inspection of the 
medical attendant — removed to an unoccu- 
pied room, or out of doors. The zeal for 
cleanliness, however, must never, either in 
infectious disorders or not, go so far as to 
dictate washing the floor of an apartment 
occupied by the sick ; a gentle sweeping 
with tea-leaves, to prevent dust, is all that 
is allowable. Cooking of any kind is out of 
the question. If it is possible to have a 
second bed into which the sick person can 
be moved occasionally, it is a valuable re- 
source. A thermometer to regulate the 
temperature of a sick-room is at all times a 
safer guide than the sensations of indivi- 
duals, and the best average temperature to 
be maintained is from 55° to 60° Fahr. All 
sources of unpleasant or teasing noise, 
creaking hinges or shoes, the ticking of a 
clock, &c., are to be obviated ; if there is a 
mirror into which the invalid can gaze, it 
should be removed. Vessels, whether for 
food or medicine, should be carefully cleansed 
each time of using. The medicines ought to 
be kept in some sort of order in a place by 
themselves — never, as is frequently done by 
the poor, placed in the window, where they 
are liable to be decomposed by the action of 
light, or by the sun's rays. All external ap- 
plications should be unmistakably marked. 

Even in disease of an infectious character, 
if proper ventilation and cleanliness be ob- 
served, the attendants upon the sick have 
comparatively little to fear, though, at the 
same time, every additional precautionary 
measure is to be adopted. Fumigations of 
tobacco, burning nitre, &c, &c, are worse 
than useless ; they give no real protection, 
and only deteriorate the air, or irritate the 
patient. Chlorine is the only effectual dis- 
infectant to be employed, and by far the best 
preparation for the purpose is Collins's pa- 
tent disinfecting powder, which requires no 



trouble, and maintains a continued, suffi- 
ciently effective, and not unpleasant chlorin- 
ated atmosphere in the apartment. [Chloride 
of lime wet with water or«, little oil of vitriol 
and water, also answers admirably.] Vine- 
gar, sprinkled or burned, has no power of 
protecting against, or of destroying the 
power of morbid emanations ; but it is some- 
times grateful to the patient and pleasant 
to the attendants. Darkening a sick-room 
is too often resorted to, and should not be 
done except by order of the medical attend- 
ant, for some special reason. Bed and body 
linen of course require to be frequently 
changed, in fevers, &c, once in twenty-four 
hours if possible ; that is, if it can be done 
without exhausting the patient. 

Those in attendance upon the sick, espe- 
cially of an infectious disorder, should live 
sufficiently well, and, if accustomed to it, 
take a moderate proportion of wine or malt 
liquor ; but not, as many do, have recourse 
to extra potations of brandy, which can afford 
no power of resistance, but only render the 
body more susceptible of noxious influence, 
when the depression which follows excess 
supervenes. A sitter-up should have tea or 
coffee during the night, and those who have 
to go about a fever-patient in the morning, 
ought previously to take a cup of one or 
other of these beverages. The breath and 
exhalations generally of any one labour- 
ing under an infectious disorder should be 
avoided, as well as any continued position, 
toward which a draught of air may be di- 
rected from the patient. With these precau- 
tions, those whose duty calls them to attend 
upon the sick, ought never to shrink from 
that duty, but face it with cheerfulness and 
trustful reliance upon Providence. 

There are now so many inventions for pro- 
moting the comfort and convenience of the 
sick, that it would be impossible to enume- 
rate them here, but a few of the most useful 
requisites may be suggested. 

A measure, marked for spoonfuls, to be 
used instead of metal spoons, which vary in 
size, and are apt to be stained ; a drop or 
minim measure ; a piece of water-proof 
sheeting, either of gutta percha or some one 
of the numerous materials now manufac- 
tured ; a fan ; a night-light, either simple or 
made to keep water hot ; an air or water 
cushion, of waterproof material. A "sick- 
feeder" or half-covered cup, with a spout 
and handle, is most useful for giving either 
liquid aliment or medicine in severe illness, 
when it is desirable that a patient's head 
should not be elevated. After severe illness 
of any kind, the chamber which has been 
used ought to undergo a thorough cleansing : 



BED 



57 



BSE 



after fever or other infectious disorder, 
every thing should be individually cleaned. 
The room itself ought to be papered, paint- 
ed, or -whitewashed afresh, the bed-frame 
taken down, scoured, and with other furni- 
ture exposed to the open air for some days ; 
feather-beds and hair-mattresses taken to 
pieces, their coverings washed, their con- 
tents rebaked or fumigated ; whatever can 
be washed, should be. Expose articles 
which have been about the sick freely to 
the action of air or water, and they will 
speedily get rid of the noxious particles, — 
"fomites," as they are called. Shut them 
up, or bundle them together, and they will 
retain the power of propagating disease for 
months, it may be for years. 

The crowded rooms of the poor have been 
mentioned — bad enough in health, they be- 
come ten times worse in sickness, and this 
is chiefly felt in country districts. In towns, 
a person seized with an infectious disorder, 
if accommodation and means at home are 
insufficient, has the hospital as a resource ; 
in the country he has not ; the consequence 
is that, to their own detriment and that of 
others, the sick are compelled to be lodged 
in the crowded family dwelling, with every 
chance of the disease spreading through the 
house or village — the case is continually oc- 
curring. It might easily be prevented, by 
providing some isolated cottage in a healthy 
situation, properly laid out and furnished for 
the reception of the sick, with accommoda- 
tion for a wife or a mother when nursing 
the invalid. Such a small village hospital, 
whether for the reception of those afflicted 
with infectious disease, or indeed any se- 
vere disease, would be most invaluable to 
all ; it might be maintained for the use of 
a small surrounding district at trifling ex- 
pense ; and there is many a female recipient 
of parish relief who might be worse employed 
than attending to it. 

BEDS — Water — Elastic — Spring, &c. — 
All who have attended much upon the sick, 
must be painfully aware, that with even the 
greatest precaution, it is sometimes impos- 
sible to prevent the formation of " bed-sores" 
upon the most prominent and exposed parts 
of the body. To obviate this, and relieve 
the great suffering attendant upon long con- 
finement to the horizontal posture, many 
different kinds of beds have been contrived. 
It is not necessary to describe the various 
constructions of bed, but persons should 
have some idea of the means of relief in 
their power. Dr. Arnott, to whom the profes- 
sion and the public are indebted for nume- 
rous useful inventions connected with mecha- 
nical medicine, has invented an hydrostatic 



or water-bed, which in some cases answers 
admirably. Mr. Hooper, of London, has 
recently manufactured, in conjunction with 
his water-pillows, a most excellent invalid's 
bed, of vulcanized India-rubber ; and an 
adjusting bed, made of a number of extended 
straps of webbing, any one of which can be 
relaxed at pleasure, is also a recent inven- 
tion, and one adapted to fulfil many useful 
indications in illness. [A variety of air or 
water-beds, pillows, &c. may be readily 
obtained in Philadelphia or New York at the 
stores for the sale of India-rubber goods.] 

There are many other varieties of bed for 
fractures, spinal disease, &c. &c. 

BEE.— See Stings. 

BEEF.— Beef Tea.— Beef, the most strong- 
ly nutritious animal flesh in use, is not 
quite so digestible and light as mutton for 
those of weak digestion ; but this depends 
in some degree upon the part selected. A 
slice from a coarse-grained shoulder of mut- 
ton may be much more difficult of diges- 
tion than one from the under side of a sir- 
loin. As a general rule, however, mutton 
is preferable for the dyspeptic and the con- 
valescent. 

Beef-tea is a most important article in 
sick cookery, but is very often badly made, 
and much too weak for the purposes for 
which it is ordered. In diseases of ex- 
haustion, or in the last stage of fever, strong 
beef-tea is perhaps the form of nourishment 
most easily assimilated, and adapted to af- 
ford powerful support to the system. Beef- 
tea may be made from beef cut into thin 
slices, and placed in an uncorked bottle 
with a little water, the bottle being placed 
in a pot of water, and the contents thus 
boiled. But the method recommended by 
Professor Liebig is supei'ior to any other. 
This celebrated chemist directs a pound of 
lean beef, free from fat and bone, to be 
chopped small, as for mince-meat, and to be 
"uniformly mixed with its own weight of 
cold water, slowly heated to boiling, and 
the liquid, after boiling briskly for a minute 
or two," to be "strained through a towel." 
A little salt, or any allowable seasoning, 
may be added. [Or one pound of beef, pre- 
pared in a similar manner, should be placed 
in one pint of cold water, allowed to heat 
slowly, and then simmered for five hours, 
after which it may be seasoned.] 

BEER.— See Ale. 

BEET-ROOT— Contains so large a quan- 
tity of sugar as to make its extraction an 
object of commerce. The sw'eetening pow- 
ers are less than those of cane-sugar. The 
root itself, when boiled, is easy of diges- 
tion. Its beautiful colouring matter mighi 



BEL 



58 



BIL 



often be substituted for more deleterious 
substances. 

BELLADONNA.— The deadly nightshade 
grows wild in many parts of Britain. The 
juice of the plant is powerfully narcotic 
and anodyne. It is a valuable medicine 
in proper hands. Domestically, belladonna 
should be known as a poison, which has 
proved fatal to children, who have been 
tempted to eat its violet-black shining ber- 
ries, which are about as large as a wild 
cherry, and furrowed on each side. The 
flowers (fig. xxiii.) grow solitary from the 

Fig. xxiii. 




axils of the leaves, are bell-shaped, and 
purple at the border. Wherever the plant 
is found, children should be warned against 
it. The symptoms of poisoning by night- 
shade are dryness of the mouth and throat, 
difficulty in swallowing, a kind of laughing 
delirium, followed by insensibility and ex- 
treme dilatation of the pupil. With such 
symptoms, a powerful stimulant emetic can- 
not be too soon administered, and will pro- 
bably make the case clear, by bringing up 
the black skins of the berries. Cold douche 
to the head, mustard plasters to the back 
and legs, and sal-volatile internally, are ap- 
propriate remedies, and may be used until 
the arrival of the medical attendant. 

Belladonna is said to have the power of 
protecting against the infection of scarlet 
fever, when given in repeated small doses, 
during the prevalence of the disease, to 
those exposed ; but the evidence is very con- 
tradictory. Eight grains of the extract are 
to be rubbed up with a fluid ounce of water, 
and of this, from five to twenty drops, ac- 
cording to age, given twice a day. It would 
be right to try the remedy during the pre- 
valence of a malignant epidemic. 

BELLY. — See Abdomen. 

BENZOIC ACID— Obtained from gum 
benzoin, is in the form of white silky scales, 



and has a penetrating, not unpleasant odour. 
It has been found useful in cases of obsti- 
nate " wetting of the bed" in children. Dose, 
five grains made into pills with bread crumbs, 
twice a day, to a child of ten years old. It 
is an ingredient in paregoric. 

BERIBERI and BARBIERS.— Diseases 
peculiar to India. — See Tropical Diseases. 

BILE. — The peculiar fluid secreted by the 
liver from the blood, is in man of a brown- 
ish-yellow colour, and has a bitter taste. 
Its composition is complex, and it undoubt- 
edly fulfils more than one important office 
in the functions of the body. Bile is sepa- 
rated by the liver from dark blood, which, 
passing through that gland, on its way to 
the heart, from the abdominal organs, is 
thus purified of noxious matters, contain- 
ing a large amount of carbon, before re- 
entering the general circulation. The sepa- 
rated bile is discharged into the duodenum, 
(see Alimentary Canal,) and mixing with 
the digested food, appears to assist in fitting 
certain of the constituents for absorption 
into, and assimilation or transformation in 
the body. A large proportion of the con- 
stituents of bile are along with the food re- 
absorbed into the system, and are probably 
intended and adapted to support the pro- 
cesses of respiratory combustion. It is 
chiefly the colouring matter of the bile which 
is discharged from the bowels in health. 
Bile itself, when duly formed, even when 
absorbed along with its colouring matter 
into the blood, as we see in jaundice, scarce- 
ly produces injurious effects upon the sys- 
tem, but the elements of bile allowed to re- 
main unformed in the blood, act almost like 
a narcotic poison. — See Liver, Digestion, 
&c. 

BILIARY DISORDER— Including Bi- 
lious or British Cholera, [Cholera Mor- 
bus.] — Biliary derangement is so frequent 
an ailment in civilized life — its history is 
so intimately connected with the general 
principles of health, and the prevention, or 
at least alleviation, of the disorder is so 
much under individual control, that it has 
special claims upon our attention. 

It has been shown in the last article, that 
in ordinary health there must be a certain 
balance maintained between the secretion 
and ultimate destination of the bile, the as- 
similation of food, and the functions of re- 
spiration: that in the excreted bile the 
blood is freed from certain principles, con- 
taining a large amount of carbon, which 
could not be retained in it without injury to 
health. That further, the bile, after being 
separated from the blood by the liver, and 
thrown out into the. general tract of the ali- 



BIL 



59 



BIL 



nientary canal, performs an important part 
in the function of assimilation ; and that, 
lastly, a considerable proportion of the bile 
— without the colouring matter — is reab- 
sorbed into the system, with the nutriment, 
in such a state as to fit it, or rather its car- 
bon, for union with the oxygen which enters 
by the lungs, so that while heat is gene- 
rated, the carbon, by taking the form of 
carbonic acid, is fitted for excretion by the 
lungs or skin. Upon these facts hinge the 
causes of one at least of the most preva- 
lent biliary disorders, that which depends 
npon the introduction into the system of a 
proportion of carbon aliment too great to 
be removed by the oxygen obtainable through 
the lungs, and which has its ordinary ter- 
mination in the attacks which are termed 
"bilious attacks," "sick headaches," "bow- 
el complaints," "bilious or British cholera," 
according to the manner in which the pa- 
tient is affected. 

The second form of biliary disorder de- 
pends upon torpidity or inactivity of the 
liver itself. The third form is the reverse 
of the first ; the gland itself may be suf- 
ficiently active, but the blood does not afford 
sufficient material for it to work upon, and 
bile is deficient. This is most frequent in 
children. 

In addition to those affections, there is 
jaundice, which will be treated of in its 
proper place. 

The first form of biliary disorder, that de- 
pendent upon the accumulation of carbon, 
or of the elements of bile in the blood, must 
evidently be owing to one of the following 
causes, or a combination of them : either too 
much food, especially of a highly carbonized 
character, such as fats, oils, sugar, &c, is 
habitually consumed, or the habits are too 
physically inactive to keep the functions of 
respiration, animal heat, and motor change 
and circulation in healthy action. Or the 
external atmosphere is so temporarily or 
permanently rarefied by heat that the indi- 
vidual cannot obtain the full supply of oxy- 
gen in respiration ; lastly, the excretory 
functions of the skin may be impeded. 
Now, although it is unquestionable that 
some individuals have a much greater tend- 
ency to biliary disorder than others, it is 
also unquestionable that all have it in their 
power in a great degree, if not entirely, to 
control or obviate that tendency, by atten- 
tion to, and practical application of, the 
above principles. In those who suffer ha- 
bitually from sick-headaches — which depend 
generally upon the presence of bile in the 
stomach — and from other forms of biliary 
disorder common to this country, [especially 



in the Southern and Western portions of the 
United States,] there is generally traceable 
great error in ^iet. Fats, as found in ham 
and bacon generally, melted butter, pastry, 
meat, malt liquors or wine, and other highly 
carbonized articles of diet, are taken too 
freely, or at least are too regularly indulged 
in, while at the same time very little active 
exercise is taken ; the blood becomes over- 
loaded with carbon; languor, sleepiness, 
headaches, giddiness, loss of appetite, furred 
tongue, depression of spirits are the conse- 
quences, and continue until at last the sys- 
tem is relieved, wholly or partially, by an 
excessive excretion of vitiated bile, which 
passes off either by vomiting or purging. 
That deficient exercise has much to do with 
the formation of such a state of system is 
evident from the much greater prevalence 
of such attacks among females, who take 
little exercise, than among men ; and indeed 
they would still be more prevalent among the 
former, were it not for the monthly relief. 
Habitual neglect of the skin, also, by imped- 
ing the excretion of carbonic acid from its 
extensive surface, undoubtedly assists the 
evil. Again, we have bilious attacks, more 
especially those known by the name of British 
cholera, (cholera morbus,) prevalent among 
the community generally ; but at particular 
periods of the year — that is, in summer or 
autumn — during or immediately succeeding a 
prevailing high temperature, and to this high 
temperature must we look for the cause ; for 
while, as a general rule, habits have not been 
changed, people have been — in consequence 
of the rarefied atmosphere — inhaling a less 
proportiun of oxygen than usual. Liebig 
calculates the difference at one-eighth be- 
tween winter and summer in Germany. Here 
we have another traceable and universally 
acting cause, permitting the accumulation 
of carbon in the blood, and one which is 
likewise found to operate upon Europeans 
especially, who, in tropical climates, adhere 
too nearly to the habits of comparatively full 
living admissible in colder climates. 

From what has now been said it is evident 
how much the avoidance of biliary disorder 
is under individual control ; the question is 
in reality not one of medicine, but of diet 
and regimen: medicine certainly may be 
required, but not by any means to the ex- 
tent it is often used. Those who are ha- 
bitually liable to biliary disorder ought most 
strictly to regulate the diet ; fats of all kinds, 
(except, in some cases, bacon,) must be 
avoided ; butter either entirely avoided, or 
used in very small proportion, and never 
when melted ; animal food may be taken in 
moderation, but should never be consumed 



BIL 



60 



BIL 



at night ; much sugar, strong tea or coffee, 
malt liquor, and the heavier wines, such as 
port or sweet wines, are all «bad. In addi- 
tion to plain meat, bread, well-boiled vege- 
tables, farinaceous preparations, and fruits, 
ripe or cooked, are the best articles of diet, 
and if stimulants are required, a little 
sherry, brandy, or gin, with water. Exer- 
cise regularly in the open air must be taken, 
and the skin kept clear and in an active 
state. If the bowels are confined, a pint of 
warm water, used as a clyster, will be a 
most suitable aperient, or one or two of the 
compound rhubarb and blue pills may be 
taken ; it is much better, however, not to 
trust to medicine. When, from any cause, 
the languor, sleepiness, furred tongue, &c, 
give notice of an impending bilious attack, 
five or six grains of blue pill should be taken, 
and followed by a black draught or dose of 
infusion of senna and salts, or of castor-oil, 
in the morning. Having thus cleared the 
system, it is better to trust to diet and regi- 
men than to a repetition of the dose as a 
corrective of indulgence. 

British Cholera, [Cholera Morbus.] — 
When, during prevailing high temperature, 
an individual is threatened with an attack of 
bilious cholera, or, as it is frequently called, 
when unattended with vomiting, "bowel 
complaint," there is for some time pre- 
viously much languor and sleepiness, espe- 
cially after meals, headache, pain between 
the shoulders, furred tongue, loss of appe- 
tite, fulness in the region of the stomach, 
and high-coloured urine. The complex- 
ion, perhaps, is dusky. When such symp- 
toms show themselves, one or two doses of 
calomel or blue pill — four grains of the 
former, six or eight of the latter — is nearly 
all that is required for their removal. The 
mercurial may be followed or not, as re- 
quired, by a dose of senna-tea or castor- oil. 
The diet of course ought to be restricted. 
If there is any tendency to heat or feverish- 
ness, ten grains of carbonate of potash along 
with a teaspoonful of sweet spirit of nitre, 
taken in a wineglassful of water, or of infu- 
sion of dandelion, twice a day, will relieve. 

If the symptoms above mentioned are 
neglected, the acute bilious attack, usually 
known as bilious or British cholera, [cholera 
morbus,] is the winding-up ; it is ushered 
in by a sensation of chilliness, giddiness, or 
headaches, bitter .taste in the mouth, and 
nausea in most cases, quickly succeeded by 
vomiting of bile, and griping and purging. 
An attack of this kind may pass off lightly, 
leaving the patient better than for some 
time previously, or it may be so severe as to 
threaten life. In the latter case the vomit- 



ing is incessant, the purging profuse, pain- 
ful, and exhausting, and the motions, which 
were at first feculent and bilious, become 
light-coloured, like thin gruel ; there is 
much thirst, cold and blue skin covered 
with cold perspiration, cramps, much de- 
pression, the pulse imperceptible, or nearly 
so, and perhaps the secretion of urine sup- 
pressed. In short it is difficult to distinguish 
the attack from one of the malignant Asiatic 
cholera. Between the severe form and the 
mildest the disease occurs in every degree 
of severity. If severe, the attack is always 
painful and alarming, and may be dan- 
gerous ; and in the country, or at a distance 
from medical aid, requires to be quickly 
dealt with. The first thing to be kept in 
mind is, that the manifestations are not the 
disease, that the actual outbreak is only an 
effort of nature to free the system of morbid 
matter ; that we may guide, control, and stop 
if matters go too fast, but must not thwart. 
A mild attack of British cholera [bilious 
diarrhoea] is better left alone, as far as me- 
dicine is concerned ; diluent drinks, such as 
barley or rice water, &c, being given to 
dilute the bile, which is generally acrid, 
and to assist its passage from the system. 
In a severer attack, when pain, purging, and 
other symptoms become urgent, it is time 
to interfere. The patient, if not in bed — ■ 
which, however, frequently happens, from 
the attacks coming on in the night — should 
go there at once, and hot applications, bran 
and such like, used to the bowels to relieve 
the pain ; or more extensively to the limbs, 
back, &c, if there is much coldness or cramp. 
A mustard-plaster the size of the hand, to 
the pit of stomach, will sometimes abate the 
sickness — general friction is serviceable. 
Twenty to five-and-twenty drops of lauda- 
num should be given to allay pain and 
moderate purging, and repeated two or 
three, or even more times in succession, 
every half-hour till some effect is produced 
— if the first dose comes up, the second should 
be given at once; if that does not stay, then 
the third. If the stomach will not retain 
liquid of any kind, if it is to be procured, 
the powder of opium should be given in a 
one-grain pill ; and if it remains, the dose 
repeated, if required, in an hour, or a half 
dose given. Sometimes the vomiting is so 
obstinate that no ordinary means will stop 
it. Many families in the country now keep 
creosote for toothache; in such a case as 
the above, a single drop rubbed up with a 
little gum or thick barley-water might be 
tried, and repeated once ; or four to eight 
drops of chloroform, in a little sugar and 
water, or brandy and water, might have the 



BIL 



61 



BIL 



desired effect. Two tablespoonful doses of 
the ordinary chalk-mixture, either with or 
without the laudanum, or half-drachm doses 
of aromatic confection, will be useful "when 
purging continues. In addition to these 
means, diluent demulcent drinks, barley and 
rice-water, with isinglass or gelatine dis- 
solved in them, are to be freely taken. In 
case of extreme depression, stimulants, hot 
brandy and water, &c, are to be adminis- 
tered. The attack of bilious cholera is so 
sudden and its course so rapid, that if there 
is any great distance to send for medical 
assistance, there will be full time for the 
employment of the above means, not only 
to the relief but also to the safety of the 
patient. 

After the attack has somewhat subsided, 
keeping in mind that the tendency of it is 
to clear the system, the bowels must not be 
allowed to get confined, but kept slightly 
relaxed; if requisite, a dessertspoonful of 
castor-oil, with half a dozen drops of lauda- 
num, or a small dose of rhubarb and mag- 
nesia, with or without laudanum, may be 
given. The diet should be chiefly of a dilu- 
ent character, for a short time, but nourish- 
ing. Should any of the symptoms which 
preceded the attack, such as languor, fulness 
about the region of the liver, pain between 
the shoulders, furred tongue, &c, continue, 
a few doses of the compound rhubarb and 
blue pill will be advisable ; if the stomach 
remains weak, from five to ten grains of 
carbonate of potash in a wineglassful of in- 
fusion of calumba or gentian will be found 
useful — if the tongue is perfectly clean, and 
there is debility, one grain of quinine in half 
a glass of sherry twice a day. 

There are, however, states of biliary dis- 
order, generally connected with stomach 
derangement also, which are not the conse- 
quence of excess of aliment, but may even 
arise from the reverse, and which require 
the aid of medicine for their removal ; the 
liver is torpid, the blood is insufficiently 
freed from its superfluous carbon, and, in 
addition to impaired digestion, the indi- 
vidual suffers from the train of symptoms 
above enumerated as attendant upon such 
a condition of the circulating fluid, mental 
and physical depression being the most pro- 
minent. The bowels are confined and the 
motions inclined to be light or chalky, at 
other times almost black. There is pain 
between the shoulders and sensation of ful- 
ness in the region of the stomach. When 
such a train of symptoms occurs it is better 
to take proper medical advice ; if this can- 
not be done, in order to relieve, a few grains 
of blue pill, or grey powder given every 
F 



night, or every other night, are each to be 
followed by a moderate dose of castor-oil, 
or infusion of senna in the morning. At 
first the infusion of taraxacum, with five to 
ten grains of carbonate of potash, and, if the 
stomach is weak, a teaspoonful of tincture 
of calumba, taken twice a day, will be of 
much service. The diet should be nourish- 
ing and easy of digestion, such as plain 
meat, potato, and light puddings, but pastry, 
cheese, and oily preparations of all kinds — 
except toasted bacon — must be avoided. In 
cases of debility, wine, malt liquor, or a little 
weak brandy and water, whichever generally 
agrees best, are not to be allowed merely, 
but must be taken medicinally in modera- 
tion. Daily exercise to the extent of slight 
fatigue, relaxation from business, cheerful 
company, early hours, and attention to the 
state of the skin, by means of the tepid bath 
or sponging, are all assistant means, and 
will even of themselves be sufficient to re- 
move slight attacks. Where the bowels are 
obstinate, clysters of tepid water are espe- 
cially useful, and preferable to the continual 
use of purgatives, which weaken the digestive 
power of the stomach. When the tongue is 
tolerably clear, and debility of the stomach 
or of the system generally remains, twenty 
drops of dilute nitric acid may be taken with 
advantage twice a day, either in water or in 
infusion of taraxacum, with or without the 
addition of a tonic bitter. 

It is important to have a clear distinction 
in the mind between the two conditions of 
biliary disorder treated of. In the former, 
that which precedes the attack of British 
cholera, the liver fails because there is more 
given it to perform than it can do, even in 
its most healthy state. In the latter, the 
liver itself is incapable of doing the work 
it ought, to maintain a healthy condition of 
body. In the former case, reduction of diet 
is evidently the most common-sense pre- 
vention and cure. In the latter, the organ 
must be brought up to its work, and made, 
if possible, to do its part in the assimilation 
of sufficient nutriment for health. The 
diet is to be regulated, not diminished, the 
general functions kept active, and especially 
the nervous system, by moderate exhilarat- 
ing exercise both of mind and body, is to 
be maintained in such a state of regular 
tonicity as will enable it to impart that due 
stimulation — which is so much wanted in 
these cases — to every function connected 
with assimilation. When cases of chronic 
biliary disorder present feverish symptoms, 
the mercurial at night, and the aperient in 
the morning are still to be used, and also 
the potash and taraxacum, but without the 



BIN 



62 



BIN 



bitter ; animal food and stimulants strictly 
forbidden, and milk and farinaceous diet sub- 
stituted ; the tepid bath used, and clysters. 
Although such general directions as will 
be found useful in the treatment of chronic 
biliary disorder have been given, it is not 
recommended that home medicine should 
be resorted to when medical assistance is 
within reach. Much certainly maybe done 
by judicious management, but it is probable 
that efficient medical advice will save both 
time and suffering. 

In children, particularly those of fair 
complexion, deficiency of biliary secretion is 
frequently evidenced by the irregular action 
of the bowels, and light-coloured chalky 
motions. It is of course desirable to correct 
this, but it must not be attempted by the 
"grey powders," (mercury with chalk,) so 
usually resorted to. They will, undoubted- 
ly, for a time improve the appearance of the 
motions by causing an increased flow of bile, 
but this is obtained at the expense of the 
system, which does not appear able to fur- 
nish sufficient material for the secretion. In 
a few days the motions are as deficient in 
bile as ever. Such a condition can only be 
permanently corrected by a good allowance 
of animal food, and general tonic treatment, 
iron being especially requisite ; a few grains 
of gray powder, however, being given once 
or twice a week. 

BINDER. — The bandage which is put 
round the abdomen of the mother after 
child-birth, and which forms a most import- 
ant requisite, both as regards the comfort 
and safety of the patient. Many forms of 
binder are used, but none are so generally 
applicable or so efficient as a light, small 
tablecloth, or shawl, or square of calico, 
folded broad like a cravat, so that it will 
embrace the whole of the lower portion of 
the abdomen, and can be tied in a double 
knot at the back, outside the bed-dress, 
where it is under the control of the attendant. 
The binder ought always to be put on at the 
commencement of labour, and tied so as just 
to give comfortable and moderate support to 
the abdomen : as the process of parturition 
progresses it must be gradually tightened, 
and as soon as the child is born, as much so 
as will afford comfortable support. Lastly, 
after the separation of the after-birth, it 
must be tightened again. In all these 
changes, the best guide is the feeling of the 
patient, comfortable' efficient support being 
all that is requisite ; if tied too tightly, the 
binder will do mischief. The greatest bene- 
fit which results from the early application 
of the binder is the prevention of faintness. 
The sudden emptying of the abdominal 



cavity which takes place when the child is 
expelled, is quite as frequently a cause of 
the above symptom as loss of blood, the 
effect being in great measure purely me- 
chanical, and similar to what occurs when 
fluid is drawn from the belly in dropsy. 
This mechanical support given by the binder, 
moreover, exerts regular and regulated 
pressure, which must give some assistance 
to the efforts of the womb, and lastly, after 
the concluding processes of labour are over, 
it is no slight advantage to have a firm, ef- 
ficient binder in its place, instead of having 
to disturb the patient by its adjustment. In 
cases of hemorrhage or flooding, such an 
arrangement may be of the very highest 
importance. In the course of an hour or 
two after labour is concluded, the form of 
binder which has been recommended above 
can be exchanged for the ordinary broad 
band, fastened round the abdomen by pins 
or buckles, or for one of the numerous forms 
of binder, shaped to fit the abdomen, of 
which fig. xxiv. represents one of the most 
Fig. xxiv. 




useful. It is made of the shape represented, 
of double calico, and about ten inches wide 
in the centre ; one of the ends being rather 

Fig. xxv. 




BIK 



63 



BLA 



broader than the other, so as to admit of 
the latter running through the slit, (fig. xxv.,) 
and both being sufficiently long to be brought 
round and fastened in front. [In the United 
States it is not usual to apply the binder 
until after the delivery of the after-birth.] 

Refer to Child-birth. 

BIRTH.— See Child-birth. 
m BISMUTH— Is a metal. Its only medi- 
cinal preparation is the oxyde, sometimes 
called the nitrate of bismuth, which occurs 
in the form of a yellowish-white, rather 
heavy powder. It is found useful and fre- 
quently prescribed in nervous pain of the 
stomach, gastralgia, and in waterbrash. In 
the distressing diarrhoea of the last stages 
of consumption, it will sometimes afford re- 
lief when other remedies have failed. The 
usual dose is five or six grains, twice or three 
times a day, in any thick-vehicle, such as lin- 
seed-tea, or thick barley-water. 

BISTOURY.— A small surgical knife. 

BITES— See Wounds. 

BLACK-DROP — Is a preparation of opium, 
formerly secret. It is, essentially, a prepa- 
ration of acetate of opium, and is devoid 
of some of the stimulating properties of 
crude opium. Black-drop is estimated 
at three times the strength of ordinary 
laudanum. 

BLACK-DRAUGHT— So well known as a 
domestic remedy, is a mixture of infusion 
of senna with Epsom salts, and frequently 
some aronjatic, such as ginger or caraway. 
It is a certain and active purgative, but not 
well suited for weak habits. Quarter of an 
ounce of senna-leaves may be infused in a 
pint of water ; to this is added one ounce of 
Epsom salts ; along with it, if there is no 
fever, a couple of drachms of tincture of 
senna ; of this mixture, a small teacupful 
[or ordinary wineglass] should be taken every 
two hours, till the desired effect is produced. 

BLADDER.— The urinary bladder (fig. 
xxvi.) is the receptacle for the urine, after 
it has been secreted by the kidneys, and 

Fig. xxvi. 




previous to its discharge from the body. It 
is an oblong membranous bag, composed of 
three layers or coats, the middle one being 
muscular, and is situated in the pelvis, just 
behind the pubic bone, rising, however, 
when much distended, into the abdomen. 
At the neck of the bladder, in the male, is 
situated the prostate gland, (fig. i.) 

Many of the diseases and disorders of the 
bladder are brought on by carelessness, 
neglect, or too great subservience to the 
conventional restraints of society ; those 
persons especially, who habitually or neces- 
sarily are frequently compelled to restrain 
the desire, and forego for a time the relief 
of emptying a distended bladder, are liable 
to affeetions of the organ. In early child- 
hood, but sometimes even beyond puberty, 
the bladder habitually empties itself during 
sleep ; night after night this occurs, and 
proves a serious annoyance, and expense 
too, from the consequent destruction of bed- 
ding. The habit or disorder is sometimes 
extremely difficult, if not quite impossible, 
to eradicate. The regular use of the cold 
hip-bath every morning is one of the most 
efficient remedies, and the tincture of mu- 
riate of iron, or " tincture of steel," as it is 
frequently called, given twice a day, in ten- 
drop doses, in water, is often useful. Ben- 
zoic acid and nitrate of potash are both said 
to have proved successful. In such cases, 
fluid is to be taken in small quantity only 
in the evening. Malt liquor always in- 
creases the evil. Where the habit is invete- 
rate, it is better to use one of the India- 
rubber urinals attached to the person, than 
to allow the patient to be a nuisance to him- 
self and others. [This habit in children 
may be overcome by attention, and the pa- 
rent or nurse who will insist on the child's 
rising at 9 or 10 p. m. and urinating, will 
find that they can accomplish a cure in a 
few nights. I have never known an instance 
where it failed. Whipping is worse than 
useless : it' increases the evil.] 

Rupture of the bladder is almost invaria- 
bly fatal. It is generally caused by blows 
or falls when the viscus is full of urine, but 
sometimes without violence, simply from 
over-distension. In the former case, intoxi- 
cation is in most instances the first cause of 
the accident ; the individual sits drinking 
till the bladder is quite full, staggers out to 
relieve himself, and either falling or stum- 
bling against some object, the urine is effused 
into the cavity of the abdomen or surround- 
ing tissue; agonizing pain and extreme 
vital depression are the immediate conse- 
quences, and the patient speedily dies. In 
the latter cases, when the bladder is rup- 



BL A 



64 



BLI 



tured from over-distension without violence, 
it is generally caused by long retention of 
urine, from obstruction to its discharge. In 
this case, the first sensation of rupture is 
rather one of relief than otherwise ; the rent 
being at the lower part of the organ, the 
fluid is diffused into the loose tissues of the 
scrotum and surrounding parts, giving rise 
to severe inflammation and mortification. 
The bladder is sometimes ruptured by ex- 
treme violence, such as that of the passage 
of a cart over its region. In all these cases, 
the attendance of a surgeon is absolutely 
requisite, if possible. Death is all but in- 
evitable ; but if life cannot be saved, much 
relief may be afforded by the moderate use 
of stimulants and the free use of large doses 
of opium. 

Strangury. — During the prime of life, the 
bladder is not generally liable to suffer from 
chronic disorder, except in persons of dissi- 
pated or intemperate habits ; but one acute 
and very painful affection, strangury — 
generally caused by the application of a 
blister — is not uncommon. The affection is 
characterized by burning pain, extending 
through the urinary passages up to the neck 
of the bladder, accompanied with constant 
and distressing desire, and straining effort 
to pass urine, which will only come away in 
very small quantities, often mixed with blood. 
While it lasts, the condition is a painful and 
most distressing one. The means of relief 
are warm hip-baths, demulcent drinks co- 
piously taken, such as barley-water with 
gum arabic, linseed-tea, &c. Warm clys- 
ters, consisting of half a pint of gruel con- 
taining twenty or thirty drops of laudanum, 
give much relief; [an opium pill pushed into 
the bowel answers the same purpose, and is 
readily accomplished.] Twenty drops of lau- 
danum, or ten or fifteen drops of the sedative 
solution, may also be given by the mouth, and 
repeated if requisite. When the patient is 
not in the bath, hot bran poultices are to be 
used over the lower part of the abdomen. 

Stoppage of Urine. — -With declining 
years, the bladder becomes more subject to 
disorder and disease ; perhaps the most fre- 
quent affection is sudden inability of the 
organ to expel the urine. This may arise 
from its having been allowed to become 
over-distended; from cold; from drinking 
hard malt liquor — a very frequent cause in 
England— or sometimes from external vio- 
lence. The case is one of much distress and 
alarm, and being not devoid of danger, can- 
not be too soon placed under proper medical 
treatment. In the mean while, the person 
should be got into a hip-bath, of the temper- 
ature of 96 Q Fahr., and kept in for at least 



half an hour, a warm bed being ready to re- 
ceive him on coming out, and hot bran poul- 
tices be applied as soon as he is placed in 
bed. Just before entering the bath, a table- 
spoonful of castor-oil with ten or fifteen 
drops of laudanum should be administered. 
It is not improbable, that relief may be ob- 
tained by these means; but all efforts at 
straining must be avoided as useless and 
hurtful. Of course fluid must be eschewed 
as long as the stoppage continues. While 
the above measures are being carried out, 
medical assistance ought to be procured ; 
for, should other means fail, the introduc- 
tion of the catheter must be resorted to, to 
save life. Nevertheless, the prosecution of 
the mode of treatment recommended, if it 
does not prevent such a necessity, will cer- 
tainly facilitate a sometimes difficult opera- 
tion. [The common practice of administer- 
ing sweet spirits of nitre, gin, or other 
diuretics, is most injurious when the patient 
is thus situated. They increase the flow of 
urine into the bladder, but not the power of 
evacuating it.] 

Weakness of Bladder. — Weakness of the 
bladder, and inability perfectly to retain the 
urine, is a frequent disorder of advanced 
age : it often commences with and is accom- 
panied by imperfect emptying of the organ, 
either through carelessness or weakness. 
Sponging the lower parts of the abdomen, 
&c. &c, with vinegar and water, or salt- 
water, may be of service. Dr. Day recom- 
mends the use of tincture of the ergot of rye 
in these cases ; but as a general rule they 
should be placed under regular medical su- 
perintendence. The same may be said of 
that very troublesome complaint of old age, 
catarrh of the bladder, in which large quan- 
tities of thick mucus are discharged. 

Stone in the bladder may be suspected 
when the urine is liable to become bloody 
after exercise, when there is pain in the 
bladder and surrounding parts, in the back 
and down the thighs, and when the stream 
of urine is apt to stop suddenly during the 
act of passing. Under such circumstances, 
proper advice cannot be too soon obtained. 

Refer to Kidney — Urine — Blister. 

BLEEDING.— See Hemorrhage. 

BLINDNESS.— Loss of sight may be the 
one effect of a great variety of causes. Dis- 
order of the brain itself, or sympathy of that 
organ with the stomach, may be the occa- 
sion of the symptom. The optic nerve, or 
its expansion within the eye, named theretina, 
maybe the affected parts ; or, lastly, some of 
the transparent structures of the organ of 
vision may, by becoming opaque, obstruct, 
wholly or partially, both light and visioa. 



BLI 



65 



BLI 



Loss of sight may come on suddenly, or 
very gradually ; in the former case, it is 
generally consequent upon some disorder, 
actual or sympathetic, of the brain or nerv- 
ous tissues, and is always to be regarded 
seriously. It may last only for a few seconds, 
or it may be permanent. In diseases such 
as apoplexy, or water in the head, loss of 
sight is a very constant symptom ; at least, 
the eye is insensible to the usual impres- 
sions. In these cases it is dependent upon 
pressure on the brain. In diseases of ex- 
haustion, or after copious loss of blood, the 
same symptom occurs. 

A transient loss of sight, unrepeated, and 
occurring unaccompanied by symptoms in- 
dicative of head affection, will sometimes 
be occasioned by simple disorder of the 
stomach, which abstinence and one or two 
doses of the blue and compound colocynth 
or rhubarb pills will rectify; but in the 
event of the symptoms recurring, and with 
it other symptoms, such as headache, gid- 
diness, or sickness, medical advice should 
be instantly procured ; in the mean while, if 
the person be of full habit, a few leeches 
may be applied to the temples, a smart dose 
of calomel and compound colocynth taken, 
and abstinence and perfect quiet enjoined; 
if the habit be spare, milder action upon 
the bowels, moderate diet, and quiet will be 
the safest course till the case is seen by a 
medical man. For other information on this 
point, see Amaurosis. 

Blindness which ensues in consequence of 
changes of structure in the eye itself, is 
either the result of active inflammation, or 
if not, is very gradual in its approaches. 
Refer to Eye, diseases of. 
BLISTER.— The term is applied either to 
that which causes effusion of serum — the 
watery portion of the blood — underneath the 
scarf or outer skin, or it is used to denote 
the effect itself, that is, the bag or vesicle 
containing fluid, which is formed. There 
are various methods of producing blisters 
on the skin ; in fact, any powerful irritant 
may have the effect ; ancT we may regard the 
effusion of fluid underneath the insensible 
or outer skin as an effort of nature to pro- 
tect the true and acutely sensitive skin from 
the action of the irritant substance. Steam, 
boiling water, strong ammonia, mustard, 
and many other irritants, have the power of 
raising blisters, and are used for the purpose 
by medical men ; but by far the most con- 
venient, certain, and generally adopted 
agent, is the cantharis vesicatoria, or Spanish 
fly. The most usual form in which it is used 
is the common blistering plaster, which being 
spread upon leather, or some other material, 
f2 



[such as brown paper or muslin,] is applied 
to the skin. A solution of the active prin- 
ciple of cantharides in strong acetic acid, 
and a collodion blistering fluid are also used ; 
but the most convenient, elegant, and suffi- 
ciently efficacious applications, if properly 
applied, are the blistering tissues or papers. - 
To the old form of the blistering-plaster 
there are many objections ; its weight and 
smell in the first place, its tendency to leave 
small particles of irritating matter adhering 
after its removal, and more especially its 
liability to occasion strangury, (see Bladder,) 
rendered an improvement desirable, and 
the end has been quite accomplished by the 
very efficient blistering-tissues now manu- 
factured. They are light, almost free from 
smell, are removed with the greatest ease, 
are not liable to affect the kidneys or blad- 
der, and are remarkably well suited for 
children. In applying a blister to any por- 
tion of the body, the first care must be to 
insure accurate contact with every portion of 
the surface it is intended to affect, the fitting 
to irregularities being insured by snipping 
the edges, and all hairs, whether about the 
head and face or elsewhere, being shaved 
off clean, just before the blister is put on. 
In the case of the paper blisters, it is better 
to add the weight of a folded napkin placed 
about them. If the old form of blistering- 
plaster be used, a few drops of oil rubbed 
over the surface will increase its activity 
and facilitate its removal ; this, however, -is 
still better insured, and the injurious effects 
apt to follow the use of this preparation 
prevented, by the interposition of a piece of 
thin muslin [or tissue-paper] between the 
plaster and the skin. The evening is gene- 
rally the best period of the four and twenty 
hours for the application of a blister, which, 
on an average, takes twelve hours to rise 
well, but sometimes much longer, especially 
in those who have very dry skins, or are 
far advanced in life, or when there is much 
nervous depression. In children, and in 
those of very delicate skin, the time is much 
under twelve hours. In the former, the 
action of a blister ought to be closely 
observed, and the more so the younger the 
child: the application being removed as 
soon as it begins to rise, and a soft bread 
poultice substituted, and kept on for a few 
hours, full rising will usually take place. 
When a blister has well risen, the plaster 
being removed, and a cloth placed so as to 
catch the fluid, the vesicle or bag of water 
is to be punctured at the most dependent 



* Brown's blistering tissue and Smith's tissue are 
both good preparations. The former is the cheapest. 



BLI 



66 



BLO 



part, by the point of a penknife, or with a 
pair of scissors, and the thin skin -which has 
been raised allowed to subside unbroken, 
and the dressing applied. If there are more 
vesicles than one, each must be punctured, 
unless very small. It is very common for 
medical men to be told that a blister has 
only risen in one place, or at the lower part; 
but this is generally erroneous, the blister 
having risen all over, but the fluid gravi- 
tated to the lower side. It sometimes hap- 
pens that instead of watery fluid, blisters 
contain a jelly-like matter, which will not 
run out : no attempt at squeezing should be 
made in such a case ; if the dressing be ap- 
plied, gradual oozing will df ain the vesicles. 
Very various methods of dressing blisters 
have been proposed and practised, that 
more generally followed being by means of 
lint and linen spread with lard or simple 
cerate or spermaceti ointment. The use of 
jewellers' fine cotton, or cotton wadding, 
has been proposed by Dr. Douglas Maclagan, 
of Edinburgh, and is said to answer well ; 
but by far the pleasantest and lightest dress- 
ing the writer has met with, and one 
which once used has always been preferred 
by his patients, is Brown's tissue-dressing, 
which consists of a cerate evenly and thinly 
spread upon fine tissue-paper. This elegant 
dressing forms as it were a second cuticle, 
it becomes adherent to the surface by means 
of the dried serum, and is so light as to 
require no extra applications to retain it in 
place — in this point differing from the heavy, 
ointment-covered, serum-hardened lint of 
linen, which in many situations it is impos- 
sible to keep on, and which, falling off, 
usually pulls the cuticle with it. When a blis- 
ter, from mismanagement or any other cause, 
becomes inflamed, or, as it is popularly 
called, gets "the fire in it," a soft bread and 
milk poultice applied for a few hours will 
give great relief. Blisters should always be 
healed: the custom of dressing them with irri- 
tant ointments to keep them " open," is at 
once barbarous and injurious ; the teasing 
pain, by its irritating effect upon the nervous 
system, does much harm. If continued 
counter-irritation is required, it is much 
better to apply a succession of small blis- 
ters, not on, but close to the same spot. 
" Flying blisters" are blisters which are 
taken off as soon as the skin is reddened and 
irritated : a diluted mustard poultice an- 
swers much the same purpose. 

Blisters are often applied domestically, 
without medical advice, but often injuriously, 
during the continuance of acute inflamma- 
tion and fever. In such cases, especially 
when put on just over, or very near the af- 



fected part, they do harm; they increase 
general fever, and may aggravate instead 
of relieving the local disease. This error 
is frequently perpetrated in cases of acute 
inflammation affecting the throat, or in pleu- 
risy, when a bran poultice would be much 
more serviceable. In persons who are suf- 
fering under or who are liable to affections 
of the kidneys, blisters must not be used, 
except under medical sanction, and that 
will be given in but few cases. Persons 
are sometimes needlessly much alarmed at 
the fact of a blister not rising. Unques- 
tionably, such a result may be owing to 
extreme and fatal depression, but is quite 
as frequently due to trivial causes. 

THE BLOOD.— The vital fluid. "The 
life." — As the living blood circulates in 
the living body, it is made up of "liquor 
sangui7iis," or the liquid of the blood, and 
of blood corpuscles or globules. The liquor 
sanguinis holds dissolved the animal prin- 
ciples, fibrine and albumen, and various 
mineral salts, and in it float the globules. 
When blood is drawn from the body, it 
separates, as most are aware, into a solid 
and watery portion. The former consists 
of the fibrine, which thus solidifies out of 
the liquid blood, when withdrawn from the 
direct influence of vitality, and entangles 
the gloubles in the process : the latter, or 
serum — the same kind of fluid which is 
thrown out in a blister — still retains in 
solution the albumen and the salts, the 
former being easily coagulated, like the 
white of egg, by heat. The blood corpus- 
cles, or globules, are of two kinds, red, (fig. 
xxvii.,) which are much the most numer- 
ous, — and white, or colorless, (fig. xxviii.) 

Fig. xxvii. 



Pig. xxviii. 



These bodies are of course very minute, the 
average diameter of the human red globule 
being 3200th of an inch — of the colourless, 
a little more. The red globules of the blood 
are composed of a membrane which en- 
closes the coloured fluid ; under the micro- 
scope they have the appearance of flattened 
discs with a depression in the centre, (fig. 
xxvii.) When fresh drawn from the body, 
they have a tendency to arrange themselves 
in connected rows. Blood circulates in the 
living body in the two very different forms 
of arterial and venous blood. In the former 




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67 



BLO 



case, it flows in the arteries, is bright red, 
and conveys life-giving influence and nou- 
rishment to every portion of the frame; in 
the latter, it is black-looking, flows in the 
veins, and possesses properties destructive 
to life, until, by the action of the liver, and 
more especially by exposure to the action 
of the atmosphere in the lungs, it becomes 
purified. The properties and composition 
of the blood in health, and the changes 
which these undergo in disease, have of late 
years received much attention, and many 
important discoveries bearing upon the 
nature and treatment of disease have been 
the result; but the greatest improvement as 
regards the blood, in the practice of medi- 
cine, is the much greater caution exercised 
in the abstraction of the vital fluid. Bleed- 
ing frcm the arm, which formerly was so 
generally resorted to, even as periodical a 
habit, is comparatively rarely practised. 
This is strikingly evident from the newspaper 
reports. Very few years ago, the addition 
to the accounts of accidents, of whatever 
kind, might have been stereotyped, that " a 
surgeon came and bled" the sufferer, and 
with it the too frequent addition of the 
" vital spark had fled ;" and certainly, if 
any thing could extinguish the spark of life 
flickering after the shock of a severe acci- 
dent, it must have been the senseless, un- 
meaning custom of bleeding, when perhaps 
brandy and water or ammonia were re- 
quired. The disappearance of such notices 
as above from the public prints evince the 
improved practice; but even now, in the 
country, it is difficult to persuade people 
that they do not require bleeding after an 
accident, and all bad consequences are 
attributed to the omission of the mysterious 
agency of blood-letting. Blood, we are 
told on the highest authority, is the " life," 
or at least the medium of life to the body, 
and it is, we know, the great feeder of every 
portion of the frame ; and to feed, it must 
be fed, and every drop extracted unnecessa- 
rily is money from the poor man's pocket; 
but worse still, if largely abstracted by de- 
sign, or lost by accident, it frequently can- 
not be recovered, and the constitution re- 
ceives a shock, and facility of yielding to 
disease, which it never gets the better of. 

Blood-letting. — But yet in blood-letting 
we have a powerful auxiliary in the treat- 
ment of some diseases, although one to be 
used with due caution ; and the ability to 
perform the operation may be serviceable 
in remote or thinly-settled districts. Any 
man who has the idea of using the lancet, 
if required, should see the operation per- 
formed. One practical lesson, accompanied 



with a little kind explanation, is worth aft, 
description, although this may be useful as 
a reminder afterward. 

Bleeding with the lancet may be perform- 
ed wherever a superficial vein can be de- 
tected. The large vein of the neck (the ju- 
gular) is not unfrequently opened by the 
surgeon — also the veins of the hand or 
foot ; but the bend of the elbow is the most 
usual site of the operation. In this po- 
sition, if regularly distributed, there should 
be a tolerably large vein (fig. xxix. 2, 3) 
Fig. xxix. 




running up each side of the arm, and a 
central vein, (4,) which, dividing into two 
branches, sends one to each of the vessels 
above mentioned. It is the branch (fig. 
xxix. 5) going to the outer vein which is 
usually opened in bleeding. The veins on 
the inner side of the arm, being as a gene- 
ral rule avoided by the surgeon, if blood in 
sufficient quantity can be procured from the 
more external branches. The reason of the 
selection is the presence of the main artery 
of the arm close beneath the inner veins, 
and the possibility of its being wounded in 
the operation. A skilful bleeder may un- 
doubtedly avoid so serious a mishap. But 
certainly no unprofessional person should 
run the risk ; and, indeed, in whatever situ- 
ation, and by whomsoever a vein is opened 
in the arm, it must always be ascertained 
beforehand, by pressing the finger down upon 
the part, that no artery is pulsating under- 
neath. 



BLO 



68 



BLU 



The first thing, -when the operation of 
bleeding from the arm is to be performed, 
is to have all things in readiness. These 
are a bandage of some kind, or soft half 
handkerchief, a piece of linen folded six or 
eight times into a pad an inch and a half 
square, a basin, or two or three cups, a stick 
to support the patient's arm if requisite, a 
towel, and a little cold water. The band 
is to be tied round the arm, with a bow- 
knot, about two and a half inches above 
the elbow, (fig. xxix. 1,) with sufficient 
tightness to stop the flow of blood in the 
veins, but not in the artery, which may be 
ascertained by feeling the pulse at the wrist. 
The operator, while supporting the arm of 
the patient with the fingers of the left hand, 
presses upon the vein with the thumb, a 
short distance below the intended opening — 
this pressure serving to steady the vein 
under the incision of the lancet ; and also, 
if the operator be alone, to prevent the free 
flow of blood until he has had time to lay 
down his lancet and hold the basin. The 
lancet being held between the thumb and 
forefinger of the right hand, with its sides 
in the position represented, (fig. xxx.) and 
the hand being supported by the other 
fingers, the point of the instrument is to be 
made to pierce the vessel, and it is carried 
forward so as slightly to enlarge the open- 
ing, and then withdrawn. If the blood 
does not flow freely, the patient may be 
made to grasp a stick, or any solid body 
which will partly fill the hand. "When it is 
desired to stop the flow of blood, the band 
is to be untied, the left thumb and fore- 
finger being placed upon the wound, so as 
to pinch together its sides ; the arm, if re- 
quisite, cleansed ; the linen pad substituted 
for the thumb upon the wound, and secured 
by the band or handkerchief passed round the 
Fig. xxxi. 




arm in the form of a figure of 8, (fig. xxxi.) 
The arm ought to be kept at rest for some 
hours after the operation, and not used in 
exertion for some days. 

Such is the operation of bleeding — not 
to be undertaken rashly — never by one who 
has not seen it performed ; but yet one 
which it is desirable that some one in a 
remote district should have the ability to 
perform. Again it is repeated, the lessons 
must, in the first instance, be practical, 
and then the few simple directions above 
given may afford timely aid to the memory. 
It must be kept in mind that a person in 
the upright posture faints sooner from loss 
of blood than one who is lying down, and 
that when faintness does come on, a little 
cold water and a perfectly flat position are 
the best restoratives. 

The emergencies in which bleeding may 
be ventured upon by the unprofessional will 
be noticed under their proper heads. 

Local Blood-letting, Cupping, Leeching, 
Scarifying. — See their respective articles. 

BLOWS — May be serious either from the 
violence used in their infliction or from the 
site of the injury. A blow on the head 
may cause merely bruising of the scalp ; if 
more severe, concussion or injury to the 
brain, or fracture of the skull. The latter 
accident is most likely to happen at the 
side of the temple, where the bone is thin ; 
but severe injury to the brain frequently 
occurs from blows at the under and back 
parts of the head. A severe blow on the 
spine may cause paralysis of the lower 
limbs, with or without fracturing the ver- 
tebrae. When a blow, even comparatively 
slight, is inflicted upon a spot immediately 
over a collection of nerves, most distressing 
effects, and sometimes immediate death may 
result. Such is the case from blows on the 
neck, on the pit of the stomach, or over the 
region of the heart. The deadly faintness 
which ensues should instantly be combated 
by the first stimulant — ammonia, ether, or 
spirit of any kind — which can be procured. 
Cold water should be suddenly dashed over 
the surface or down the spine. If this is 
unsuccessful, the patient is to be put into a 
warm bed, and artificial respiration em- 
ployed along with external heat, mustard- 
plasters to the spine and pit of the stomach, 
and stimulant injections. 

Refer to Brain — Bruises, $c. 

BLUE DISEASE.— Cyanosis.— A condi- 
tion dating from birth, in which, from mal- 
formation of the heart, the blood is only 
partialy arterialized in the lungs. Few 
subjects of this disease survive infancy, but 
there are instances of their attaining ma- 






BLU 



B01 



ture age. The disease is characterized by 
the purple appearance of parts which are 
usually red, by languor of all the functions, 
and by great susceptibility to cold. The 
disease must not be confounded with the 
leaden-blue colour of the skin brought on 
by long-continued internal use of nitrate of 
silver. [Dr. Charles Meigs, of Philadelphia, 
advises keeping the child on the right side, 
and thinks it is always useful. The sim- 
plicity of the measure should insure its 
trial.] 

BLUE PILLS. — See Mercurials. 

BOIL. — A boil consists of local inflam- 
mation affecting the true skin and subja- 
cent cellular membrane. A whitish-looking 
point, in the conical centre, is surrounded 
by an inflamed hard base. A core or slough 
occupies the interior of the boil, and this 
must be discharged before there is relief to 
the often intense pain, and before a cure 
can be effected. The pain may, however, 
be soothed, and the natural process facili- 
tated, by the use of warm fomentations, 
simple, or made with poppy capsules, and 
poultices ; the latter being continued until 
the core is fully thrown out : after which 
simple water-dressing may be applied. Per- 
sons who are compelled to go about their 
occupations during the progress of a severe 
boil, will find a small piece of lint, dipped in 
olive-oil, and retained in its place by a disc 
of adhesive plaster, a very soothing and 
convenient application. Boils are apt to 
recur in succession, for the reason, proba- 
bly, that they depend upon some derange- 
ment of the system, which requires atten- 
tion. If the person (and boils generally 
occur in the young) be of full habit, the 
diet should be reduced, all fat and rich 
things eschewed, meat partially or entirely 
given up for a time, and stimulants avoided. 
A blue pill and black draught, or one or 
two doses of calomel and compound rhubarb 
pill, are to be taken, and regularly for some 
time every morning a teaspoonful of Epsom 
salts in half a pint of water. If the habit 
is delicate, a few five-grain doses of Pluni- 
mer's pill may be given at bedtime, or 
the bowels regulated by the blue pill and 
compound rhubarb. The diet should not 
be reduced, but regulated, and the general 
means of health attended to. 

Boils are popularly said to be "healthy," 
and in one sense they may be so, that is, if 
the deranged state of the system relieves 
itself by their eruption ; but they are also to 
be regarded as warnings that some change 
in habits or that medicine is required. A 
series of neglected boils may wind up with a 
carbuncle. Carbuncle is of the same nature 



as a boil, but more severe and dangerous.— 
See Carbuncle. 

BOILING — Is the process in cookery by 
which food is submitted to the action of 
water at the boiling point of 212° Fahr. 
Theoretically this is the case, but in the 
cooking of meat especially boiling should 
not be permitted. According to Liebig, a 
temperature fifty or sixty degrees lower is 
sufficient, if proper time be given, to cook 
meat thoroughly, while it is rendered much 
more tender and easier of digestion than 
when the process is carried on more quickly, 
and by a greater degree of heat. In fact, 
meat to be properly cooked in this way ought 
rather to be stewed than boiled. Something, 
however, must depend upon the end in view 
in cooking the meat. If it is desired to be 
simply a piece of well-cooked meat, not only 
as regards taste but as to nutritive powers, 
the method recommended by Liebig should 
be followed ; that is, the water in which the 
meat is to be cooked should be made to boil 
briskly at the time the latter is put into it, 
and for a few minutes after, and then suffi- 
cient cold water is to be thrown into the pot 
to reduce the temperature of the whole to 
150°, at about which point it should be 
maintained until the meat is thoroughly 
cooked, that is, till all appearance of red- 
ness has disappeared. The principle of the 
process is, that by the sudden immersion of 
the meat in boiling water the most external 
of the constituents of the flesh, but more 
particularly the albumen, become quickly 
hardened and coagulated, so as to form a 
kind of case around the interior portions. 
Of course, if the high temperature is pre- 
served, this process of hardening will go on 
throughout the whole mass, which is thus — ■ 
and too often it is the case — made hard and 
indigestible. But in consequence of the 
reduction of temperature produced by the 
addition of cold water, this is prevented, 
the meat is cooked by a heat which cannot 
harden it, and its nutritive soluble principles 
are kept from exuding by the case-harden- 
ing of the first few minutes' boiling. The 
reverse of the above must, in some degree, 
be the case when meat is boiled for the sake 
of the soup : it must then be put into the 
water while it is cold, and the temperature 
gradually raised to near the boiling point. 
In this way there is no outer hardening to 
interfere with the water dissolving out the 
soluble nutrient principles of the whole mass 
— the latter of course losing proportionally. 
As meat cannot be cooked in water without 
a certain portion of its nutrient matters 
being dissolved out, the water should never 
be thrown away ; if the saving is unimportant 



BOL 



70 



BRA 



to those who cook the meat, there are plenty 
of poor to receive the unused liquor ; but 
if it is a consideration that nothing be lost, 
then may the soup be turned to account by 
being consumed along with the meat. Of 
course the cooking may be so managed as 
to make both palatable. 

Vegetables require thorough boiling, and 
often disagree for want of it. — Refer to Food. 

BOLUS. — A large, rather soft pill, which 
can be swallowed. This form of administer- 
ing medicine is not at present much used. 

BONE — Is the component of the hard 
frame-work of the animal body which sup- 
ports and protects, and to which are attached 
the soft parts. Bone, in mass, is made up 
of mineral, or earthy, and of animal matter, 
and both are so intimately united and diffused 
through one another that either, the one by 
the action of heat, or the other by the aid 
of an acid, may be entirely removed, and 
yet the form of the bone maintained by the 
remaining constituent. The animal matter 
of bone is nearly pure gelatine, which may 
be and is used as an article of food in va- 
rious ways. The extraction by manufactur- 
ing process is complete ; but for domestic 
purposes much of the bone gelatine may be 
extracted by the use of Papin's digester. 
There is not perhaps as much real nutri- 
ment in gelatine as popularly imagined, but 
there is quite enough to make its extraction 
important, even domestically, as an addition 
to soups. 

The bones of the body are divided into flat 
bones, like those of the head ; long bones, as 
of the arm and thigh, and irregular bones, 
of which the vertebrae are examples. The 
outer case of a bone is always harder than 
the interior, and is covered by a firm invest- 
ing membrane, the periosteum. Bones are 
liable to various diseases ; one of these, 
caries, is to this tissue what ulceration is to 
the soft parts of the body ; another, necrosis, 
is the actual death of the bony substance. 
In both these cases there is generally deep- 
seated continued pain in the bone, followed 
by swelling and redness of the soft parts 
covering the affected spot; matter forms 
and is discharged, but healing does not take 
place as after a common abscess ; the dis- 
charge continues, is thin, perhaps acrid, 
frequently fetid, and communicates a dark 
stain to the dressings. The opening in the 
skin, or rather openings, for there are usu- 
ally more than one, may be small, or there 
may be diffused ulcerations of the integu- 
ment. These diseases — unless from situa- 
tion, as in the head — are not rapidly fatal, 
but if unremedied, wear out the patient by 
long-continued irritation. The suspicion of 



their existence should be the signal for 
placing the sufferer under proper medical 
advice without delay. Too often they are 
trifled with, and one quack ointment after 
another — each professing more than its 
neighbour — is had recourse to, while the 
constitution of the patient suffers irretriev- 
ably. Bones may become softened in con- 
sequence of a deficiency of earthy matter. 
In adults this is the result of defective 
constitution, insufficient nourishment, and 
unhealthy dwellings, and is a fatal disease. 
In children the disease named rickets, in 
which the bones likewise become soft and 
capable of bending, is the result of similar 
causes ; but in the latter, good diet, change 
of situation, and a course of tonic remedies 
will effect a cure. 

Refer to Rickets — Fractures — Papin's Di- 
gester. 

BORAX — Is a compound of boracic acid 
and soda. It is well known, and used do- 
mestically in cases of sore mouth ; but its 
good effects, especially in thrush, are often 
nullified by its admixture with honey or 
saccharine matters. As a general rule, bo- 
rax is most advantageously used in the form 
of lotion, a drachm and a half in half a pint 
of water being a convenient strength. In 
mercurial salivation this wash for the mouth 
is very serviceable. [A saturated solution 
of borax forms an excellent wash to cleanse 
the head from dandriff: but some fatty or 
oily substance, as beef's marrow or bear's 
grease, should be subsequently used to pre- 
vent the dryness which follows the use of 
the borax.] 

BOUGIE. — A surgical instrument used for 
the dilatation of the male urethra. 

BOWELS.— The tract of the alimentary 
canal contained within the abdomen. — See 
Alimentary Canal. 

BRAIN. — The brain is the large mass of 
nervous matter contained within the cranium 
or skull-case. By anatomists and in medi- 
cal science the organ is variously divided 
and subdivided, but more especially into 
the cerebrum, or large brain, (fig. xxxii. 1,) 
and the cerebellum, or little brain, (fig. 
xxxii. 2,) the latter being situated at the 
inferior and posterior part of the cavity 
within the head. The nervous matter is 
partly white and opaque, and partly greyish 
and semi-transparent. The whole organ is 
supported and enveloped by three mem- 
branes, and is defended from all ordinary 
injury by the arched bones of the head. 

Concussion of the Brain. — One of the 
most frequent injuries to which the brain 
is exposed is concussion. Either in conse- 
quence of a fall or a blow, a person becomes 



BE A 



71 



BRA 



stunned ; the effect may be but momentary, 
there is transient unconsciousness, and the 
individual " comes to himself," without 




further symptoms ; but if the concussion 
be severe the state of unconsciousness con- 
tinues, the power of motion is almost or en- 
tirely lost, the breathing is slow and quiet, 
the pupils frequently contracted, but some- 
times dilated, and very generally there is 
vomiting ; the pulse is small and weak. 
This condition may continue for a longer 
or shorter period, according to the violence 
of the shock, and may terminate in death ; 
but if it be simple concussion, there is gene- 
rally a restoration of the usual condition of 
health, which is permanent or otherwise. 
In some cases of simple concussion of the 
brain but little active interference is re- 
quired ; the patient should, if possible, be 
put in bed, and the warmth of the surface, 
particularly of the feet, attended to ; if there 
is extreme depression, a little sal-volatile or 
brandy and water may be given, but sparingly, 
on account of the subsequent reaction. The 
chief danger to be apprehended after con- 
cussion of the brain is inflammation, affect- 
ing either the organ itself or its covering 
membranes, and on this account the suf- 
ferer from the accident ought to be very 
careful for at least ten days or a fortnight 
after the receipt of the injury. All alcoholic 
stimulant is to be avoided, and rest both of 
body and mind submitted to ; the bowels 
being kept relaxed by the use of gentle 
aperients. If the immediate reaction is 
great, that is, if a few hours after the acci- 
dent there is much pain in the head, shiver- 
ing, followed by heat, quickened pulse, and 
sickness, the case demands the most serious 
attention, and should be seen by a medical 
man as soon as possible. In such a case as 
this occurring — and they frequently do occur 
— at a distance from medical aid, an unpro- 
fessional person who could bleed would be 
quite justified in abstracting from a man 
of full habit from twelve to twenty ounces 
of blood, and in applying a dozen or a dozen 



and a half of leeches about the head, either 
with or without the general blood-letting ; 
or eight or ten ounces of blood might be 
taken from the nape of the neck by cupping. 
The hair should be cut or shaved off, and 
the head kept cool with cold or iced appli- 
cations ; the most perfect quiet, in a dark 
situation, observed, and active purging with 
calomel and colocynth, jalap and calomel, 
or the most active aperient at hand. The 
diet is to be reduced to the very lowest ebb. 
Such cases are generally so urgent, and 
their cause and nature so palpable, that they 
not only require the most active treatment, 
but also render that treatment justifiable in 
the hands of the unprofessional, in the ab- 
sence of, or during a lengthened interval 
of, the non-arrival of medical assistance. 
Symptoms similar to those detailed above, 
though not directly referable to reaction, 
may, coming on some days after a concus- 
sion of the brain, indicate the commence- 
ment of inflammatory action. In such a 
case bleeding must be more cautiously re- 
sorted to, but the other measures should be 
carried out. It ought to be known, that 
direct violence to the head is not always 
requisite to produce concussion ; a heavy 
fall on the feet may equally cause it, by the 
shock conveyed through the spine to the 
brain. But violence may go beyond the 
production of mere concussion — there may 
be rupture of the substance of the brain, or 
of a single vessel, causing effusion of blood. 
In such a case, the individual may never 
rally from the first condition of unconscious- 
ness, or he may rally only partially, to sink 
again, as reaction comes on, into a state of 
apoplectic stupor, or become the subject 
of those symptoms of inflammation of the 
brain already described ; in wiiich case, of 
course, the same treatment is to be pursued. 
If the case runs on to a fatal termination, 
there is generally apoplectic stupor, para- 
lysis, and convulsions, one or all of them. 

Fracture of the Skull. — Violence, ap- 
plied either directly to the head, or commu- 
nicated to the skull through the spine, may 
be sufficient to fracture the bone with or 
without breaking the skin. The accident is 
sometimes sufficiently obvious even to the 
inexperienced ; at other times, as in the case 
of a simple crack, it is not detectable even 
by the most skilful ; but whether plainly ap- 
parent, or only suspected, the existence of 
fracture amounts to the same thing, as far 
as the unprofessional are concerned, as con- 
cussion ; the case ought to be seen as soon 
as possible by the surgeon. " The symptoms 
will in many respects resemble those of and 
following concussion, and may be similarly 



BRA 



72 



BRA 



treated ; if there is an external wound as 
well as fracture, simple water dressing 
should be used. When a portion of bone is 
driven down upon the brain by external vio- 
lence, it occasions apoplectic insensibility 
by the pressure it produces. In such cases, 
the aid of a surgeon is imperatively called 
for, to relieve the brain by elevating the 
depressed bone. 

The brain, or its investing membranes, are 
liable to become inflamed. Shivering, fol- 
lowed by hot skin, thirst, furred tongue, 
intense pain in the head, intolerance of 
light, the eyes being blood-shot and wild- 
looking, sickness, and delirium, are the most 
general symptoms. At other times, a se- 
vere attack of convulsions ushers in the dis- 
ease, or continued and obstinate vomiting 
may be the first symptom of the brain being 
afi'ected, the more direct symptoms referable 
to the head coming on later. However it 
may be, such cases can only have proper 
energetic treatment in the hands of the prac- 
titioner ; but until his assistance can be pro- 
cured, the plan of treatment recommended 
to be followed in cases of inflammation after 
violence is to be adopted — particularly cold 
to the head, thoroughly applied. 

Inflammation of the brain may arise from 
a variety of causes — violence is one of the 
most common ; but it may arise in the course 
of acute disease, or after the suppression of 
an accustomed discharge, and it is not un- 
common in cases where there has been a 
long-continued discharge from the ear. 

In children, particularly those of a scrofu- 
lous constitution, inflammation of the brain 
at its conclusion frequently takes the form 
of what is popularly termed — 

Water in the Head, or water on the 
brain. The 'fatality of this disease when it 
has once established itself in the constitu- 
tion, renders a knowledge of its earlier 
symptoms a matter of serious and important 
interest to every parent. As mentioned 
above, children of scrofulous constitution 
are most liable to this disease, and should 
be closely watched, especially from the 
second to the sixth or seventh year of life, 
the most general period of attack, and par- 
ticularly after the child has suffered from 
any of the diseases incidental to childhood. 
At first, the patient is languid, looks heavy, 
is subject to irregular heats and chills ; the 
appetite is capricious, the bowels irregular, 
and the discharges from them unnatural in 
colour. The sleep is disturbed, there is fre- 
quent starting, moaning, perhaps screaming ; 
the teeth are grated, and the thumbs folded 
across the palm of the hand. When awake, 
the brow is contracted ; the nose is continu- 



ally picked; and the child, if able to speak, 
complains of the head, which is hot. As the 
disease advances beyond the first stage, all 
these symptoms become more marked, and 
probably obstinate vomiting, and when the 
stomach is empty, retching, occur. Toward 
the termination of the disease, insensibility, 
dilated pupils, convulsions, &c. come on; 
but long before the latter stages, the case 
should be under proper medical treatment. 
The object here is to put parents on their 
guard as to the advances of an insidious and 
very fatal malady — not to induce them to 
incur the responsibility, and, unless under 
very extreme circumstances indeed, the cul- 
pable responsibility, of its treatment. Many 
of the symptoms above detailed undoubtedly 
occur, in less alarming combination, in many 
of the diseases of children ; but come as they 
may, and when they may, they should not 
be neglected. Some amount of treatment 
ought however to be employed to save time, 
and the most important and safest indica- 
tion is to purge the child well with calomel 
and scammony — the head is to be kept cold, 
and quiet strictly to be observed. One or 
two leeches may be applied. The term 
" water in the head," as regards the disease 
above treated of, is erroneous ; the effusion 
of water which takes place is but one of the 
stages of the affection, which is truly inflam- 
mation of the brain and its coverings. The 
causes are numerous, but sometimes the 
disease arises without any being distinctly 
traceable ; the irritation of teething, long- 
continued disorder of the digestive organs, 
falls or blows on the head, exposure of the 
child's head to the heat of the sun, infantile 
febrile disorders, may any of them give the 
first impetus to the diseased tendencies. 
Most important, as undoubtedly it is, to de- 
tect the first symptoms of threatened inflam- 
mation of the brain in children, still more so 
is it to detect and improve that state of con- 
stitution which facilitates the incursion of 
that and so many other disorders. If a 
child is scrofulous, or has a tendency to a 
scrofulous constitution, let not parents fool- 
ishly shut their eyes to the fact, but rather 
endeavour as far as possible to correct the 
misfortune ; more especially, let them be- 
ware, lest they in any way foster into acti- 
vity the seeds of so deadly a malady as acute 
dropsy in the head. Those children who 
are most obnoxious to its attack are often 
the most endowed intellectually ; and there 
is a morbid tendency to excitement in the 
brain, which gives it power beyond what ia 
natural to its age. If permitted or encour- 
aged, the child will give up the sports and 
exercise of its time of life, for the sake of 



BRA 



73 



BRA 



mental employment, and sometimes a pa- 
rent's pride permits the erroneous system, 
"which, in all probability leads either to early 
death from active disease of the brain, or to 
the possession in after life of a sickly body 
and morbid mind. In no children is it so 
necessary to insist upon strict observance of 
all the laws of physical health, as in those 
who exhibit precocious development of mind. 

Water in the head, properly so called, is 
a chronic disease, dating from birth or very 
early infancy. The effusion of water ad- 
vances by slow degrees, distending more and 
more the brain and the bones of the head, 
until the latter attains an enormous size. 
The head has measured as much as forty- 
four inches in circumference. The disease 
may last for years. 

Brain ix Old Age. — In the aged the brain 
becomes more liable to disease than hereto- 
fore. Congestion of blood from various 
causes, more especially in consequence of 
disease of the heart, is frequent, but quite 
as often, headache, giddiness, slowness of 
intellect, or paralysis, arise from deficiency 
of blood in the brain. The distinction is 
important, as in the latter case lowering 
measures are certain to be followed by an 
aggravation of the disorder. Softening of 
the brain, so frequent a disease of advanced 
life, has many symptoms similar to those 
consequent upon deficiency of blood, but in 
an aggravated degree ; the mental functions 
are more regularly and permanently im- 
paired, and paralysis is more certain. Al- 
though cerebral softening is incurable, if its 
threatenings are early dejected it may be 
retarded by the use of tonics and abundant 
nutriment. The arteries of the aged brain 
lose their elasticity, become brittle and liable 
to rupture if unduly distended, a fact which 
renders all excitements, whether of the pas- 
sions or otherwise, so dangerous to those 
advanced in life. The other affections of 
the brain, such as apoplexy, paralysis, de- 
lirium tremens, will be found under their 
respective heads. 

BRAN — Is the broken-up testa or skin of 
the grain of wheat, which is separated from 
the flour after grinding. When heated, it is 
one of the most useful adjuncts we possess 
in the alleviation of disease and pain, and 
particularly in a domestic point of view. It 
is generally to be procured, is soon made 
hot. and retains the heat well; it is at the 
same time soft and adaptable. 

Heated bran is best applied in a flannel 
bag, which should be made ample in size, 
compared with the part affected. It maybe 
either a dry or a moist application, but the 
latter is in most cases preferable. The best 
G 



method of heating is in the frying-pan, 
sprinkling with hot water during the pro- 
cess, so as to give just perceptible moisture, 
and turning it over and over until the sub- 
stance is thoroughly hot throughout. It is 
to be quickly transferred to the bag, and the 
latter fastened by pins or thread. When 
moist, if covered, after it is applied to the 
skin, by a piece of oiled silk, oiled calico, or 
any other water-proof material, the heat will 
not only be better retained, but the vapour 
also, and no dampness will be communicated 
to the clothes. Sometimes, the bran is put 
into the bag dry, and the bag and all dipped 
into boiling water, but in this way too much 
moisture is absorbed. 

Dry hot bran may produce perspiration, 
but frequently it causes only feverish dry 
heat, and if it does not do harm, does little 
good, compared with the soothing heat and 
vapour of the moist preparation, which is in 
fact a continued local vapour-bath, causing 
free perspiration from the skin over the 
affected part, and often relieving to an ex- 
tent sufficient to render the use of leeches 
or cupping, which would otherwise have 
been required, uncalled for. 

In severe pain, whether spasmodic or 
inflammatory, the bag of hot moist bran, 
efficiently used, is one of the best, softest, 
and most certain alleviators we possess ; 
and, greater advantage than all, may be 
used in most cases of pain with the most 
perfect safety. In many acute inflamma- 
tory affections, such as those of the chest 
or abdomen, its use is very often preferable, 
both as regards the comfort and real good 
of the patient, to either blister or mustard- 
plaster. In the inflammatory affections of 
childhood, and in threatened croup, it is in- 
valuable, from its easy application, soothing, 
and at the same time, most beneficial effect. 
When weight is an objection, of course the 
bag must be more lightly filled. The bran 
may be heated in a dry state, and the effects 
of moisture procured by laying underneath 
it a double fold of flannel wrung out of hot 
water. Again it is repeated, that the hot 
bran bag, to be efficient, must be sufficiently 
ample and well filled to retain the heat so 
long that frequent changing is not required. 
It must be thoroughly hot, slightly moist, 
but not wet, and is better covered after it is 
put to the part by some material which will 
prevent evaporation. [Soaking a limb 
night and morning, in warm water, which 
contains sufficient bran to thicken it slightly, 
will be found an excellent remedy in '-salt 
rheum," and other forms of " dry tetter."] 

For the dietetic uses of bran, see Bread. 

BRANDY — Is procured by distillation 



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from grape wines, and, according to Dr. 
Paris, owes its peculiar flavour to the pre- 
sence of an etherial spirit, formed by the 
action of the acetic or tartaric acid on the 
alcohol. 

Brandy, like every other ardent spirit, 
ought not to be freely or regularly used, 
either diluted or otherwise. As an addition 
to our stimulant medicines, and as a dietetic, 
it is most valuable. As a medicine, it does 
not, perhaps, possess any particular advan- 
tage over pure spirit of any kind ; but in 
England, at least, it is preferred by most to 
either whisky or gin, and it is generally the 
first procurable stimulant in most cases. As 
a dietetic, dyspeptics, and the aged, who 
require stimulant, and yet cannot take it 
in other forms, can often use regularly and 
with the greatest benefit a measured quan- 
tity of brandy in a little cold water, with 
their meals once or twice a day, and cer- 
tainly without any of that subsequent de- 
pression, or craving for an increase of the 
dose, which is by some said to be the con- 
sequence of the habit. [The substitution 
of the tincture of ginger will often do better 
than brandy in the cases of dyspeptics.] 

BRANKS.— The Scotch name for the 
mumps. 

BREAD. — The term as usually applied in 
this country, means the leavened, raised, 
or fermented loaf of wheaten flour, but may 
also be appropriate to any of the other forms 
in which flour or meal is made up, either 
from wheat or the other bread corns. The 
flour of wheat consists of three ingredients ; 
the gluten, which approaches animal matter 
in composition, starch, and mucilage. Wheat 
flour, simply made into a cake with water, 
and baked, like the "damper" of Australia, 
will undoubtedly yield nourishment equally 
as well as leavened bread, to those whose 
digestion is equal to the task ; but for the 
general purposes of civilized life, leavened 
bread is much to be preferred for the great- 
er ease with which it is dissolved in the 
stomach. "The careful mixture with the 
saliva during the mastication of bread is a 
condition essential to the rapid digestion of 
the starch. Hence the increase of digesti- 
bility obtained in bread by the porous form 
given to it. This porosity and lightness is 
produced in the dough by a process of fer- 
mentation. Beer-yeast is added to the 
dough, which brings into fermentation the 
sugar formed by the action of the gluten on 
the starch ; and the open porous texture of 
the mass is the result of the carbonic acid 
thus formed in every part of it. Many 
chemists are of opinion that the flour, by 
the fermentation in the dough, loses some- 



what of its nutritious constituents, from a 
decomposition of the gluten ; and it has 
been proposed to render the dough porous 
without fermentation, by means of sub- 
stances, which, when brought into contact, 
yield carbonic acid." Baron Liebig, from 
whose " Letters" the above extract is taken, 
says " this view appears to have little found- 
ation." 

Various kinds of " digestive bread," raised 
without fermentation, are, however, now 
used. Carbonate of ammonia (hartshorn) 
has been employed for this purpose ; but 
carbonate of soda, with the addition of some 
acid — buttermilk will do — to disengage the 
carbonic acid, is the most general agent. 
The following method is a good one: — Two 
drachms of carbonate of soda in fine pow- 
der are to be well mixed with a pound and 
a half of flour ; to rather less than a pint 
of water, there is to be added two and a 
half drachms of muriatic acid, and the 
water and acid together are to be added to, 
and mixed up with the flour. A rather 
liquid dough, which must be baked immedi- 
ately, is formed, and if properly managed, 
is well and lightly raised by the disengage- 
ment of the carbonic acid from the soda, 
the latter being at the same time converted 
into common salt by union with the muria- 
tic acid. These various kinds of unferment- 
ed bread have been extolled as particularly 
digestible, but it is a question whether they 
are more so than the ordinary bread which 
has undergone fermentation. To be tho- 
roughly wholesome, bread must be well 
raised, well baked, and at least twenty-four 
hours old before it is used. The finer de- 
scriptions of bread made with fine flour are 
apt to constipate, and the coarser, which 
contain much coarse bran, are too irritating 
for many stomachs. It is a matter of much 
importance as regards the nutritive proper- 
ties of bread, " the staff of life," in what 
manner the flour from which it is made is 
prepared. Generally, in consequence of the 
very large separation of bran effected in 
grinding, in this country at least, a great 
proportion of the real nutriment is abstract- 
ed, and the finer flour which remains has 
much too large a preponderance of starch, 
which does not afford real nutriment. This 
fact was well exemplified by the experiment 
of Magendie, who fed two dogs on wheaten 
bread exclusively ; but to one he gave that 
made of fine flour, deprived of bran; to the 
other the coarse brown bread made of bran 
and flour together. The former died in 
forty days, while the latter was perfectly 
healthy at the end of the period. The first 
dog was in fact starved, in the same way 



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75 



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that he would have been if fed upon arrow- 
root, or sugar alone. The experiment indi- 
cates very significantly how much real nu- 
triment is lost by the copious separation of 
the bran in preparing fine flour. It is not 
necessary for bran to be coarse ; by more 
thoroughly grinding it into the flour, not 
only would bread made from the flour be 
much more nutritious and wholesome, but 
the actual amount of bread food supplied 
to the people would be considerably in- 
creased. Moreover, the mechanical aperi- 
ent action of the bran upon the bowels, 
could not fail to be useful in a country 
where constipation is so general a disorder 
as it is in this. No one who is liable to 
habitual constipation should regularly con- 
sume fine bread. 

In times of scarcity, bread is liable to 
adulteration with flour from potatoes, beans, 
or with rice, and other cheap grains. So 
far as the health of the consumer is con- 
cerned, such adulterations cannot be very 
injurious ; and the deleterious additions to 
flour, of plaster of Paris, chalk, &c. are 
now scarcely ever heard of. During times 
of plenty almost the only adulteration of 
bread, and that chiefly of the lighter and 
finer kinds, is with alum ; indeed, the 
" Lancet Sanitary Commission" (London) re- 
cently found this to be the only adulteration 
practised by those bakers whose bread they 
examined. The addition cannot be looked 
upon as harmless, if for no other reason 
than the constipating effects it must exert 
upon the consumers. A certain proportion 
of bread should form an addition to every 
meal, with those whose digestion is at all 
weak. It must not be new ; fatal accidents 
have occurred from the distension of the 
stomach by an excessive meal of newly- 
baked bread. Sour bread is, of course, 
most unwholesome. A great mistake is 
often made in feeding young infants upon 
bread in various forms ; it always occasions 
disorder, gi-iping, and flatulence. If cir- 
stances render it necessary that bread must 
be given, it should, at all events, be slowly 
toasted, or rebaked as hard as a biscuit or 
rusk throughout, and then well soaked. 

Biscuits, though not raised, are rendered 
more digestible by the double baking from 
which they derive their name. 

Refer to Grain — Flour, §c. $c. 

BREAKFAST— The first morning meal, 
is to the strong and healthy a most enjoy- 
able one, and it may always be taken as 
one of the best signs of health when a man 
can eat and digest a good breakfast, espe- 
cially after exercise. The circumstance 
that the strong and healthy can enjoy with 



impunity a full breakfast, has given an erro- 
neous idea as to the advisability of invalids 
making it a hearty meal, and still worse, of 
prefacing it by exercise. With very many, 
perhaps the majority of people, especially 
in towns, the interval between rising and 
breakfast is not one of great vigour. The 
powers both of body and mind are undoubt- 
edly recruited if there has been due rest, 
but they are not in full action, and if, inju- 
diciously, too long an interval is permitted 
to elapse before food is taken, they become 
exhausted, and still more so if physical ex- 
ertion is engaged in. Instead, as is too 
frequently supposed, the exertion improving 
the digestive power, it weakens it. Appetite 
there may be, but digestion will, in a weak 
individual, be sadly deficient ; the nervous 
power which should aid the process has been 
used up. The very same deficiency of ner- 
vous power renders a full breakfast, under 
any circumstances, inadmissible for those of 
weak digestion ; instead of giving strength it 
causes discomfort and inaptitude for business 
for the first hours of the forenoon. Thus it 
is, why it speaks well for the health and con- 
stitution of the individual who can make the 
first meal of the morning a hearty one. 

It would, perhaps, be difficult to find a 
social custom more suited to the present 
state of civilized life than the warm tea, 
coffee, or cocoa breakfast, taken along with 
bread, and, if it agrees, with the addition of 
meat, fish, or egg; it just affords the gentle 
stimulation which the system requires. The 
amount and nature of the nourishment taken 
at breakfast must vary, of course, with the 
habits and powers of the individual ; if 
digestion is weak it is better to be content 
with little, and wait for an early luncheon. 
Some dyspeptics can scarcely take any kind 
of food at the morning meal without its dis- 
agreeing; such will sometimes find it of 
advantage, when it can be done, to have a 
small cup of hot coffee, or of some warm 
fluid, brought to them just before rising ; 
with others, a very slight supper just before 
going to bed, a biscuit or piece of toast, 
with a little wine and water, will relieve 
the weakness in the morning. Above all, it 
should be kept in mind by those with whom 
breakfast is apt to disagree, that exhaustion 
of any kind before the meal, such as walk- 
ing, gardening, bathing, or even cold spong- 
ing, are almost certainly injurious. As a 
breakfast for children, bread and milk is 
better than the stimulants tea and coffee; 
for strong children, nothing is better than 
oatmeal porridge, such as is used in Scot- 
land and Northern England. 

Refer to Digestion — Bathing. 



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BREAST.— The term, as here used, is 
applied to the female breast, the organ 
peculiarly devoted to the nourishment of 
offspring. The essential component of the 
breast is the "mammary" gland, which 
secretes the milk. This gland, along with 
the breast generally, becomes fully deve- 
loped and fitted for its functions as woman- 
hood advances ; and, at the same time, the 
nipple enlarges, if it is permitted to do so 
by the stays, which too often offer such im- 
pediment to its development as to entail 
much suffering when women come to be 
mothers. Too frequently, when the nipple 
ought to be fit for the suckling of the child, 
it is found so flattened into the breast that 
it is nearly impossible, sometimes quite so, 
to get it drawn out sufficiently ; much suf- 
fering, and not unfrequently abscess in the 
breast is the consequence. 

Females are often morbidly sensitive re- 
specting any ailment affecting the breast, 
and render themselves unnecessarily mise- 
rable if they detect, or fancy they can, any 
thing unusual. Sympathetic pains are put 
down as the certain precursors of some 
dreaded disease ; or the slightest hardness 
is observed and fingered till it really be- 
comes tender and inflamed, and in conse- 
quence enlarged. In such cases, if the 
patient is reasonable, and can be persuaded 
to give up the habitual interference with 
the ailment, the uneasy symptoms and sus- 
pected "lump" will often disappear together. 
Still, they may not do so, at least quickly, 
but that is no reason why the affection is 
necessarily a serious one ; the best plan in 
these cases is to take professional advice 
without delay ; if the cause of alarm is 
unimportant the mind is set at rest; should 
it be otherwise, its nature cannot be too 
soon detected. Above all things, tampering 
with such matters must be avoided ; the 
rubbings, &c. too often employed may irri- 
tate a slight swelling into rapid and painful 
increase, or something worse. 

If the above advice is followed, as it ought 
to be, it is unnecessary in a work like this 
to treat of that dreaded disease, cancer of 
the breast. A suspected case ought neither 
to be left to unprofessional opinion nor do- 
mestic treatment ; and to detail the incipient 
symptoms, which are many of them common 
to more harmless affections, might only tend 
to excite groundless fears. When cancer has 
reached the confirmed open stage, opiates 
and narcotics are the chief sources of physi- 
cal comfort; hemlock poultices will some- 
times relieve pain, and a chlorine lotion 
will in some measure neutralize the fetor. 



The disease generally occurs after the age 
of forty. 

Inflammation and Abscess of the 
Breast. — The disease from which the 
female breast most frequently suffers is 
inflammation, followed by abscess, [or "ga- 
thering."] This may occur at any time, 
but most commonly it is within the first few 
weeks after childbirth. Generally within 
twenty-four hours after the birth of a child 
the breasts become turgid and slightly hot, 
from the increased flow of blood which is 
directed toward them to supply the secre- 
tion of milk. In this excited condition, and 
indeed during suckling generally, they are 
peculiarly liable to become inflamed ; cold, 
any slight bruise, such as that from a bone 
in the stays, over-distension with milk, or 
even mental excitement, may, any of them, 
give rise to the inflammation which ends in 
abscess. All these causes, and any others 
likely to injure, must therefore be most 
carefully avoided, and particularly the ac- 
cumulation of milk, to prevent which the 
breasts should be well emptied. If from 
flatness of the nipple, weakness of the child, 
or any other cause, the milk is not well 
drawn out, measures which will relieve must 
be adopted. Various forms of breast-pumps 
are used, the suction being made through 
them, either mechanically or by the mouth. 
A leech-glass is tolerably convenient, or a 
wide-mouthed bottle, capable of holding a 
couple of quarts, may be employed, being 
first dipped into hot water to exhaust the 
air, and then applied to the breast, the suc- 
tion exerted as it cools causing the milk to 
flow freely. Some nurses have the art of 
drawing the breasts with the mouth more 
thoroughly than any instrument, and when 
such aid can be procured it is right to make 
use of it. [Young pups are also sometimes 
employed, and, when their paws are covered 
with rag, draw the breast without causing 
pain.] The first symptoms of threatened 
abscess [or gathered breast] are pain and 
knotty hardness in the part ; if the process 
goes on unchecked, there is much throbbing 
and sensation of weight, the skin over the 
part affected becomes red, gradually thins, 
and at last gives way, allowing the escape 
of the matter occasionally mixed with milk. 
Some amount of irritative fever accompanies 
the progress of the affection. After the 
discharge of the matter the abscess may 
quickly heal, or it may remain open and 
running for a considerable time. 

The first few hours of threatened mam- 
mary abscess are the most valuable ; if it 
is to be prevented, it must be then. The 



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BRI 



breasts being well emptied, gentle friction, 
continued for ten minutes at a time, and 
repeated every four or five hours, must be 
most assiduously employed. A soft palm is 
indispensable for the process, and fresh olive 
or almond oil is the best for rendering the 
friction easy ; the various applications, such 
as goose-fat, &c. &c, often recommended 
and used, are disagreeable, and not better 
than the simple oil, the mechanical friction 
being the active agent for good. During 
the intervals between the friction, the best 
application is lint soaked in tepid water 
and covered with oiled silk. The bowels 
should be kept clear : ten grains of Plum- 
mer's pill may be given, and followed in 
four hours by castor-oil, and from six to ten 
grains of carbonate of potash, with the same 
quantity of nitrate of potash, are to be given 
every five or six hours in a wineglassful of 
water. The diet should be light and cooling. 
Leeching the breast in cases of threatened 
abscess is useless, and tepid moisture is 
better than much heat. It is of much im- 
portance to support the breast, and it is 
sometimes found beneficial to exert press- 
ure by strapping with plaster, or, as lately 
practised, by means of collodion applied all 
over, which, as it dries, contracts and pro- 
duces an equable compression. When, from 
the throbbing character of the pain, or from 
the tension and inflammation of the skin, 
there is reason to suspect that matter has 
formed, the treatment must be changed ; hot 
fomentations and poultices are to be regu- 
larly applied, the distressing weight of the 
whole breast being relieved by slinging 
with a handkerchief round the neck. The 
bowels are to be kept open, not purged, the 
pain and restlessness relieved by an opiate 
at night; cooling drinks allowed, and the 
diet light but nourishing. In certain stages, 
and under certain conditions, it is the prac- 
tice of medical men to open breast or milk 
abscess with the lancet ; for the unprofes- 
sional the safest course is to permit it to 
discharge itself. The hot poultices ought 
to be continued for a few days after the 
evacuation of the matter, and then ex- 
changed for simple water-dressing. 

After the discharge of the abscess, a more 
nourishing diet is to be allowed, and wine 
or malt liquor may probably be required. 
If there is much debility, a wineglassful of 
infusion of bark with thirty minims of sal- 
volatile, or a grain of quinine in a glass of 
sherry, may be taken twice a day. If the 
system is relaxed, and tendency to perspira- 
tion exists, twenty minims of diluted nitric 
acid should be substituted for the sal-volatile 
in the bark infusion. As long as mammary 
62 



abscess is merely threatened, the child ought 
to be allowed to suck, but from the time of 
matter having formed till its discharge, it 
must be kept from the affected breast. 

If hardness remains after the breast is 
healed, friction may be used with soap lini- 
ment, either simply or with the addition of 
a drachm of compound tincture of iodine to 
each ounce. 

Refer to Nipple, §c. $c. 

The breasts of infants a few days after 
birth are liable to become distended with a 
thick milky-looking fluid, which some nurses 
barbarously squeeze out. This should never 
be practised ; bathing with warm water, and 
the use of cold cream, or some simple oint- 
ment, is all that is requisite. 

Youths, about puberty, occasionally suffer 
from a hard, slightly painful swelling around 
the nipple, which sometimes creates alarm. 
It is of' no moment, and requires no treat- 
ment beyond warm fomentation, if painful. 

BREATH and BREATHING.— Breath is 
the mixture of gas and watery vapour ex- 
haled from the lungs at each expiration. Its 
indications are often valuable guides in the 
treatment of sickness. In febrile diseases 
the breathing becomes quickened, and more 
especially so when the lungs are affected. 
In affections of the head or of the nervous 
system, it is often slow, and very gentle, 
sometimes irregular, or it may be laboured 
— " stertorous." The position which a per- 
son suffering from disease, particularly of 
the chest, instinctively assumes, as that in 
which he can most easily breathe, is always 
to be observed. 

The odour of the breath is a good index 
of the state of the body. When tainted, it 
is so, not uncommonly, from decayed teeth, 
or from a morbid secretion of the tonsils ; 
but more frequently, in children especially, 
it is indicative of disordered stomach, and 
of loaded bowels. The cause of the symp- 
tom should always be inquired into, and as 
far as possible remedied. A brisk purgative 
may be all that is required. Disease of the 
lungs is sometimes accompanied with into- 
lerably fetid breath. 

Refer to Aeration — Lung — Respiration. 

BRIGHT'S DISEASE— Is an affection of 
the kidneys, first described by Dr. Bx-ight. 
Its most peculiar symptom is the presence 
of the serum of the blood in the urine, so 
that when the latter fluid is heated to near 
boiling, the albumen becomes coagulated 
like the white of an egg, causing merely a 
cloudiness if in small proportion, but some- 
times existing in such quantity as to form a 
nearly solid mass. This condition of the 
urine is always to be looked upon seriously. 



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78 



BRO 



It sometimes comes on slowly, more particu- j 
larly in those addicted to the excessive use 
of ardent spirits ; or it may be the imme- 
diate consequence of severe cold and re- 
pressed perspiration ; it is not an unfrequent 
sequel to scarlet fever. The sudden deve- 
lopment of this condition of urine is accom- 
panied with feverish symptoms and dropsical 
swelling of the face, with stiffness of the 
eyelids, swelling of the extremities, and if 
it proceed far, of the trunk of the body also. 
It ought at once to be submitted to the treat- 
ment of. v a medical man. In the absence of 
this assistance, should sudden swelling, as 
above described, come on, and with it symp- 
toms of general fever, a portion of the urine 
may be heated in a metal spoon to boiling; 
if it becomes thick or cloudy, and if it is not 
cleared by the addition of a few drops of 
vinegar, it may safely be concluded that the 
kidneys are suffering. From six to ten 
ounces of blood, according to habit, may be 
taken from the loins by cupping, the patient 
confined to bed, and a bath of the temper- 
ature of 90° taken for half an hour, once in 
twenty-four hours. A diaphoretic mixture 
— such as that of acetate of ammonia — is to 
be given, and the bowels purged with calo- 
mel and compound powder of jalap, or some 
other brisk purgative. The diet must be 
kept low as long as fever continues. The 
case ought not to be trusted to domestic 
treatment further than is unavoidable. 

Refer to Scarlet fever. 

BRITISH CHOLERA.— See Biliary Dis- 
order. 

BROCOLI — Belongs to the cabbage tribe, 
the portion eaten being the undeveloped 
flower-buds. When well boiled, it is one of 
our lightest and most wholesome vegetables. 

BROILING — Is, perhaps, the most primi- 
tive method of cooking ; the savage puts 
his piece of flesh or his fish upon the burning 
coals and broils it. In civilized life, the 
gridiron is made the medium for the process. 
The principle involved in broiling is, that by 
sudden exposure to the fire, the outer por- 
tions of the meat are so hardened that they 
retain the juices of the inner, during the 
process of cooking. This is still more fully 
effected by brushing over the surface of the 
meat with white of egg before putting on the 
fire. Broiling is not so well adapted for 
weak stomachs as either roasting or boiling ; 
but meat cooked in this way is very nutri- 
tious. 

BROKEN BONES.— See Fractures. 

BRONCHITIS— Is inflammation of the 
membrane lining the air-tubes or bronchi. 
In its subacute and chronic forms it is one 
of the most common diseases, prevailing at 



all seasons, but especially in cold and damp 
weather. It may be either acute, subacute, 
or chronic, and varies according to age. 
Acute bronchitis may commence directly in 
the chest after exposure to cold ; but very 
often, particularly in children, the lining 
membranes of the eyelids, nostrils, and 
throat are first affected, and the disease 
spreads downward into the air-passages of 
the chest. In the latter case, watering of 
the eyes, &c. precedes the actual bronchitic 
attack for a day or two. Acute bronchitis, 
as it occurs in the adult, is a severe disease, 
requiring the most prompt medical attend- 
ance ; it is generally the result of exposure 
to cold in some way, but may be caused by 
irritant vapours. In it the fever is high, the 
breathing extremely oppressed, the cough 
frequent, and expectoration at first difficult. 
The disease terminates, either with the sub- 
sidence of these symptoms, the breathing 
and expectoration in particular, becoming 
easy ; or respiration becomes more and more 
oppressed and difficult, the mucus, which 
ought to be expectorated, accumulates in the 
bronchial tubes, and the blood being un- 
changed, the lips and surface generally be- 
come blue and cold; delirium preceding 
death. The rapid progress which this dis- 
ease sometimes makes, from its commence- 
ment to a fatal termination, renders the 
sending for medical assistance as quickly as 
possible an imperative duty ; but the same 
reason renders it important that those around 
should be aware of the best method of treat- 
ment. Confinement to bed is a matter of 
course ; but foot-baths, hot bran poultices 
to the chest, and warm diluent drinks are 
all serviceable. In a person of full habit, 
from eight to twelve leeches may be applied 
to the chest, or five or six ounces of blood 
taken from between the shoulders by cup- 
ping ; but the chief dependence is to be 
placed upon nauseant medicines, and ipeca- 
cuanha is the best and safest. Four grains 
should be given in a little water every twenty 
minutes, till free vomiting is produced ; and 
this repeated every two or three hours. 
About an hour after the first vomiting, four 
grains of calomel are to be given, and if the 
disease continues severe, repeated in six or 
eight hours. In the event of symptoms of 
collapse or sinking coming on before the 
arrival of medical assistance, it will be ne- 
cessary to stop the nauseating treatment, 
and to give stimulants, such as five grains 
of carbonate of ammonia, in three table- 
spoonfuls of water, every half-hour or hour ; 
or a teaspoonful of sal- volatile may be given 
instead, in the same quantity of water, and 
at the same intervals. If these stimuli are 



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not to "be procured, the most readily obtain- 
able alcoholic stimulant must be substituted ; 
but ammonia is always preferable ; the 
strength must at the same time be sustained 
by tablespoonfuls of strong meat-broth fre- 
quently given. When the urgency of the 
attack has yielded under the use of the nau- 
seant and emetic systems, the severity of the 
treatment may be relaxed, and the following 
substituted: — Three grains of ipecacuanha 
powder, a drachm of carbonate of potash, 
and an ounce and a half of spirit of minde- 
rerus are to be made into an eight-ounce 
mixture with water ; and of this, two table- 
spoonfuls should be given every three or four 
hours. If the cough is very troublesome, 
three or four drops of laudanum may be 
added to some of the doses — but this cau- 
tiously. The diet should be light and nour- 
rishing. 

The acute bronchitis of children is not 
usually so rapid and strongly marked a dis- 
ease as that just described ; it often begins 
with the irritation of the membrane of the 
nose and eyes, and extends itself into the 
chest. Languor, succeeded by fever, op- 
pressed and quickened respiration, and 
cough, are the usual symptoms. If these 
set in severely, from one to four leeches, ac- 
cording to the age of the child, may in an 
early stage of the disease be applied to the 
chest ; but here, as in the adult, the chief 
dependence must be on ipecacuanha, half a 
grain to a grain, or more, frequently repeat- 
ed so as to cause occasional vomiting. Bran 
poultices ought to be used to the chest. The 
warm bath may be useful in the first stage 
of depression ; but when fever is high, it is 
not advisable. If the child is unweaned, it 
must not be allowed to suck, either from the 
breast or bottle, during a severe attack of 
bronchitis, but ought to be fed with the 
breast-milk, or its usual food, by means of 
a spoon. The bowels, of course, will require 
attention. It is of the greatest importance 
to attend to the atmosphere surrounding 
either child or adult suffering from bron- 
chitis : the chamber should be well venti- 
lated, and the temperature not suffered to 
fall below 55° Fahr. In the latter stages of 
infantile bronchitis, a small blister, about 
the size of half a dollar, applied for a few 
hours to the forepart of the chest, may give 
relief. Bronchitis in children is so hazard- 
ous, and frequently fatal a disease, that its 
domestic treatment ought never to be under- 
taken, except under necessity. Its exciting 
cause is almost invariably cold and moisture, 
particularly during the prevalence of east 
wind in the spring months ; while careless 
and insufficient clothing among the poor, 



and absurd modes of dressing amid the 
higher classes, render children more sus- 
ceptible of these injurious influences. 

Subacute and chronic bronchitis, known 
also as winter-cough, catarrh, and often 
erroneously called influenza, is quite the 
commonest form of this chest affection, and 
assumes every condition, from the almost 
acute attack, to the cough which comes on 
with the first advent of cold weather, and 
lasts through the winter and spring. The 
malady may commence with irritation of 
any portion of the continuous membrane 
of the eyes, nostrils, throat, or trachea; the 
part affected feels sore and raw, and, instead 
of its usual bland mucus, secretes a thin 
somewhat acrid fluid. Along with the local 
symptoms there is more or less feverish 
disturbance of the system, and often severe 
frontal headache ; cough is or is not pre- 
sent, at first, according to the part affected. 
If a threatened attack of subacute bron- 
chitis is to be checked, it must be done in 
the earliest stage, and for this purpose 
nothing is more efficacious than the vapour- 
bath, and, in its absence, the employment 
of means to produce free perspiration, such 
as hot foot-baths, a hot bed, and the free use 
of warm diluent drinks. The most efficient 
medicine for the purpose of checking the 
disease is opium, in small doses, and no 
better form can be found than that of pare- 
goric ; one or two teaspoonfuls, along with a 
tablespoonful of spirit of mindererus, and 
twenty drops either of ipecacuanha or anti- 
monial wine, being given at bedtime, along 
with sufficient water to fill a wineglass. A 
teaspoonful of spirit of sweet nitre may be 
substituted for the spirit of mindererus. 
An aperient should be taken in the morn- 
ing. The above dose may be repeated for 
two or three nights in succession, if the dis- 
ease is unchecked. In this case, of course, 
confinement to the house, or to bed, is 
required ; and demulcent drinks — barley- 
water is the best — are to be freely used. 
There is seldom occasion for much medi- 
cine. For the alleviation of the cough, the 
following mixture will be found useful : — • 
Tolu syrup, one ounce and a half; thick 
mucilage of gum-arabic, cne ounce and a 
half; ipecacuanha wine, one drachm; water 
sufficient to make up six ounces. Of this, 
a tablespoonful may be taken every four 
hours. If the cough is very troublesome, 
forty drops of laudanum may be added, and 
toward the end of the attack, a drachm 
of tincture of squills. Bran poultices to 
the throat and chest are of service at ihQ 
commencement of subacute bronchitis ; mus- 
tard-plasters are not advisable when there 



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is much fever or heat of skin, but a small 
blister to the upper part of the chest will 
frequently stop the further progress of the 
malady. In the attacks, the diet of course 
ought to be reduced, and meat and stimuli 
eschewed while they last. An attack of 
subacute bronchitis ought never, if it pos- 
sibly can be avoided, be allowed to esta- 
blish itself for any length of time ; consump- 
tion, asthma, and other chest affections are 
too nearly allied to it ; and too often the 
seeds of fatal disease, which otherwise 
might have lain dormant for years, are 
quickened into activity by the neglected 
cold. 

The bronchitic attacks of the aged are 
always to be regarded with serious atten- 
tion ; what in youth might be but a slight 
cold, may now be a fatal disease. This 
arises partly from the viscid nature of the 
secreted mucus, but more especially from 
the inability of persons advanced in life to 
expectorate it ; accumulation of phlegm 
takes place in the bronchial tubes, the oxy- 
genation of the blood is interfered with, 
torpidity of the vital functions ensues, and 
adds to the already existing inability to free 
the lungs, and death quickly takes place, 
often unexpectedly sudden. For the above 
reasons, colds in old people must always be 
watched ; all lowering measures must be 
avoided, the diet kept nourishing, and the 
medicines be stimulant expectorants. Opium 
should not be ventured on without medical 
sanction; the compound squill pill is useful. 
Camphor in the form of julep, carbonate of 
ammonia, and sal-volatile are frequently 
required. The inhalation of steam will 
assist the expectoration of viscid mucus. 
Confirmed chronic bronchitis, or winter- 
cough, requires rather management than 
medicine. Protection of the skin generally, 
particularly that of the chest, by flannel 
worn next it, being most important. Some 
persons derive much comfort from wearing 
on the chest a dressed hare-skin, with the 
fur inward ; it is probable that some of 
the benefit in this case arises from a gentle 
counter-irritant effect. The feet, of course, 
are to be well protected from cold and damp 
by thick, or gutta-percha or cork-soled 
shoes ; and the air passing into the lungs 
warmed by means- of one of the various 
respirators now in use. As an ordinary 
method for allaying irritation, a teaspoon- 
ful of paregoric, taken at bedtime in a lit- 
tle water, is most serviceable ; or, where 
the opium is objectionable, three or four 
grains of extract of henbane, or of hem- 
lock, in the form of pill. In all forms of 
bronchitis the condition of the stomach and 



digestive organs require due attention. 
When cough is frequent and violent, the 
mechanical effect upon the stomach is 
liable to disorder digestion, and this again 
reacts upon the lungs, increasing irritation ; 
for this reason the food must be kept light, 
and a dose of compound rhubarb and blue 
pill taken occasionally. The infusion of 
hop, at once a good bitter tonic and a seda- 
tive, is useful. In some forms of bronchitis, 
in which the cough assumes a spasmodic 
character, and particularly in children, 
coming on when the stomach is empty, a 
little food taken will more certainly allay 
its incessant irritation than any other 
means. 

Refer to Expectorants. 

BRONCHOCELE— Goitre— Derbyshire 
Neck — Full Throat — Are all names for 
the same disease, an enlargement of the 
"thyroid gland," situated in front of the 
windpipe. The disease is endemic, that is to 
say, it is confined to particular districts of 
country. In England, Derbyshire and the 
adjoining counties of Stafford, Leicester, 
and Nottingham form its chief locality. In 
Switzerland and the Tyrol it is common ; 
and it occurs in Hindostan, Canada, &c. 
&c. 

Full throat varies in size, from the en- 
largement so slight as to be scarcely per- 
ceptable — or even, in some eyes, to add 
grace to the neck — to a tumour many 
pounds in weight. In England or America, 
however, it seldom attains the immense size 
it does elsewhere. The thyroid gland con- 
sists of two lobes, which lie on either side 
of the windpipe, and of a connecting neck. 
The whole of these parts may suffer en- 
largement at once, or only one of them. 
Bronchocele is much more common in 
females than in males ; indeed, in this coun- 
try it is rarely seen among the latter ; and 
in both sexes, as a general rule, does not 
appear till after puberty ; children, how- 
ever, do suffer from it even from earliest 
infancy. The rise and progress of bron- 
chocele are for the most part slow, and un- 
accompanied with pain ; but occasionally 
rapid enlargement occurs, and then pain is 
severe. Coughs, child-bearing, strong mus- 
cular exertions, are all liable to induce and 
accelerate the progress of bronchocele : the 
monthly period also exerts considerable in- 
fluence upon it. Females of lymphatic tem- 
perament are more liable to be attacked. 

Bronchocele is a disease for the most part 
devoid of danger ; the chief inconvenience 
attending it, when of large size, being im- 
pediment to the breathing, and fulness of 
the head arising from obstruction to the 



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circulation in the vessels of the head and 
neck. The appearance of a large bron- 
chocele is of course unsightly, although in 
those localities in which it prevails it is 
scarcely observed. 

Various causes have been assigned for 
the production of bronchocele ; but none 
with so much probability as that which 
attributes it to the regular use of water con- 
taining lime and magnesia — impregnations 
of the fluid found coincident with the dis- 
ease. The use of snow-water, as formerly 
supposed, is now proved to have nothing to 
do with its development. Carrying heavy 
weights upon the head has been said to 
cause the disease ; it is not probable that 
of itself the practice could produce true 
bronchocele ; but, undoubtedly, in common 
with all other physical efforts or forces, 
such as cough, which tend to impede tem- 
porarily and violently the general circula- 
tion about the neck, it will hasten its pro- 
gress. It is certainly more common among 
the class of females who are forced to make 
strong physical exertions. Many different 
cures have been proposed ; fortunately, we 
possess one so efficacious and certain, that 
it alone claims our attention. Iodine exerts 
the most powerful influence. Even before 
its discovery, the element was used, though 
ignorantly, in the form of the lozenge 
of burnt sponge. It is now most gene- 
rally employed in the form of ointment. 
One drachm of the compound of iodine and 
potash (the hydriodate of potash) is rub- 
bed up in a mortar with twenty or thirty 
drops of water, and then with an ounce of 
lard, and a portion of this^about the size of 
a small bean rubbed well into the tumour 
every night, intermitting the application, if 
the skin — as it often does — becomes sore. 
Or the tumour may be painted over every 
night with compound tincture of iodine, 
but this causes a yellow stain, [which is not 
permanent.] Should the tumour resist 
either of these means after they have been 
persevered in for some time, they may be 
assisted by five drops of compound tincture 
of iodine taken twice a day in water, on a 
full stomach. Acute attacks of broncho- 
cele require the application of leeches and 
the use of purgatives, to allay excited ac- 
tion, before iodine can be used with advan- 
tage. Bronchocele ought always to be sub- 
mitted to treatment as soon as discovered. 
If this is done there is seldom much diffi- 
culty in its removal ; but if it is allowed 
to gain a large size, or if it is of old stand- 
ing, it will resist the most persevering treat- 
ment, and perhaps prove a serious cause of 
inconvenience, especially if it becomes 



hardened, which it not unfrequently does 
as life advances. A curious superstition 
with respect to bronchocele prevails in some 
of the places in which it is endemic. It is 
believed that a cure will be effected, if the 
tumour is rubbed over by the right hand of 
the corpse of a " bachelor !" 

Refer to Iodine. 

BRONCHOTOMY or TRACHEOTOMY— 
Is the operation of making an artificial open- 
ing in the trachea or windpipe, in cases in 
which suffocation is threatened, from any 
cause which impedes or stops the passage 
of air into the lungs at a point nearer the 
mouth or nostrils than the site of the artifi- 
cial orifice. It always requires educated 
surgical skill for its safe performance. 

BROOM. — The common broom is one of 
our most certain and valuable diuretics, too 
much neglected ; it is, too, perfectly safe. 
The infusion is best made from the green 
tops ; a good handful — about an ounce — to 
a pint of water, which should be poured upon 
it boiling, and the whole allowed to stand in 
a covered vessel near a fire for some hours 
— of this, a teacupful may be given twice a 
day in all cases in which it is desirable to 
increase the flow of urine. It rarely fails. A 
few juniper-berries may be added to the infu- 
sion. In cases of liver affection, the substi- 
tution of half dandelion-root for one-half 
broom is a valuable combination. The seeds 
may be used when the tops cannot be pro- 
cured. 

BROTH — Is the decoction obtained from 
animal substances, and, when made for the 
sick, must, of course, be varied in strength, 
according to the state of the patient. It is 
best made by putting the article from which 
it is to be formed into the requisite quantity 
of cold water, and keeping the whole at a 
heat 'somewhat short of boiling, for many 
hours : it should then be allowed to become 
cold, and have the fat skimmed off. In 
cases of diarrhoea, broth, in quantity, is apt 
to increase the tendency to looseness, but it 
is at the same time extremely beneficial, if 
properly managed : in such cases, it is best 
made from veal or fowl, thickened with rice 
— which may be strained off — and must be 
given in small quantities only at a time. In 
Scotland, by broth is meant the decoction 
from meat, boiled with pearl barley and a 
good proportion of vegetables ; it is a much- 
used and wholesome article of diet, and 
might, with advantage, form an addition to 
the fare of all, but especially labourers, 
when economy in food is necessary. To be 
wholesome it must be thoroughly boiled. 

Refer to Beef— Beef-Tea— Mutton— Veal 



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BROW AGUE — A name for neuralgia de- 
rived from the marked periodicity of the at- 
tacks of pain. 

Refer to Neuralgia. 

BRUISES and CONTUSIONS— Are the 
effects of external violence applied to the 
body, and may he simple, or complicated 
with wound of the skin. The effects of 
bruises depend of course, greatly, upon their 
situation, and the possibility of the violence 
which produced them having injured import- 
ant parts, this being more likely to happen 
when the contusion affects the head, neck, 
or trunk. The first effect of a bruise is to 
cause effusion of blood, more or less, within 
the textures injured; on the head, this is 
very evident from the large tumour which 
will often rise immediately after a blow ; — 
a black eye renders the effused blood visible. 
Blood effused, as the result of a bruise, does 
not remain in one spot, but diffuses itself 
through the loose surrounding textures, and 
causes discolorations to appear at a distance 
from the bruise, days after the receipt of 
the injury. The changes in colour, from 
black or blue to greenish-yellow, &c. &c, 
which take place during the recovery after 
a bruise, and which are probably caused by 
the mode of absorption of the effused blood, 
are too well known to require description. 
After bruises of the abdomen, particular at- 
tention should be directed to detect the oc- 
currence of blood, either in the stools or 
urine ; if a medical man is called in, it is 
highly important for him to have informa- 
tion on these points. In bruises of the sur- 
face generally, the best and most agreeable 
application is lint soaked in cold water, or 
in a cold lotion made with half an ounce of 
tincture of arnica to the pint of water. 
After the lapse of five or six hours, hot ap- 
plications — poultices — will be most required. 
If heat be used too soon, it may tend to in-, 
crease the effusion of blood, which the cold 
checks. The same treatment may be fol- 
lowed, whether the bruise is simple, or com- 
plicated with wound. It is a frequent error, 
popularly, to apply leeches immediately after 
a bruise, when they cannot possibly be of 
service ; they cannot remove the blood 
which is effused, and are only useful in the 
event of inflammation succeeding the injury. 
After pain and inflammation, in a bruise, 
have subsided, simple water-dressing may 
be substituted for the poultices for a few 
days, and after that, should discolored swell- 
ing remain, friction with soap-liniment will 
hasten its removal. A severe bruise may 
run on to the formation of an abscess, or 
end in mortification of the part. In ei- 
ther case, the effect is known by the super- 



vention of the usual symptoms attendant on 
these processes, and must be treated accord- 
ingly. Severe bruise of a bone is liable to 
be followed by death and separation of the 
injured part. 

Refer to Abscess — Concussion — Mortification 
— Wounds Bruised. 

BUBO — Is the inflammatory swelling of 
a lymphatic gland, tending to suppuration. 
The term is most generally applied to the 
glands of the axilla and groin, when affected, 
either by venereal causes, or in the progress 
of the plague. The treatment of bubo is 
similar to that required in abscess generally. 

BUCK-BEAN, [Marsh Trefoil]— Is one 
of the most beautiful of our marsh-plants. It 
bears a trefoil leaf, and flowers in England 
in June. [In the United States it grows as 
far south as Virginia, and flowers in May.] 
The blossoms are white and feathery -looking, 
with a tinge of pink. The leaves of the 
buck-bean are powerfully bitter, and might, 
perhaps, be more generally used as a tonic 
than they are at present. The infusion may 
be made with an ounce of dried leaves to a 
pint of water. 

BUCK-THORN— Is a shrub, native to 
Britain, [but also found in New York and 
other sections of the United States ; it flowers 
in May, and its berries are ripe in Septem- 
ber.] A syrup made from its berries is used 
as a purgative, but it is apt to gripe, and 
need not be used when there are so many 
better medicines of the same class. 

BUNION — Is the result of chronic inflam- 
mation of a small bursa which is situated 
over the joint — at the ball — of the great toe, 
and is generally occasioned by the pressure 
of tight shoes. It is a most inconvenient 
and unsightly affection, and the more it en- 
larges, the more does it become exposed to 
those sources of irritation which originated 
it. A bunion ought to be attended to at 
first, and one or tAvo leeches, warm fomenta- 
tion, and poultice used to allay irritation, the 
offending shoe being at' once discarded. 
Malposition of the bones at the joint is a 
frequent attendant, and, perhaps, an ante- 
cedent cause of bunion. When the disease 
is fully formed, the best plan is to avoid, by 
the make of the shoe, &c. &c, every source 
of irritant pressure. 

BURGUNDY PITCH— Is a resin obtained 
from the pine tribe, but the real article is 
seldom procurable ; that sold for it being a 
preparation made from common resin. It 
is used for plasters ; they are slightly stimu- 
lant. 

BURIAL. — As a general rule, it is desir- 
able that the bodies of the dead should be i 
consigned to the earth as soon as consistent 



BUR 



83 



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■with decency and necessary arrangement, 
more especially where, as in the dwellings 
of the poor, space is confined and crowded, 
As an invariable rule, some means for the 
disengagement of chlorine — and Collins's 
powder [or chloride of lime] is perhaps the 
best — should be provided in the chamber 
occupied by a corpse ; it retards decomposi- 
tion, and destroys all noxious and offensive 
exhalations. 

Refer to Death. 

BURNS aio SCALDS — Are injuries in- 
flicted upon the body by heat, the latter 
term being confined to those cases in which 
the medium has either been liquid or vapour. 
A burn may vary in intensity, from the 
slightest scorch to complete roasting of the 
tissues : a scald is not so severe in its effects. 
There are. perhaps, no accidents for which 
more remedies have been proposed and used 
than those resulting from heat : but it will 
be sufficient if the best and most generally 
and easily applicable are kept in mind. 

In the cas,e of slight burns, and of scalds 
generally, quite the best application is the 
cotton wadding in sheets : it should be at 
once used to envelop the injured parts, 
double if possible, and bound or bandaged 
on with moderate firmness. If this mode of 
treatment be resorted to within the first 
twenty minutes after the injury, nothing 
more need be done : the cotton may be al- 
lowed to remain on from twenty-four hours 
to three or four days, according to the se- 
verity of the accident. Under its use blis- 
tering rarely occurs, and if it has commenced 
before the application, it subsides quickly 
and painlessly. For the -first ten minutes 
after the cotton-dressing is put on, the pain 
of the injured parts seems increased, but ere 
long it diminishes, and the inflamed skin 
appears to relieve itself by gentle perspira- 
tion. In the cases above named, when cot- 
ton is to be procured — and no house in the 
country ought to be without one or two 
sheets of it — it is perfectly unnecessary to 
use any other measures. 

Spirits, whisky or brandy, turpentine 
and other stimulants, all have their advo- 
cates, but the milder methods are preferable, 
at least domestically. A mixture of oil and 
lime-water is employed by some, but is dis- 
agreeable and dirty : it may be used in the 
absence of a better remedy. A lotion made 
with an ounce and a half of vinegar to a pint 
of water may with advantage be kept con- 
stantly applied to a burn if it be not arte 
— a saturated solution of carbonate of soda 
has likewise been recommended. Cold water 
is perhaps the most directly grateful appli- 
cation to a burnt or scalded surface, and if 



i continued sufficiently long, will undoubtedly 
restore the usual condition of the part, but 
it must be persevered with for many hours : 
and when a burn or scald is extensive, this 
is a serious objection, in consequence of the 
extreme constitutional depression which so 
often follows the accident, especially in the 
young. And here the opportunity is taken 
of warning parents of the necessity of 
watching closely the effects of even slight 
j injuries of this kind upon children, particu- 
larly when the chest or abdomen are the 
seat of the accident : extreme depression — 
requiring the use of stimulants — may unex- 
pectedly come on, and death, from an appa- 
rently very slight cause, be the result. When 
cotton is not readSy procurable, flour dredged 
over the surface is an admirable substitute, 
even in slight burns, but is more useful still in 
those severe effects of heat in which the tis- 
sues are deeply destroyed by the action of 
fire : in these cases, flour applied at once, 
. and repeated again and again for days to- 
gether, wherever slight moisture seems ooz- 
ing through the caked covering it forms, is 
the most generally applicable, pleasant, and 
safest remedy : a little fresh sweet-oil ap- 
plied to the surface in the first instance will 
make it adhere. [Coating the surface with 
thick white paint has proved an excellent 
plan of treatment. It should be allowed to 
dry and remain until thrown off by nature.] 
Whatever application is used in the treat- 
ment of a burn, should be calculated to ex- 
clude the action of the external air ; it ought 
to be one, also, which does not require fre- 
quent changing ; indeed, the more extensive 
the surface involved in the accident, the 
greater care should be taken not to expose 
it to atmospheric influence, which, in the 
first place, increases pain, and, in the second, 
adds to constitutional depression. This de- 
■ pression must always be carefully -watched, 
; and combated by the use of ammonia, wine, 
j or spirit, sufficient to support without sti- 
mulating. "When pain is excessive, and is 
| irritating the nervous system, a gentle opiate 
is required : but in some of the severest 
I burns, the sensation, not only in the injured 
] part, but generally, is either wholly or par- 
; tially abolished, in consequence of the shock 
! to the nervous system at large. The symp- 
tom is of most serious, and indeed fatal im- 
port. In the less severe forms of injury 
from heat, if the cotton, the flour, or cold 
water, have been properly used, little after- 
treatment is necessary ; but when a burn 
has been neglected or badly treated, the 
blisters broken, and when the true skin be- 
neath is inflamed and secreting matter, a 
simple tepid bread and water poultice 



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84 



BUT 



should, in the first place, be applied for six 
or eight hours, and after it an ointment com- 
posed of one drachm of liquor of lead or 
Goulard, rubbed up -with an ounce of per- 
fectly fresh lard. This ointment spread on 
linen quickly relieves the very painful con- 
dition of the injured surface, and is often 
preferable to the lead lotion sometimes used. 

In cases of deep burn, with destruction of 
the tissues, after the flour has been applied 
some days, it begins to be pushed off by 
the matter formed underneath : at this time 
poultices are to be continued until the caked 
flour is separated, and the surface be- 
low exposed, after which the simple dress- 
ing with tepid water will generally be the 
best and safest application ; or, in a later 
stage, if healing is slow, the lead oint- 
ment above recommended will be found 
useful. 

During the cure of burns involving con- 
tiguous parts, such as the fingers, care must 
always be taken to keep the surfaces asun- 
der by the interposed dressings : other- 
wise they may become united. After ex- 
tensive burns or scalds, the constitution re- 
quires attention — the stimulating treatment 
of the first few hours or days must be drop- 
ped when feverish symptoms come on, and 
mild and cooling diet, gentle aperients, and 
cooling saline medicines administered: opium 
being given if requisite, to allay pain or 
nervous irritation. This system will again 
require to be changed for one of stronger 
nourishment — meat soups, meat and wine, 
or other stimuli, if there is continued dis- 
charge. The use of stimulating diet, how- 
ever, requires caution, on account of the 
tendency to inflammation of the lining mem- 
brane of the stomach and bowels, which 
exists during convalescence from injury to 
the skin by heat. 

The frequent occurrence of accidents from 
burns or scalds, renders it desirable that 
all should be aware of the best methods of 
managing these painful injuries, which, 
when slight, may be well attended to with- 
out the aid of the surgeon ; but which, 
when severe and extensive, and when, in 
children, the chest or abdomen are involved, 
ought, without delay, to be put under pro- 
fessional care : accidents and symptoms may 
arise which educated skill alone can foresee 
or counteract. Scalds of the throat are 
not unusual accidents to children in conse- 
quence of their attempting to drink from 
the spout of a kettle of boiling water. The 
injury is imminently dangerous, and when 
it has occurred, whether alarming symptoms 
come on at once or not, a surgeon should be 
summoned. It may probably become ne- 



cessary very speedily to open the windpipe, 
to save from death by suffocation ; and the 
operation may be resorted to with good hope 
of success. In the interval, before the ar- 
rival of medical aid, leeches, from two to 
six, according to the age of the child, should 
be applied to the throat externally, and 
four grains of calomel administered at once. 
If ice is to be procured, it should be con- 
stantly put into the mouth in small frag- 
ments. 

In managing burns or scalds immediately 
after their occurrence, the following should 
be remembered : — 

To protect from the action of the atmo- 
sphere ; and the greater the extent injured 
the more necessary the precaution — [hence 
the advantage of coating it with the white 
paint, which thus serves the purpose of a 
scarf-skin, and shields the raw surface] — ■ 
to give stimulants or opium cautiously. The 
remedies, cotton, flour, paint, oil, and lime- 
water, vinegar and water, cold water. 
Refer to Skin — Water-dressing, §c. 
BURSAS — Are small bags of membrane, 
containing an oil-like fluid. They are placed 
in various parts of the body liable to press- 
ure or friction. 

BUTTER— The oily constituent of milk, 
separated by the process of churning, is one 
of the commonest, and, when properly used, 
most wholesome articles of food. When 
fresh, that is, free from rancidity, it forms 
a nutritious, it might almost be said in- 
stinctive, addition to farinaceous diet. Much 
has been said, in writings upon diet, re- 
specting the unwholesomeness of butter ; 
and, undoubtedly, in certain states of the 
system and of the digestive organs, it is so ; 
but for healthy individuals it is the reverse. 
Butter in some persons, and, if immoderately 
used, in all, gives rise to biliary derange- 
ment, partly, doubtless, from its furnishing 
an excess of biliary material, but also from 
its presence in the stomach, as observed by 
Dr. Beaumont, causing a flow, or regurgi- 
tation of bile into that organ. The above 
remarks apply to simple butter unspoiled 
by cookery. When butter is exposed to 
gentle heat it melts, and under this con- 
dition has obtained a reputation for in- 
digestibility which is due rather to the 
quantity consumed than to its being merely 
put in that state which it assumes when it 
is exposed to the heat of the stomach. The 
case is very different, however, when butter 
has been exposed, whether alone or com- 
bined with farinaceous articles, to a high 
temperature, such as that of an oven : it 
now becomes altered in character, (empyreu- 
matized,) and is rendered very indigestible 



BUT 



85 



CAM 



and irritating to the weak stomach. It is 
for this reason that baked pastry is so ranch 
more indigestible than boiled, from the 
greater heat to which the former is ex- 
posed. Batter, when it becomes rancid, 
contains various acids which are so un- 
wholesome that they may almost be ranked 
as poisons. 

BUTTERMILK— The thin acid fluid left 
after the separation of the butter, is a most 
wholesome and refreshing article of diet, 
either in health or sickness, and one too 
much neglected. In diseases attended with 
fever it may be given largely with benefit. 
It can be made artificially, by shaking a 
quantity of milk in a bottle capable of con- 
taining four times the quantity, until the 
butter (which must be strained off) is se- 
parated. The cork of the bottle being re- 
moved occasionally during the process, to 
permit of the renewal of the air. 

CABBAGE — As an article of diet, is not 
only wholesome, but extremely nutritious. 
It is, however, only suited for persons of 
good digestive powers. [Unboiled cabbage, 
in the form of " cold-slaw," is more easily 
digested than that which is boiled, as the 
heat drives off the ammonia, which, as a 
stimulant, assists digestion.] From the ex- 
treme liability of cabbage to pass into a 
state of putrefaction, it should always be 
used as fresh as possible. 

CACHEXIA — Is a term used to express 
an unhealthy state of the system, induced 
by causes which tend to depress without 
causing fever, such as deficient or unwhole- 
some nourishment. — See Scurvy, Rickets, 
&c. 

CADDIS.— Lint. 

CiECUM. — The commencement of the 
large intestine. — See Alimentary Canal. 

C/ESARIAN OPERATION— Is the pro- 
cess of extracting the infant by cutting 
through the walls of the abdomen and 
womb. It is occasionally resorted to by 
medical men, as a fearful necessity, to save 
life, when delivery can in no other way be 
effected. It derives its name from the tra- 
dition that Julius Csesar was brought into 
the world in this manner. 

CAFFEINE — Is the characteristic princi- 
ple of coffee, identical with that of tea, 
"theine." It is a compound, nearly ap- 
proaching the kreatine of animal muscle in 
its constitution. — See Coffee. 

CALAMINE — Is a carbonate of zinc em- 
ployed in medicine in the form of a gray 
powder ; it is chiefly used to sprinkle upon 
excoriations, chaps, &c. &c. ; but there are 
so many better applications that it might 
be altogether dispensed with. Mixed with 
H 



wax and olive-oil, it forms the ointment 
known as " Turner's cerate." The propor 
tions are, calamine and Wax, of each half a 
pound, olive-oil sixteen fluid ounces. The 
wax and oil are melted together, and the 
powdered calamine is stirred in during the 
process of cooking. 

CALCULUS, [Stone.]— See Gravel. 

CALOMEL. — See Mercurials. 

CALORIC— The term used to distin- 
guish the cause of the sensation of heat, 
from the sensation itself. — See Heat. 

CALUMBA, or COLUMBO, or COLOMB A 
— Are different modes of spelling the name 
of the same root. Columbo-root is sold in 
transverse sections of various diameter and 
thickness, which are covered by a brown 
wrinkled bark, are of a grayish-yellow co- 
lour, and rayed on the cut surface. Coluni- 
bo is one of the best pure bitter tonics we 
possess ; it is free from astringency, and ex- 
erts a sedative action. In irritable dys- 
pepsia, with vomiting, and particularly in 
the vomiting of pregnancy, its effects are 
most beneficial, especially when it is com- 
bined with from five to fifteen grains of 
either bicarbonate of soda or of potass. 
Columbo may be given in powder, in infu- 
sion, or tincture, but never in decoction. 
The dose of the powder is from ten grains 
to forty ; of the infusion, from a tablespoon- 
ful to a wineglassful ; of the tincture, one 
to two teaspoonfuls in water. The powder 
of columbo may be taken in water, simple 
or aromatic : eight parts of columbo-pow- 
der, eight parts of carbonate of soda, and 
two parts of ginger form a most excellent 
stomachic in dyspepsia, of which half a tea- 
spoonful may be taken in a wineglassful of 
water once or twice a day. An infusion of 
columbo is made by pouring a pint of boil- 
ing water upon five drachms of the sliced 
root, and macerating for a couple of hours 
in a covered vessel. It ought to be made 
fresh every day, as it quickly spoils. Tinc- 
ture of columbo is better purchased. — See 
Tinctures. 

CAMBOGE, or GAMBOGE— The well- 
known pigment, is a drastic cathartic, too 
powerful to be used alone with safety as a 
domestic remedy. In an overdose it se- 
riously irritates the lining membrane of 
the stomach and bowels, causing inflam- 
mation of a dangerous or fatal character. 
Camboge is said to form a constituent of 
some of the quack purgatives ; and certainly 
any compound medicines containing it can- 
not be safely adopted for general or ''uni- 
versal" use, however valuable the medicine 
may be when administered in proper cases. 
When simple purgative action is required, 



CAM 



CAM 



camboge cannot be requisite while we pos- 
sess safer and equally effective drugs ; but 
from its property of producing free watery 
evacuations from the bowels, in cases of 
dropsical swelling, it is very serviceable. 
Camboge is most safely and advantageously 
given in combination, and the compound 
camboge pill is a powerful cathartic, adapt- 
ed for those in whom confined bowels ac- 
company a full and strong habit of body. 
The pill is made by mixing together, in fine 
powder, camboge one drachm, aloes one 
drachm and a half, ginger half a drachm, 
and beating up the whole into a mass with 
two drachms of soap. The dose of the pill 
is from five to ten grains. It is not suited 
to delicate habits. 

liefer to Dropsy — Cathartics. 

CAMPHOR — Is a white, semi-transpa- 
rent, volatile substance, but resembles in 
some degree the volatile oils. It is stimu- 
lant, diaphoretic, antispasmodic, and ano- 
dyne. Camphor is but sparingly dissolved 
by water, but sufficiently so to communicate 
both taste and smell, and to form a slightly 
stimulant solution or julep, which may 
either be used internally or as a refrige- 
rant lotion. It is most simply made by 
keeping a few fragments of camphor in a 
bottle of water. In the low stages of fever, 
camphor is one of the most valuable re- 
medies we possess, exerting at once a sti- 
mulant and a soothing effect. It is some- 
times given for this purpose in almond 
emulsion, but quite the best vehicle is milk. 
From twenty to thirty grains of powdered 
camphor are to be rubbed up in a mortar 
with an ounce of milk, and five ounces of 
water gradually added ; of this mixture the 
dose will be two tablespoonfuls. It must be 
remembered that camphor cannot be re- 
duced to powder, unless the lump is first 
wetted with a few drops of alcohol, or spirit 
of some kind. Spirit, oil, and acetic acid, 
all dissolve camphor readily : its solution or 
tincture, in the first, is well known as a 
dentifrice, and is frequently given domes- 
tically, dropped into water, as a stimulant, 
in colic, hysteria, &c. &c. It is made by 
dissolving one ounce of camphor in eight 
ounces of spirit. The dose is from ten to 
forty drops, in water. The solution of one 
ounce of camphor in eight ounces of olive- 
oil forms the common domestic stimulant 
embrocation, camphorated oil. An over- 
dose of camphor produces giddiness, con- 
fusion of sight, and delirium : an emetic is 
the best remedy. 

Refer to Dentifrice — Embrocation. 

CANCER — Is one of the most fearful, 
and justly one of the most dreaded diseases 



to which the human frame is liable ; and 
while its formidable nature classes it with 
those which ought at once to be placed under 
proper medical care, the same reason ren- 
ders it most important that its first symp- 
toms should be known and attended to, 
while there is yet time to save life. Cancer 
usually commences as a hard tumour, un- 
accompanied with inflammation, and either 
painless, or the seat of intermittent shoot- 
ing pain. It more frequently occurs in fe- 
males than in males, and attacks the breast 
oftener than any other organ. In men, the 
genitals are liable to be affected ; and chim- 
ney-sweeps particularly become the subjects 
of cancer of the scrotum, produced, in all 
probability, from continual contact of the 
soot. The skin generally may become the 
seat of cancer. Of the internal organs, the 
womb in the female, and the stomach, are 
the most frequent seats of the disease ; of 
these the symptoms will be noticed under 
the head of the individual organs. Cancer 
is very rare under thirty years of age. 
When, from the nature of a tumour, its 
hardness, situation, age of the patient, and 
particularly if there be any hereditary bias 
toward the disease, incipient cancer is 
suspected, there should be no trifling, no 
leechings, or rubbing, or fomentings ; the 
advice of a skilful surgeon should be sought 
at once ; and neither time, distance, or ex- 
pense, should stand in the way of procur- 
ing that assistance which may not only pre- 
serve life, but save from a lingering and 
painful death. Should the suspicion be un- 
founded, the mind is restored to peace ; 
should they be correct, the one remedy, ex- 
cision, cannot be too soon submitted to, be- 
fore the glands adjacent to the disease, or 
other textures of the body, become tainted. 
In any stage of the disease, however, the 
advice of the regular practitioner ought to 
be taken. Above all, let the sufferer and the 
friends beware of being tempted by the specious 
advertisements of quack remedies, and of toasting 
time of which every day is precious. 

When, unfortunately, cancer has reached 
the stage at which hope of cure must be 
given up ; when it has become an open, 
gray-looking ulcer, discharging thin, fetid 
matter, the seat of shooting and stinging 
pain, and when the constitution is affected 
it only remains to make the situation of the 
sufferer as comfortable as possible. Opium 
in its various forms is the great soother, 
and the other anodynes, hemlock especially, 
both internally and as a poultice, are all of 
service. Codliver-oil in some cases allays 
the pain and retards the progress of the 
disease ; but the regulation and administra- 



C AN 



87 



CAO 



tionof these remedies must be committed to 
the care of the medical attendant : the do- 
mestic remedies must be the most perfect 
cleanliness and kindest consideration for 
the comfort and irritabilities of any one who 
is the victim of cancerous disease. Cancer 
cannot be said to be propagated by contact ; 
but this should be avoided as much as pos- 
sible — in the intimate relations of husband 
and wife especially, whatever the organ or 
structure affected. 

The lower lip is not unfrequently the site 
of cancer in old people, especially, it is said, 
in those who smoke much. A painful sore 
in this situation, which will not heal, ought 
not to be neglected, but submitted to medi- 
cal examination. 

Refer to Breast — Stomach — Womb, S m c. 

CAXCRUM ORIS— Is a species of mor- 
tification, or gangrenous inflammation, af- 
fecting the cheek and gums. It occurs in 
children of weak, scrofulous constitution, 
who are ill-fed and exposed to the influ- 
ences of unhealthy habitations ; and most 
generally immediately after acute disease. 
particularly measles. Mercury is often 
blamed as the originator of this disease, 
and, if given too freely, it may perhaps con- 
tribute toward its development ; but the 
main fault is in the constitution. The usual 
first symptom of the disease is a red, hard. 
angry-looking spot on the cheek, which 
quickly opens into a gangrenous fetid ulcer 
inside the mouth, the gums become af- 
fected, the teeth drop out, the breath, as 
might be expected, is unbearably fetid, and 
the extending ulceration goes on destroying 
the cheek and contiguous parts, tiR it is 
either stopped or death ensues. 

As the first cause of this fearful affection 
is traceable to poverty of constitution, the 
firsi remedial measure is to nourish. The 
acta -.rest meat-soup — beef-tea is the best — 
must be given in small quantities frequently 
repeated ; milk and eggs, if the Uttle patient 
will take them. Wine may be allowed if 
the debility is extreme, but scarcely, if at 
all, should fever run high, and there is 
much heat of skin. The preparations of 
chlorine are most to be relied on as medi- 
cines. A drachm of chlorate of potash is 
to be dissolved in six ounces of water, and 
to this added twenty drops of muriatic acid. 
A tablespoonful of the mixture to be given 
to a child of six years of age every four 
hours : it may be slightly sweetened. Half- 
grain doses of quinine, or an ounce of infu- 
sion of bark, may be given twice or three 
times in the twenty-four hours. A lotion 
made with a drachm of chloric aether to the 
half-pint of water is extremely serviceable 



applied to the affected parts, and diminishes 
the fetor : or a drachm and a half of the 
solution of the chloride of soda to the half- 
pint of water may be used for the same 
purpose. The case ought to be seen by a 
medical man as soon as practicable. 

CA>~ELLA BARK — Is an aromatic tonic, 
and is used as a spice. It may be given in 
powder, in doses of fifteen or t went v grains. 

CANINE TEETH.— See Teeth. 

CAXTHARILES.— The word is the Latin 
plural of Cantharis — uesicatoria, the Spanish 
blistering-fly. — See Blister. In addition to 
its uses as a blistering agent, the Spanish 
fly is used internally ; but is too hazardous 
a remedy for general use. I: is s:raeiimes 
given as a poison for malicious or criminal 
purposes. When swaUowed in a poisonous 
dose, cantharides quickly produce severe 
pain in the stomach and bowels, and in- 
tense inflammation; distressing irritation 
of the urinary organs foUows, with constant 
desire to pass urine, which comes away in 
small quantities, with or without blood, or 
is entirely suppressed : stupor and delirium 
precede death. The remedies, in a case of 
poisoning by Spanish fly, must be of the 
most soothing character. Milk given cold 
may. as it coagulates in the stomach, enve- 
lop the irritant particles, or it may be used 
boiled with flour ; white of egg, linseed-tea, 
or indeed the emoRient most quickly and 
easily procurable, should be swallowed 
largely, and vomiting, if not present, pro- 
moted by a feather in the throat, or by 
ipecacuanha. Oil is sometimes forbidden 
in such cases, from its being a solvent of 
cantharides : but after vomiting, or even 
before if the dose is not large, one or two 
doses of castor-oil may safely and advan- 
tageously be given, each in combination 
with twenty or thirty drops of laudanum. 
Clysters of starch, linseed-tea, or the Eke, 
with or without laudanum, wRl allay the 
irritation in the lower bowels. Hot appli- 
cations to the abdomen generally should be 
used, and if there is much tenderness, 
leeches freely. Should the patient recover, 
the state of the aEmentary canal and uri- 
nary organs for some time require care, 
and the mildest and most unirritating mode 
of Eving must be pursued. A Ettle can- 
tharides ointment, smeared upon the silk 
of a seton, increases the discharge when de- 
ficient. 

Refer to Blister. 

CAOUTCHOUC, op. Elastic Sum, or Ix- 
DiA-RrBBES — Is obtained from different 
species of trees, both in South America and 
in the East Indies. It is interesting in me- 
dicine, from being the basis of the various 



CAP 



88 



CAR 



elastic mechanical contrivances now so ex- 
tensively used in the relief and cure of 
disease. One of the chief inconveniences 
in the use of caoutchouc was its becoming 
hard when cold ; the discovery of its com- 
bination with sulphur — vulcanized India- 
rubber — has obviated the difficulty, and we 
now have a material which remains perfectly 
elastic and soft at all temperatures. This 
valuable property has been quickly taken 
advantage of. The water-cushion, a bed, 
is one of the most useful applications of the 
material ; it can be filled either with boiling 
or with iced water, the latter a very valu- 
able resource in fever, for keeping — what 
there is always much difficulty in doing — 
the back of the head cool. 

Refer to Elastic. 

CAPILLARY.— Hair-like. The term is 
applied to the minute vessels connecting the 
arteries with the veins in the animal body ; 
also to tubes of minute calibre. 

CAPSICUM. — Cayenne pepper is better 
known as a condiment than as a medicine. 
A product of warm climates, it is admirably 
suited as a stimulant counter-agent to the 
relaxing effects of heat. It is extensively 
used in this country, and, when not im- 
moderately, is undoubtedly serviceable to 
persons of languid digestion. In too large 
quantity it will, of course, prove an irritant 
poison. Two parts of cayenne, three of 
compound rhubarb pill, and one of quinine, 
form an excellent dinner-pill, from three to 
six grains of which may be taken twenty 
minutes before the meal, for a week or ten 
days at a time, by persons of feeble habit 
of body, with tendency to constipation. Dr. 
Christison recommends a strong infusion of 
cayenne — a teaspoonful in six fluid ounces 
of boiling water — to be used as a gargle in 
incipient sore throat — fever being absent. 
The accidental introduction of a particle of 
cayenne into the larynx is dangerous ; it 
has occasioned death. 

CARAWAY-SEEDS— Are the fruit of an 
umbelliferous plant, and are too familiarly 
known to require description. They are a 
good carminative, may be given whole, in 
teaspoonful doses, or in the form of distilled 
water, a wineglassful at a time, or may be 
added to other medicines, such as senna. 

CARBON — Carbonic Acid — Carburetted 
Hydrogen. — Carbon, charcoal, occurs in its 
purest natural state in the form of the dia- 
mond and of plumbago, both of which are 
pure carbon. It is one of the bodies con- 
sidered elementary, and forms a large pro- 
portion of the matter of our globe and of its 
productions. The most familiar form of 
carbon is that of wood charcoal, which is 



interesting in a medical and hygienic point 
of view, from its powerful antiseptic proper- 
ties, and the rapidity with which it removes 
the signs of, and tendency to, putrescency. 
Water which has become putrid, as it fre- 
quently does, at sea, is quickly restored to 
wholesomeness by agitation with charcoal 
powder. The powder is frequently applied 
to fetid and sloughing sores, either sprinkled 
upon them or mixed with one of the common 
poultices : it is a good dentifrice. 

Carbon, either in a fixed or in a tran- 
sitory condition, is an important and abun- 
dant constituent of organized bodies. Of the 
vegetable kingdom it is the characteristic 
element ; every leaf and every blade of 
grass which is exposed to the influence of 
daylight is busy abstracting from the at- 
mosphere the carbonic acid, which is con- 
tinually diffused through it in small propor- 
tions, decomposing it, and rendering back 
to the air the vital oxygen, but fixing the 
carbon as a component of the vegetable 
solids, and putting it in that form in which, 
along with other elements, it is fitted to 
become the nutriment of the animal. Car- 
bon, although not so characteristic a com- 
ponent of the animal as of the vegetable 
kingdom, yet enters largely into the con- 
stitution of the former ; it assists to give 
permanent form to the various tissues, and 
furnishes one of the most active material 
agents, which, under the influence of life, 
make up the sum, and contribute to the 
varied changes and effects which are ever 
going on in the animated body. We have 
every reason to believe that carbon is the 
medium by which, as it combines with the 
oxygen inhaled by the lungs, and carried 
through the system by the blood — the ani- 
mal temperature is maintained. Such being 
the case, it is evident that, next to oxygen, 
carbon is the element which must be most 
regularly and sufficiently supplied to the 
living body ; the other constituent elements 
must undoubtedly be provided in food, but 
their omission for a time is not so apparently 
and quickly felt as that of carbon ; if this 
be not furnished from outward sources, it is 
used up from the bodily tissues as long as 
they will yield it, even though its use in- 
volves their destruction, and the dispersion 
of the other elementary bodies of which they 
are composed. This actually happens in long 
fevers, during which little or no nourish- 
ment is taken ; the carbon — and hydrogen — 
of the fat in the first place, and afterward 
of the other portions of the body, is used up 
in sustaining the animal heat — as fuel — 
until a point is reached when it can be 
yielded no longer, and when the patient will 



CAR 



89 



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actually die of colcl, unless there is freely I 
administered the gelatinous soups, the wine 
and spirit, with their abundant carbon and 
hydrogen, which yield their own combustible 
elements, to maintain the heat and to pro- J 
tect the tissues of the already exhausted 
patient. 

The discoveries of modern chemistry show 
us how beautifully the Almighty, in his I 
goodness, has arranged the products of the 
various latitudes of the globe, has disposed 
the varied articles of food he gives to , 
his creatures, to man, in accordance with 
the various climates, and modes of life in 
those climates, so that carbon may be con- | 
sumed in due proportion along with the j 
other elements ; less in the watery fruits of 
the tropics and of our own summers, more 
in the fats and oils of the cold north. 

Refer to' Aeration — Blood — Bile — Diges- \ 
lion — Food — Respiration, §c. 

CARBONIC ACID GAS, ok Choke-damp— \ 
Is a compound of one part of carbon with j 
two parts of oxygen : it is colourless, and 
much heavier than atmospheric air, a pro- 
perty which gives it a dangerous tendency 
to collect at the lower parts of any enclosed 
spaces in which it may be disengaged. Old j 
wells, brewers' vats, the holds of ships, &c. j 
are all liable to become the receptacles for 
carbonic acid gas, which, formed from some i 
decomposing vegetable matter, lies like a j 
stratum of water at the bottom of the re- 
ceptacle. Should any one incautiously ' 
descend, so as to become enveloped in the 
carbonic acid atmosphere, respiration is j 
either instantly stopped by spasmodic clo- ■ 
sure of the chink at the upper portion of : 
the windpipe, and complete suffocation is ■ 
the consequence ; or the gas, if sufficiently 
diluted with air to be drawn into the lungs, ■ 
speedily manifests its narcotic effects upon 
the system, and the person quickly falls in 
a complete state of stupor. The respira- 
tion becomes laboured, and after a time 
ceases ; the countenance is livid or pale, 
and there may be convulsion and frothing 
at the mouth. In such a case, the body 
of the individual must be removed, if 
possible, and as soon as possible, from 
the poisonous atmosphere, or the lat- 
ter must be destroyed or dispersed. The 
many fatal accidents which have occurred 
from persons venturing rashly into wells, 
and such like places, might be a warning 
for the future, and prompt the invariable 
employment of the simple test of lowering 
a lighted candle into the suspected place. 
If the flame be extinguished, the atmo- 
sphere is certainly destructive to life ; if it 
burn even with a feeble and diminished in- 
h 2 



tensity, there is danger. Of the various 
modes for destroying a carbonic acid atmo- 
sphere, none is more speedily effective than 
the introduction into it of newly slaked 
lime, either spread upon a board, or mixed 
with water, and dashed into the place ; 
fresh lime, having a powerful affinity for 
carbonic acid, quickly absorbs it. In the 
absence of lime, a quantity of fresh water 
dashed freely down, so as at the same time 
to absorb the gas and promote circula- 
tion of air, will be serviceable ; or large 
bundles of combustible material, which 
will cause currents of air, may, when blaz- 
ing freely, be thrown in. Caution in the 
first instance is the best preservative ; but 
in the event of an individual dropping in 
an atmosphere of choke-damp, it is per- 
fectly useless for others to rush in to bring 
him out ; they can no more exist in it than 
he could, and in stooping to lift a fallen 
body, they become all the more thoroughly 
immersed in the poisonous gas. Instead of 
rashly sacrificing life in the ill-directed en- 
deavour to rescue another, let those who are 
present dash bucket after bucket of water 
or weak lime and water into the place, and 
on the fallen person, until the unextin- 
guished flame tokens that the fatal atmo- 
sphere is weakened at least ; and when they 
do venture in, tie over the mouth a cloth 
soaked in lime water, in a iceak solution of 
caustic potash, or of simple water, if these 
cannot be obtained. 

In cases of suffocation from immersion in 
choke-damp, cold water should be dashed 
freely over the individual as soon as re- 
moved into the open air, and this measure, 
succeeded by heat applied to the surface, 
stimulant embrocations to the chest, spine, 
&c. stinmlant clysters, and ammonia held 
at intervals to the nostrils, while artificial 
respiration [compressing the chest and 
allowing it to expand, or by breathing into 
the patient's lungs] is at the same time 
brought into action, and steadily persevered 
in for some hours. [Medical advice should 
also be obtained as soon as possible.] 

Carbonic acid is produced during fer- 
mentation, or by the slow decomposition 
of vegetable matter, such as damp straw, 
sawdust, wood-chips, &c. It is the gas dis- 
engaged in effervescing liquors generally ; 
it is also produced, along with other vapours 
of which carbon forms a constituent, in the 
burning of charcoal. 

Poisoning by charcoal fumes, either by 
design or accident, is not an unfrequent 
occurrence. In the latter case, it usually 
occurs from persons ignorantly retiring to 
sleep in a closed-up room, in which burn- 



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ing charcoal is used as a means of warmth. 
The carbonic acid and other fumes disen- 
gaged act slowly and insidiously, and exert 
so powerful a narcotizing effect, that those 
exposed to the influence are quickly ren- 
dered unable to remedy the circumstances, 
and perfect insensibility ensues. Too often 
it happens that the discovery of the acci- 
dent does not take place until morning, 
long after it is too late to remedy the fatal 
effects ; the sufferers being usually found 
dead. If living, they will probably be per- 
fectly insensible ; the countenance pale and 
livid. Immediate removal to the open air, 
and free exposure to its influence by re- 
moval of the greater part of the clothing, 
is the first proceeding, when the treatment 
recommended in cases of poisoning from 
choke-damp should be followed. Carbonic 
acid is largely evolved in the process of 
lime-burning, and persons who have in- 
cautiously slept in the immediate neigh- 
bourhood of a kiln have been destroyed by 
it. The poisonous contamination of the air 
in crowded assemblies has already been 
treated of in the articles, "Aeration," 
" Air," "Blood," &c. 

There is yet another source of poisoning 
by carbonic acid, which occurs when it is 
largely given off from fluids taken into the 
stomach in a state of fermentation. This 
accident is said by Liebig to happen in Ger- 
many in consequence of persons drinking 
wine while it is fermenting ; the genera- 
tion of the carbonic acid is stimulated by 
the heat of the stomach, and it is given off 
in such quantity as to permeate even the 
lungs, causing suffocation. The best reme- 
dy is ammonia, both inhaled and taken into 
the stomach. 

In medical practice, carbonic acid is 
given in the form of effervescing drinks. 
Some mineral waters contain it naturally ; 
soda-water and other similar fluids are 
mechanically impregnated with the gas; 
it is, also, very frequently given as disen- 
gaged from one of the carbonates of the 
alkalies by means of an acid. In most cases, 
the action of carbonic acid, given in this 
way on the stomach, is very beneficial ; it 
appears to be both stimulant and sedative, 
and no remedy is more generally useful in 
cases of vomiting ; it is an agreeable form 
of medicine to most persons. When effer- 
vescing drinks are given to persons confined 
to bed, they should always sit up for a few 
minutes after the daught is swallowed, to 
allow of the eructation of the air, which, 
not being got rid of in an horizontal pos- 
ture, may produce uncomfortable distension. 

Prefer to Effervescing. 



CARBURETTED HYDROGEN.— Coal- 
gas, or fire-damp, is a compound of carbon 
with hydrogen. The fearfully destructive 
explosions in the coal-mines are the result 
of the ignition or this gas when it has col- 
lected in quantity. Its constant use in 
dwelling-houses, as a means of light, some- 
times gives rise to similar accidents ; and 
occasionally life has been endangered by 
the inhalation of it when it has escaped 
into an apartment, as has sometimes oc- 
curred from persons, unused to gas-light, 
blowing out the flame on going to bed, in- 
stead of turning the stopcock. In such 
cases, a .treatment very similar to that pur- 
sued in poisoning by carbonic acid may be 
followed out. 

CARBUNCLE resembles a boil in many 
respects, but is larger. It is a hard, in- 
flamed, intensely painful swelling, of any 
size up to that of a saucer, or even larger. 
It is flat on the top, and contains a slough, 
or mortified portion of cellular tissue, which 
must be discharged before the disease can 
subside. After the inflamed swelling has ex- 
isted for some days, small points of ulcera- 
tion begin to show themselves through the 
skin on its surface — they enlarge, coalesce, 
and at last form one large opening, through 
which the slough or core is discharged, 
either entire or broken down and mixed 
with bloody matter. When all has been got 
rid of, the cavity begins to fill up from the 
bottom ; and generally in the course of a few 
weeks becomes entirely healed. Such is 
the progress of a carbuncle, which does not 
| require interference. The treatment con- 
I sists, in the first place, of assiduous foment- 
i ation, and poultices of bread, oatmeal, or 
I linseed meal, and, in the open stage, yeast. 
When the cavity is fairly emptied of sloughs, 
the poultice must be exchanged for water- 
dressing, which will in all probability re- 
quire no alteration during the cure. A 
small carbuncle may thus, as far as the 
sore is concerned, be simply and safely 
attended to, but much more may be re- 
quired. Carbuncle occurs in two very 
opposite states of system — in those of full 
habit, and in those of broken constitution. 
In the former, eight or ten leeches may 
with advantage be applied round the base 
of a large incipient carbuncle, and free 
purging, cooling saline medicines, and low 
diet be resorted to. Should a surgeon be 
in attendance, he will probably make a free 
crucial incision to facilitate the exit of the 
core. In those of broken constitution, the 
opposite treatment will be requisite — all 
unnecessary loss of blood must be avoided, 
and while gentle alterative mercurial ape- 



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rients are given, the system must be soothed 
by opiates, and supported ty quinine or 
bark, along with strong meat-broths, wine 
or porter. In such constitutions, a car- 
buncle of any size is a serious, and not 
unfrequntly a fatal affection. Carbuncle is 
certainly indicative of a deranged state of 
the system generally, and of the assimila- 
tive powers in particular ; it more frequent- 
ly happens, too, that a large carbuncle has 
been preceded by two or three smaller 
ones, or boils, in succession. The occur- 
rence of these ought always to be taken as 
a warning; the man of full habit should re- 
duce his diet, meat and stimuli in particu- 
lar; take exercise freely, and five or six 
grains of blue pill and compound colocynth 
pill every night, or every second night, for 
a week or ten days, with a gentle saline ape- 
rient in the morning. A tendency to car- 
buncle in the delicate or aged should always 
be seriously regarded, not only as indi- 
cative of functional disorder in assimi- 
lation, but from the direct danger arising 
from the disease itself. On this account, it 
is always desirable that the case should 
be early put under efficient medical care, 
so that constitutional treatment may, if 
possible, ai*rest the threatened evil. In 
case a carbuncle of any size is developed 
in persons advanced in life, or of weak 
constitutional power, it is too dangerous 
to be left to domestic management if medi- 
cal assistance can be procured. If not, the 
treatment should be carried out as above 
directed. 

The most frequent seat of carbuncle is the 
back part of the body and head, the arms 
and thighs. 

CARDAMOMS— Are the seed-capsules 
and seed of a shrub which is a native of the 
islands of the Indian sea. They resemble 
orange-seeds in shape, are about half an 
inch long, and the covering which envelops 
the seeds is brown and tough, and must be 
removed. Cardamoms are one of the best 
aromatics we possess, particularly the com- 
pound tincture, in one or two teaspoonful 
doses in water. The powder of the seeds 
may be given in from ten to fifteen grains 
at once. 

CARDIAC— Belonging to the heart. 

CARDITIS.— Inflammation of the heart 
is named pericarditis when it affects the 
membrane covering the outer surface ; endo- 
carditis when the lining of the cavities is 
affected ; and carditis when the muscular 
substance is involved. 

Acute inflammatory affections of the heart 
may arise from cold, violence, &c. but in the 
majority of cases they are concomitant with 



rheumatism, in the progress of which they 
are so apt to arise that the medical attend- 
ant must be constantly on his guard to coun- 
teract the slightest symptom indicative of a 
tendency toward the heart becoming in- 
volved. This tendency he may sometimes 
detect by means of the stethoscope, even 
before the patient complains or is conscious 
of any uneasiness about the organ ; this is 
of course a great advantage and strong ar- 
gument why every case of rheumatic fever, 
however slight in appearance, should be 
placed under the care of the regular medical 
practitioner. But the symptoms of inflamed 
heart, particularly in the above disease, 
may come on suddenly — while medical aid is 
hours distant. The patient being seized with 
palpitation, increased rapidity of pulse, op- 
pression of breathing, and sense of extreme 
anxiety in the region of the affected organ, 
(pain may or may not be present,) every 
minute is of consequence. Leeches, if pro- 
curable, should be applied over the region 
of the heart to the number of twelve or 
eighteen, according to the condition of the 
patient. Continued nausea should be main- 
tained by the fourth or sixth of a grain of 
tartar emetic, given every three or four 
hours, and a pill containing three grains of 
calomel and half a grain of opium given 
every four hours. Perfect quiet and the 
lowest diet must be observed. If the rheu- 
matic inflammation has suddenly deserted a 
previously inflamed joint, it will be well to 
apply a mustard-plaster to the place, with 
the view of re-exciting the action which 
appears to have been transferred to the 
heart ; at the same time, it must be remem- 
bered that the heart may be affected with- 
out any such apparent transference. 

The above measures judiciously carried 
out will do much to retard the progress of 
so serious a disease as carditis ; and there is 
the advantage, that from its so frequently 
accompanying rheumatic fever, an unpro- 
fessional person will have less difficulty than 
in many other affections, of making up his 
mind on the nature of the seizure. In- 
flammation of the heart, whether arising 
in the progress of rheumatic fever or not, 
will of course be characterized by the 
same symptoms. The treatment recom- 
mended above rs to be resorted to irre- 
spective of cause. 

CARMINATIVES— Relieve flatulence and 
spasm in the bowels. The principal car- 
minatives are dill, anise, caraway, lavender, 
peppermint, pennyroyal, and their various 
preparations ; but any stimulants and aro- 
matics, such as nutmeg, ginger, spirituous 
liquors, &c. &c. are carminatives. 



C AE 



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CAROTIDS— Are the large arteries which 
pass up the neck on each side of the wind- 
pipe, to supply the head with blood. — See 
Artery. 

CARRARA WATER— Is an artificially pre- 
pared effervescing water, holding carbonate 
of lime in solution by means of an excess of 
carbonic acid. It is useful in some forms 
of dyspepsia. 

CARRAGEEN MOSS.— The article sold 
under this name is a sea-weed. When boiled 
in water it yields a vegetable jelly, or muci- 
lage, which requires flavouring to make it 
palatable. It is nutritive, but probably not 
more so than other jellies. One ounce of 
carrageen, previously soaked for a quarter 
of an hour in cold quarter, is to be boiled 
in a pint and a half of water till it is dis- 
solved. 

CARRON-OIL, [or "Lime-water Lini- 
ment"] — Is a mixture of equal parts of 
lime-water and linseed-oil ; it has been much 
celebrated as an application in burns, having 
first come into use at the Carron iron-works, 
in Scotland. It is certainly soothing, but 
need scarcely be employed while there are 
other and less disagreeable remedies at 
hand. When used it is smeared over the 
burnt part by means of a feather. 

Refer to Burns. 

CARROT— The well-known vegetable, is 
nourishing, and contains a considerable pro- 
portion of saccharine matter, but it is not 
easily digested by weak stomachs, and re- 
quires thorough boiling to make it whole- 
some for any. In the experiments of Dr. 
Beaumont, a carrot was found to take three 
hours and fifteen minutes of the healthy 
digestive process for its solution. 

CARTILAGE— Gristle— Is a white-look- 
ing, semi-transparent substance, closely re- 
sembling gelatine in composition. It covers 
the extremities of the bones at the joints, 
and also serves as a bond of union between 
different bones. Bone itself is in the first 
place deposited in cartilage, which is abun- 
dant in the young; but as age advances, 
much of the latter substance — such as that 
which connects the ribs with the breast-bone 
— becomes ossified. 

CASCARILLA BARK— Is obtained from 
a tree native to Jamaica and the Bahamas. 
It bears considerable resemblance to cin- 
chona bark, but is" more aromatic. In dys- 
pepsia and debility generally it is useful. 
The infusion is made by pouring on an 
ounce and a half of bruised cascarilla bark 
a pint of boiling water, and macerating for 
two hours. The dose is from a half to a 
whole wineglassful. The tincture is, of 
course, a warmer stimulant. One to two 



teaspoonfuls of the latter may be taken in 
water, or adgied to other bitter infusions. 
Cascarilla is used in the formation of pas- 
tiles. 

CASSIA PULP — Is obtained from the 
pod of a species of cassia by boiling. It is 
a mild laxative in doses of two or three 
ounces; but at present has fallen into 
disuse. 

CASSIA. — See Cinnamon. 

CASTILE SOAP— Is a hard soap, com- 
posed of soda and olive-oil, and is used in 
medicine for making pills, plasters, &c. It 
is sold both white and mottled ; the former 
is preferable. 

CASTOR-OIL— The well-known aperient, 
is obtained from the seeds of the Ricinus 
communis, or castor-oil plant, by expression 
either hot or cold, or by boiling in water. 
Cold-drawn castor-oil, or what is sold as 
such, is most generall}' used in this country. 
[But lard-oil is often added to it by un- 
principled dealers. The adulteration may 
be discovered by placing the suspected oil 
in a cool place, when the lard will harden.] 
Castor-oil is one of the most certain and 
safest of our aperients ; in most persons 
it acts quickly, without pain, clears the 
bowels effectually, leaves them with a greater 
tendency to relaxation than before, and does 
not require the dose to be increased in con- 
sequence of repetition. From earliest in- 
fancy to old age, castor-oil may, as a general 
rule, be given with perfect safety ; but yet 
there are some persons who cannot take it. 
Some stomachs will not retain the oil, how- 
ever disguised ; in a few individuals it acts 
almost drastically, and produces a painful 
sensation of piles, and occasionally it causes, 
during its action, deadly faintness. These, 
however, are but exceptional instances. 

In consequence of its gentle but effectual 
action it is most valuable as an aperient, 
in properly regulated doses, for persons of 
weak habit of body. Its certain action, the 
tendency to relaxation which remains after 
its employment, and the circumstance that 
the dose requires rather to be diminished 
than increased by continued use, render 
castor-oil peculiarly adapted for those who 
suffer from habitual constipation. In all 
conditions of body in which it is desirable 
to clear the bowels effectually, but without 
much disturbance, the oil is invaluable — in 
pregnancy more particularly. Irritation of 
the mucous lining of the bowels, whether 
inflammatory, or in the form of simple diar- 
rhoea, is in many cases more quickly relieved 
by castor-oil than by any other remedy. — See 
Bowel Complaint, Diarrhoea, fyc. 

The great objection to castor-oil, its sickly 



CAT 



93 



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nauseousness, has given rise to a variety of 
modes of taking it. Floated in brandy and 
•water, barley-water, or some aromatic water, 
are favourite modes with many ; others take 
it best in hot fluids, tea, coffee, or gruel, the 
heat getting rid of the feeling of oily con- 
sistency so disgusting to some. A piece of 
orange or lemon-peel, chewed just previous 
to taking a dose of castor-oil, blunts the 
acuteness of the nerves of taste. Castor-oil 
may be taken in emulsion made with mu- 
cilage or milk ; but rubbed up with yolk of 
egg is the best form of mixture. In this 
way, it is not so active an aperient as when 
uncombined ; but in irritable and inflamed 
conditions of the lining membrane of the 
bowels, it is especially valuable when com- 
bined with opium. Six drachms, by measure, 
of castor-oil, are to be well triturated in a 
mortar with the yolk of one egg, and to this 
soft water or some aromatic distilled water 
is to be added gradually to the extent of six 
ounces. If an aromatic water is not used, a 
few drops of some essential oil, such as cin- 
namon, may be added before the water. 
The mixture resembles custard in consist- 
ence. The dose an ounce — two tablespoon- 
fuls. The usual dose of castor-oil alone is 
about half an ounce, or one tablespoonful. 
[When beaten up with the froth of porter, 
the oil is perfectly disguised, and the porter, 
rising on the stomach, prevents the eructa- 
tion of the oil from causing nausea.] 

CATALEPSY— Is a peculiar affection of the 
nervous system, caused generally by sudden 
violent mental emotion. Sensibility to ex- 
ternal things and the power of voluntary 
movement is lost ; the limbs remain flexible, 
but retain whatever position they may be 
placed in. The signs of life are in this af- 
fection occasionally so obscured that the 
person has been accounted dead. Stimulants 
should be used — as ammonia to the nostrils 
and stimulant enemata, with continued 
friction over the body, particularly down the 
spine. — See Electricity. 

Refer to Death, Signs of 

CATAMENIA.— The female monthly dis- 
charge. See Menstruation. 

CATAPLASM.— A poultice. See Poultice. 

CATARACT— Is an affection of the eye 
which produces opacity of the crystalline 
lens, and more or less obstructs vision, ac- 
cording to the extent of the disease. The 
affection is most common in persons advanced 
in life, but may occur at any age. An indi- 
vidual who is becoming the subject of cata- 
ract complains of seeing objects, as it were, 
covered by a mist or veil : vision is some- 
times better in an obscure light, when the 
pupil becomes dilated. When the disease is 



a little advanced, any thing placed a little 
to one side is better distinguished than if it 
is directly in front. The first opaque spot of 
cataract occupies the centre of the lens, or 
the axis of vision, in which situation it can 
be detected by examination. 

When cataract is in its incipient stage, its 
progress may perhaps be arrested by judi- 
cious treatment : and for this reason the case 
should, as quickly as possible, be placed un- 
der medical care. In the interim, the 
bowels must be attended to, stimulants 
avoided, and a blister applied to the nape of 
the neck. When cataract occupies the 
whole circle of vision, and produces blind- 
ness, it may be removed by operation. An 
oculist or surgeon should always be con- 
sulted on the case. 

CATARRH — Is an inflammatory irritation 
of the mucous membrane lining the air-pas- 
sages — the nostrils and bronchi. It usually 
commences in the former, and extends to the 
latter. Catarrh, or "a cold," as its popular 
name implies, is generally the result of cold 
combined with damp, but quite as frequently 
of checked perspiration, in consequence of 
the individual passing from a heated room 
to a current of cold air ; it is, too, not im- 
probable that the recently discovered agent 
azone, when it exists in excess in the atmo- 
sphere, exerts an irritant effect upon the 
respiratory membrane. Catarrh commences 
with feverish symptoms more or less severe, 
shivering followed by heat. A peculiar dry- 
ness and heat of the lining membrane of the 
nostril is followed by discharge of thin acrid 
watery fluid, " a running at the nose," and 
with this there is intense headache between 
the eyes. Or the throat may be first affected, 
or the chest itself may be directly attacked, 
though if not, it will quickly become so ; the 
windpipe feels as if raw ; there is frequent 
cough, dry and harsh, or with thin expecto- 
ration, and the breathing is oppressed ; 
there is, in fact, subacute bronchitis. 

The evil of a " neglected cold" has become 
proverbial, and justly so as it is great. The 
attack ought to be checked at the first. It has 
been recommended, that as soon as the nos- 
trils become affected, a solution of sulphate 
of zinc — five or six grains to the ounce of 
water — should be injected into them by 
means of a syringe ; and it is said that by 
this means, if adopted in the very first stage, 
the catarrh may be stopped. This cannot 
be expected, however, to influence in the 
least the constitutional symptoms. The first 
measure in incipient cold is to restore and 
excite the action of the skin, to get free per- 
spiration. This is best accomplished by the 
vapour or warm-bath ; but if these cannot 



CAT 



94 



CAU 



be had, the best remedies are hot water to 
the feet, a warm bed, and hot diluent drinks, 
along with diaphoretic medicine. A draught 
consisting of half an ounce of spirit of min- 
dererus, one to two drachms of paregoric, 
and ten to fifteen drops of ipecacuanha wine, 
with water sufficient to fill a wineglass, 
should be given with five grains of Plum- 
mer's pill, on getting into bed, and about an 
hour after the warm drinks ; in the morning, 
some gentle aperient, senna, or castor-oil, 
or seidlitz powder, is to be taken. If there 
is much irritation of the chest at night, a 
bran-poultice, a mustard-plaster, or friction 
with a stimulant liniment may be employed. 
The treatment above recommended may be 
followed up for two or three nights in suc- 
cession; confinement to the house, low diet, 
and demulcent drinks, such as barley-water, 
&c. &c. being superadded. When catarrh 
is not checked, it runs on to cough, in fact 
to bronchitis, more or less severe. — See 
Bronchitis. 

Catarrh is unquestionably the effect in 
many cases of unavoidable atmospheric 
changes and influences, but it is much 
oftener the result of carelessness or impru- 
dence — of carelessness in not guarding the 
body against the effects of our changeable 
climate — for catarrh is a very common dis- 
ease, and particularly the neglect of wearing 
flannel or some woollen material next the 
skin, which is the very best preservative. 
Rooms, in the house, too warm, and exposure 
to the air insufficiently clothed, are fertile 
sources of catarrhal affection, especially in 
children. Insufficient protection to the feet, 
and dampness, is another. There is, too, in 
females, the exposure of the chest, after 
heated ball-rooms, public amusements, &c. 
&c. The use of fur round the neck is not 
unfrequently the cause of cold affecting the 
throat : while close to the skin, it produces 
warmth and perspiration, but when the boa 
or victorine is thrown back, a chill at once 
ensues. It is not meant to controvert the 
use of fur, so requisite in this climate, but 
to guard against the incautious and sudden 
relinquishment of the protection. 

Refer to Bronchitis — Influenza. 

CATECHU, [Terra Japonica.]— An ex- 
tract obtained principally from trees of the 
acacia genus. It is chiefly brought from 
the East Indies and Singapore, is powerfully 
astringent, and is met with in masses of va- 
rious sizes, either of a dark brown or of a 
pale reddish-brown colour. It is used both 
externally and internally. In some forms 
of diarrhoea, catechu, used either in the form 
of infusion, tincture, or confection, is ser- 



viceable, and also in the form of infusion as 
a gargle in relaxed sore throat or elongated 
uvula. In the latter cases, a convenient 
mode of emplojang catechu is to. permit a 
few grains to dissolve in the mouth ; for this 
purpose the pale catechu is the pleasantest. 
In sponginess of the gums, powdered catechu 
forms a good dentifrice. One of the most 
valuable external applications of catechu is 
in the sore and chapped nipples of nurses ; 
it must be used in the form of tincture, put 
on the nipple each time after the infant has 
been nursed, by means of a small paint- 
brush or feather, and wiped off with the 
wetted corner of a towel before the child is 
put to the breast. To make the infusion of 
catechu, a pint of boiling water is to be 
poured upon six drachms of the powdered 
extract, along with one drachm of bruised 
cinnamon, and the whole infused for an 
hour; the dose is from two to four table- 
spoonfuls. The dose of the tincture is from 
one to two teaspoonfuls, and of the electuary 
twenty to forty grains ; the latter is astrin- 
gent and aromatic, and contains about one 
grain of opium in every 193 grains. 

CATHARTICS— Are medicines which sti- 
mulate the bowels to increased action. 

Refer to Purgatives. 

CATHETER.— An instrument used by sur- 
geons, and with slight exception to be used 
by them alone, for drawing off urine from 
the bladder, which is retained in it in con- 
sequence of disease. Some peculiar cases 
are entirely dependent upon the use of the 
catheter for relief, and remain so for years. 
Under this state of circumstances, the pa- 
tient ought to learn to employ the instru- 
ment for himself, and many do so ; with this 
exception, it must be used by professional 
hands alone, for even in these it requires both 
skill and care, and may do serious mischief. 
In cases which require a catheter to be regu- 
larly passed, the operation generally becomes 
easier. The passage of the catheter being 
simply a mechanical operation, requiring 
tact, and a correct knowledge of the parts of 
the body implicated, may of course be ac- 
quired by any one who will take the trouble 
to educate himself upon these points. 

Refer to Bladder. 

CAUL. — The omentum. — See Omentum. — 
The term is also applied to a portion of the 
uterine membranes, which is sometimes 
carried along with the head of the child at 
birth, and covers it like a veil. The caul is 
frequently preserved. Much superstition 
used to be attached both to the circumstance 
and to the object itself. 

CAULIFLOWER— A vegetable of the cab- , 



C AU 



95 



CH A 



bage ti'ibe, agrees better than most other 
vegetables -with those of weak digestion. 
The addition of melted butter is injurious. 

CAUSTICS— Are substances which de- 
stroy organized tissues by combining with 
their constituent elements. The mineral 
acids, strong acetic acid, potassa, lime, ni- 
trate of silver, [burnt alum,] and refined 
sugar, belong to this class, and may be re- 
ferred to under their respective heads. 

CAUTERY — Is iron applied at a red or 
white heat to the animal body. It is a 
powerful means of counter-irritation. 

CAYENNE.— See Capsicum. 

CELLULAR MEMBRANE or Tissue, or 
Areolar Tissue — Is the reticular mem- 
braneous web which connects the various 
portions of the body and fills up the inter- 
stices. It is made up of numberless little 
fibres and bands crossing each other in 
every direction, and enclosing small spaces, 
which freely communicate throughout the 
body. The most familiar exemplification 
of cellular tissue, and of its free inter-com- 
munication, is seen in the blown-up veal of 
the butcher. In the living body, the areo- 
lar tissue contains a thin water or serous 
fluid, which, when it accumulates in undue 
quantity, constitutes one form of dropsy, 
finding its way by permeation through the 
cellular meshes to the most dependent part 
of the body. 

CERATE.— An ointment, of which wax 
forms a component. The hard wax and 
fluid oil or lard, when combined, forming a 
compound of convenient consistence. 

Simple cerate is formed by melting to- 
gether equal parts of white wax and olive- 
oil, and stirring during cooling. 

Calamine, or Turner's Cerate. — See Ca- 
lamine. 

[Cold Cream is made of one ounce of 
rose-water, two ounces of oil of sweet al- 
monds, half an ounce of spermaceti, and a 
drachm of white wax, melted together and 
stirred till cold.] 

Lead Cerate. — Acetate of lead five 
drachms, white wax eight ounces, olive-oil 
twenty ounces. Dissolve the wax by heat in 
eighteen ounces of the oil, rub up the acetate 
of lead finely with the remaining two ounces, 
add this gradually to the larger quantity, 
and stir during the cooling. 

Resin Cerate, [Basilicon.] — Take of 
resin five ounces, lard eight ounces, bee's- 
wax two ounces, melt them together with a 
gentle heat, and then stir the mixture 
briskly while it cools. 

Soap Cerate — Is sometimes useful : it is 
better procured ready prepared. 

CEREBRUM.— The brain.— See Brain. 



CEREBELLUM.— The lesser brain.— See 
Brain. 

CERUMEN— Is the watery matter of the 
ear, of which the chief purpose is, probably, 
the repulsion (by its bitterness and other 
qualities) of insects which might enter or 
harbour in the passage. It sometimes ac- 
cumulates to so great an extent, especially 
in the aged, and in the young, particularly 
after acute diseases, as to cause deafness, 
more or less complete, which is generally 
accompanied with noises and other uneasy 
sensations in the affected organ. The ac- 
cumulated wax may possibly be detected 
by examining the ear-passage with the aid 
of a candle, [or what is better, a ray of 
sunshine.] In order to remove the harden- 
ed mass, a small portion of warm olive or 
almond-oil must be dropped into the ear for 
two or three nights in succession, for the 
purpose of softening and loosening the wax ; 
after that has been done, the passage must 
be thoroughly syringed out with warm 
water, by means of a two-ounce syringe, 
till the wax is detached and washed out. 
Some persons become faint and giddy on 
having the ears syringed ; in such cases the 
operation is best undergone in the horizon- 
tal posture. 

Refer to Ear-syringe. 

CHALK. — Carbonate of lime occurs abun- 
dantly in various parts of the world ; it is 
used in medicine as an absorbent and ant- 
acid. For medicinal purposes it requires 
to be levigated, by which process the finer 
particles are separated: when dried, the pre- 
paration constitutes the " prepared chalk" 
of the shops. As a general antacid, chalk 
is scarcely to be recommended ; but in cases 
of diarrhoea, especially in children, where 
much acidity exists, it is highly useful. For 
the latter purpose, from twelve to eighteen 
grains of chalk rubbed up in an ounce and 
a half of dill-water form a mixture of 
which a teaspoonful may be given to an 
infant six weeks old, every few hours if 
requisite. 

In the case of adults, the ordinary chalk 
mixture is an excellent preparation ; it may 
be made with prepared chalk two drachms, 
powder of gum acacia two drachms, cinna- 
mon water, or water simply, eight ounces ; 
a drachm and a half of sugar maybe added, 
but is quite as well omitted ; better, if the 
climate is a warm one, as it causes fermenta- 
tion. To the above mixture, rhubarb, 
laudanum, &c. may be added if requisite. 
The dose, two or three tablespoonfuls, re- 
peated more or less frequently, according 
to the amount of diarrhoea. The compound 
chalk-powder, (dose thirty to sixty grains,) 



CHA 



96 



CHA 



and the same powder with opium, (dose five 
to twenty grains,) are both useful and easily 
carried preparations, which ought to form 
part of the domestic medicine-chest of the 
emigrant ; or, indeed, wherever the usual 
sources for procuring efficient medicines are 
far distant. The powders ought to be pro- 
cured ready prepared. Forty grains of that 
compounded with opium contain one grain 
of the drug. Chalk forms an ingredient in 
the aromatic confection. The practice of 
sprinkling chalk-powder upon sores, for the 
purpose of absorbing discharges, &c. is not 
to be recommended. 

CHALK-STONE— Is the concretion de- 
posited around and in the joints of those 
who sutler from chronic gout. It consists 
of the lithic acid and soda, which form a 
comparatively insoluble salt. The liability 
to the formation of chalk-stone is a reason 
why those who are subject to gout should, 
when an antacid is required, make use of 
potassa, which, in union with lithic acid, 
forms a much more soluble salt than soda 
does. 

Refer to Gout — Lithic Acid — Urine. 

CHALYBEATES— Are medicines contain- 
ing iron. The term is well known in con- 
nection with mineral waters. The most 
generally used chalybeate springs in England 
are those of Tunbridge-wells, Cheltenham, 
and Scarborough ; Leamington and Harrow- 
gate also possess chalybeate waters, and there 
are many others, including Hartfell and 
Peterhead, in Scotland, scattered throughout 
the island. [These springs are equally nu- 
merous in the United States, but those of 
Bedford, Pittsburgh, and Brandy wine are the 
most widely known. The springs of Saratoga 
also contain iron combined with other saline 
substances.] In chalybeate waters the iron 
is generally in combination with carbonic 
acid, the taste of the water is inky, and if it 
be one of those (and they are the most ge- 
neral) in which the metal is in combination 
with carbonic acid, when the water has 
stood exposed to the air for some time, it 
lets fall a yellowish sediment. Chalybeate 
waters are, by virtue of the iron they con- 
tain, powerful tonics, and well adopted as 
curative agents in diseases of debility gene- 
rally ;' but they are not to be lightly and 
unthinkingly used, or without professional 
sanction. Many persons do themselves se- 
rious injury by unadvisedly drinking mine- 
ral waters, under the idea that if they do 
no good, they cannot do much harm. To 
persons of full habit, and with any tenden- 
cy to head affection, even a short course of 
chalybeate water might be most seriously 
dangerous. — Refer to Iron. 



CHAMOMILE— The " Anthemis Nohilis" 
of botanists, is too well known to require 
description. The flowers, either fresh or 
dried, are deservedly classed amid the most 
useful, safe, and generally employed do- 
mestic remedies. They are often, it is true, 
wasted, in making fomentations and poul- 
tices, for which they are no better than the 
simple water or bran ; but their infusion 
taken internally is an aromatic bitter of un- 
doubted tonic properties, and without nau- 
seousness. In simple debility of the stomach 
and loss of appetite, chamomile tea, if not 
used too frequently, and for too long a time, 
is at once a safe and a good remedy. Half 
an ounce of chamomile flowers may be in- 
fused like common tea, in rather less than 
a pint of boiling water, or, if time be 
given, [twelve hours,] in cold water, which 
makes an equally efficacious and pleasanter 
dose. Chamomile tea taken warm is often 
employed as a gentle emetic by itself, or to 
aid the action of other medicines of the 
class ; alone it is very uncertain, unless 
made very strong. From five to ten drops 
of the essential oil of chamomile, dropped 
on sugar, is a useful, and not unpleasant 
carminative. 

CHAMPAGNE.— This well-known wine 
contains about 12 per cent, of alcohol, a 
much less proportional quantity than the 
strong dry wines, such as port, sherry, ma- 
deria, &c. When effervescing, however, it 
exerts a powerful but transient intoxicating 
effect. Champagne is often accused of 
causing gout, indigestion, &c. but perhaps 
these are more likely to be the results of 
the other luxuries which accompany a cham- 
pagne dinner, than of the wine itself. 

CHANCRES— Are small ulcers, the re- 
sult of inoculation with the venereal poison. 
They commence in the form of small pus- 
tules, which, after breaking, degenerate into 
yellowish-gray-looking sores, around which 
the skin feels firm or hard. Thorough de- 
struction of the chancre in the first instance, 
by means of nitrate of silver, (lunar caus- 
tic,) is the only safe measure. When the 
disease has advanced beyond the incipient 
stage, or indeed in any stage, it cannot be 
a subject for domestic treatment, and ought 
more especially, on account of the lament- 
able results which may ensue should the 
constitution become affected, be intrusted 
without delay to proper medical care. 

CHAPPED HANDS— So troublesome to 
many in frosty weather and during cold 
dry east winds, may partly be avoided by 
care in thoroughly drying the skin after 
washing. The following lotion will be found 
useful : — Take of borax two scruples, glyce- 



CHA 



97 



CHE 



rine half an ounce, water seven and a half 
ounces. This may be used twice a day. 

CHARCOAL.— See Carbon. 

CHARPIE. — The loose fibres from scraped 
linen, used to absorb the discharge from 
sores. It is more used in France than in 
this country. 

CHEESE — Is the curd or caseine of milk 
mixed with a proportion of butter, pressed, 
salted, and dried. A general and nutritious 
article of diet, it is not one suited to weak 
stomachs. A meal of bread and cheese 
alone, requires a thoroughly strong diges- 
tion to dispose of it comfortably. Many, 
however, who cannot eat cheese in this way, 
may take it in small quantity with impunity, 
and, when old, almost with advantage, at the 
close of a moderate meal. Much of the 
indigestibility of cheese arises undoubtedly 
from its toughness- and the cohesion of its 
particles : this diminishes as it verges 
toward decay; but is much increased by 
toasting, which renders the article decided- 
ly unwholesome. Cheese is said to assist 
the digestion of other articles of diet; and 
there is an old rhyme — 

" Cheese is a peevish elf, 
Digests every thing but itself." 

Probably, the power put forth by the 
stomach for the solution of the cheese acts 
more readily upon the less tenacious sub- 
stances submitted to it at the same time. 
The habitual use of old cheese in any quan- 
tity is injurious, and may occasion cutaneous 
eruptions. In Germany a peculiar kind of 
decay in cheese has occasioned symptoms 
of irritant poisoning. 

The caseine, or curd o'f milk, which forms 
the basis of cheese, very closely resembles 
albumen in composition ; its nutritive pow- 
er may be known from the fact, " that from 
caseine alone, the chief constituent of the 
young animal's blood, as well as its muscu- 
lar fibres, membranes, &c. are formed in the 
first stage of its life." 

The contrast shown between tough indi- 
gestible cheese and the milk-curd adapted for 
easy solution in the stomachs of the young, 
is a good example of the manner in which 
an article of diet, nutritive and wholesome, 
maybe modified as regards its digestibility, 
by preparation. Caseine is found in the 
vegetable kingdom, chiefly in seeds. 

Refer to Milk. 

CHELTENHAM.— The climate of Chel- 
tenham is. considered particularly adapted 
to health, there being neither great extremes 
of heat nor of cold. To those, however, 
with whom a dry and bracing atmosphere 
agrees, its climate is less favourable than 
some other localities. 



" The mineral springs of Cheltenham are 
exclusively employed for internal adminis- 
tration. They, for the most part, resemble 
each other as to the nature of their compo- 
nent parts, yet present considerable differ- 
ences in the relative proportions of their in- 
gredients. They are rich in muriate and 
sulphate of soda. Several of them contain 
a small portion of iron, and iodine has been 
lately detected in them. They are but 
slightly gaseous, and though two or three 
of them have, when first drawn, a slight 
odour of sulphuretted hydrogen, it soon 
passes off, and is probably dependent upon 
the springs passing through a layer of mud 
or matter in a state of decomposition. It 
must not, therefore, be supposed that the 
so-called sulphuretted wells are analogous in 
their action with the class of sulphurous 
springs. * * Besides its saline springs, 
Cheltenham possesses two chalybeate ones, 
which, like others of the same class, have a 
disagreeable inky taste, and are somewhat 
dark-coloured. From their not containing 
much carbonic acid, they do not sparkle, 
and are soon decomposed on exposure to 
the atrsosphere. 

" There are many diseases in which the 
Cheltenham springs may be used with ad- 
vantage. Persons who have lived in India 
and other tropical climates, who have been 
accustomed to take large doses of mercury, 
will generally derive benefit, less from the 
aperient than the tonic properties of the 
waters. For gouty patients, also of a ple- 
thoric or irritable habit, they are advisable. 
And in cases of amenorrhea and chlorosis 
they do good service, where with it a faulty 
condition of the digestive organs exists." 

For the substance of the above article, 
and of others similar to it, the author is in- 
debted to the work of Mr. Edward Lee, on 
the " Watering-Places and Mineral Springs 
of England," and those who desire further 
information cannot do better than have re- 
course to the publication itself. [The ex- 
cellent works on baths and mineral waters 
published in the United States, especially 
that of Dr. John Bell, will supply the Ame- 
rican reader with every item of information 
required on this subject.] 

CHERRY.— The fruit of the Primus c&ra- 
sus. Like other stone-fruits, it is apt to 
disagree. 

CHESTNUT— Is the fruit of the Castanea 
vulgaris; it is nutritious, contains much 
starch and no oil, like many others of the 
nut tribe. It is certainly, indigestible from 
its firm and coherent substance, but is ren- 
dered much more wholesome by being con- 
verted into flour, in which state it is largely 



CHE 



98 



CHE 



used on the continent. Roasted chestnuts 
are more wholesome than raw, but are not 
fit for weak stomachs. 

CHEST — Or, in medical language, the 
thorax, is the important cavity situated be- 
tween the neck and the abdomen (see fig. 
xxxiii.) which contains the heart and large 

Fig. xxxiii. 




blood-vessels and the lungs. It is separated 
from the abdomen by the diaphragm, (A,) and 
is bounded by the breast-bone anteriorly, 
laterally by the ribs, and supported poste- 
riorly by the spine, (fig. xxxiv.) It is singu- 
lar how much ignorance there is among the 
uneducated regarding the situation of what 
is called the chest : generally it is referred 
to the pit of the stomach ; and what is 
called " a pain in the chest" is in many 
instances a pain in the former situation. 
In ordering applications, leeches, blisters, 
and such like to the chest among the poor, 
it is absolutely requisite to indicate with the 
finger the exact spot on which they are to 
be placed ; otherwise the chances are, that 
if the chest simply is named, the pit of the 
stomach will be understood — a serious mis- 
take in many of the acute affections of the 
chest, particularly in children. 

The form of the chest itself is, or ought 
to be, that of a truncated cone, broad be- 
low, narrow above, (fig. xxxiv.) It is true it 
appears the reverse of this, even naturally, 
and is made to do so still more by the ab- 
surd ideas about small waists : but the 
greater apparent width at the upper part of 
the chest in the living person is due to the 
shoulders and arms; when these are removed, 
the contrary is seen to be the case, and 
the cavity itself, as exemplified in fig. xxxiv., 
is evidently much more capacious in its 



Fig. xxxiv. 




< ^t»- 



lower than in its upper part. The princi- 
pal contents of the chest are the lungs (fig. 
xxxiii. 2, 3,) and the heart (1) with the 
large vessels immediately connected with 
it. 

When by tightly laced stays, or other con- 
trivances, the lower part of the chest is 
compressed, the contained viscera must find 
room somewhere ; the diaphragm yields 
more readily than the long ribs, and is 
pressed down upon the liver, stomach, and 
bowels, disordering their functions, and 
laying the foundation of disease, while at 
the same time the free play of both lungs 
and heart are impeded. In other words, 
the possessor of that most-desirable physical 
conformation, a capacious chest, is doing all 
that is possible to render it otherwise ; or 
should the cavity be naturally small, to 
make it still more deficient in size, by arti- 
ficial restraint, instead of every means being 
used to augment its capacity. A small chest 
always gives a greater liability to disease ; 
all tendency therefore to contraction, stoop- 
ing of the shoulders, &c. ought most sedu- 
lously to be watched and attended to, par- 
ticularly in young people, while the bones 
are still soft and yielding ; disease may be 
either the cause or the consequence. The 
spine, too, should be well examined. Exer- 
cises which, from moderate exertion, call 
for full expansion of the chest by respira- 



CHE 



99 



CHI 



tion, and fall play of the arms, are gene- 
rally useful. The elastic "chest expander," 
made of vulcanized India-rubber, is a most 
excellent contrivance for the purpose. 
Some trades, particularly that of shoe-mak- 
ing, tend in the course of time to affect 
the conformation of the cavity of the chest. 

The physical examination of the chest as 
regards measurement, the sounds elicited by 
tapping upon it in various ways with the 
fingers, and heard by the application of the 
ear, either directly, or mediately by means 
of the stethoscope, are most important aids 
in the investigation of disease, and should 
never be omitted or objected to. For the 
purpose of facilitating description, the ca- 
vity is mapped out by vertical and horizontal 
lines, in a similar manner to that shown on 
the abdomen. 

Refer to Abdomen — Heart — Lungs — Respi- 
ration. 

CHEST— Water in.— See Dropsy. 

CHICKEN-POX— Is a mild eruptive dis- 
ease, which spreads by infection, and chiefly 
attacks children, occurring once during life. 
It is preceded in most, but not in all cases, 
by slight feverishness for one or two days. 
The eruption first appears in the form of 
conical pimples with a white head, on the 
breast, shoulders, and neck, more sparingly 
on the face, and on the body generally. 
On the second day, the vesicles appear like 
little globular blisters, but with very slight 
surrounding inflammation ; on the third and 
fourth days the fluid they contain becomes 
opaque or whey-like ; they now either break 
or shrivel up, forming ^hin puckered crusts, 
which fall off piecemeal in one or two days 
more, seven or eight days being the whole 
time occupied by the course of the disorder. 
Little or no treatment is required beyond a 
gentle aperient repeated once or twice, and 
care taken that the child does not irritate 
by scratching. 

Chicken-pox might be mistaken for modi- 
fied small-pox by the inexperienced ; it is 
distinguished by the absence or extreme 
mildness of premonitory fever, and by the 
rapid development, course, and different 
form of the vesicles, particularly in the 
absence of the central depression, which 
characterizes the true small-pox vesicle. 

CHICORY. — The Cicorium intybus, the 
root of which, when roasted and ground, 
forms the well-known adulteration of coffee. 
Some persons consider the admixture of 
chicory with coffee an improvement, and at 
all events harmless, but the recent investi- 
gations of the "Lancet Sanitary Commis- 
sion" tend to show that infusion of chicory, 
alone especially, and also when mixed with 



coffee in the proportion of twenty-five per 
cent., produced sense of weight at the sto- 
mach, languor, and headache ; it has, by an 
eminent continental authority, been assigned 
as one of the exciting causes of amaurosis. 
Infusion of chicory occasionally acts as an 
aperient, at other times as a diuretic. ■ In 
consequence of chicory not containing es- 
sential oil, it has not, when roasted, the 
fragrance of coffee. Its infusion has a 
"sweetish and mawkish taste, and is dark 
coloured, thick, and glutinous." But, al- 
though chicory is used as an adulteration, 
the recent Lancet investigations go to prove 
that it is itself extensively adulterated with 
various substances. These are " carrot, 
parsnip, mangel-wurzel, beans, lupin-seeds, 
wheat, rye, dog-biscuit, burnt sugar, red 
earth, horse-chestnut, acorns, oak-bark, 
tan, mahogany sawdust, baked horse's and 
bullock's liver, Hamburg powder," which 
consists of peas roasted and ground, and 
coloured with the next article, "Venetian 
red," also an adulteration. Perhaps after 
such disclosures, few persons will prefer 
chicory in their coffee ; and, at all events, 
the moral fraud of vending for the pure 
article that which is mixed, ought not to be 
suffered. When hot water has been allowed 
to stand for some time on coffee containing 
chicory powder, the grains of the latter 
lose their colour and resemble small brown 
sago, while those of the coffee become rather 
darker than before. 

CHILD-BED.— The term may be applied, 
either to the actual labour itself, or to the 
confinement generally, from the first com- 
mencement of the symptoms to the com- 
pletion of convalescence. It is in the latter 
sense it will be considered in this article. 

The process of child-birth exhibits a series 
of the most beautiful adaptations to the 
mechanism and structural and vital endow- 
ments of the human frame, with every pro- 
vidential provision for the safety both of 
the mother and infant during the trying but 
important event. When the full period of 
pregnancy is completed, the process, which 
is to free the womb of its contents, com- 
mences with the preparatory relaxation of 
the various parts connected with the pas- 
sage of the child into the world. Shortly, 
the long-closed orifice, or "mouth" of the 
organ begins to open or dilate, allowing, in 
the first place, the protrusion of the mem- 
braneous bag which contains the fluid, or 
waters, in which the infant floats, and which 
protrusion forms a soft wedge, dilating the 
maternal structures preparatory to the pas- 
sage of the hard head of the infant, which 
follows as propelled by the expulsive efforts 



CHI 



100 



CHI 



of the womb. Sooner or later, however, 
this membraneous bag gives way under the 
pressure, the waters are discharged with a 
gush, and the head itself becomes, in a great 
measure, the dilating agent. Although at 
the commencement of labour, the head of the 
infant is not in this position it should pass 
at its conclusion from the mother with the 
face looking directly backward, and in the 
great majority of cases it does so, attaining 
the position by a series of turns which can- 
not be profitably explained to the unprofes- 
sional. In some cases, however, the position 
of the head is reversed, so that it passes 
with the face directed forward, causing a 
more protracted and painful labour. More- 
over, the head may not come forward, or 
"present" first, at all, but some other por- 
tion of the child will appear, thus causing 
an irregular or cross birth. 

Most women form, or endeavour to form, 
a calculation as to the period at which they 
may expect to be confined, and, while some 
do it with considerable apparent exactness, 
others get far wrong, much to the inconve- 
nience of themselves and of those appointed 
to attend upon them. The most usual calcu- 
lation as regards the duration of pregnancy, 
is forty weeks from the last menstrual crisis, 
and this is generally made the basis of the 
calculation ; but as more cases fall within 
the period than extend beyond it, it is safer 
for expectant mothers to arrange their pre- 
parations for the thirty-eighth week than 
later. By some it is thought that the 
duration of pregnancy in the case of a male 
child is longer than in that of a female. 
As, however, cases of premature confine- 
ment of living children are not uncommon, 
it is always desirable that essentials be pro- 
vided as early as possible. 

The most generally received premonitory 
sign of approaching labour at the full period, 
is "sinking," that is, from twenty-four to 
forty-eight hours before the actual process 
commences, the female seems as if she were 
smaller and lighter altogether, the waist 
especially showing a diminution in size. At 
this time, also, there "is generally a degree 
of fidgetiness, or undefined mental anxiety, 
similar to that which is observable in the 
lower animals, and there frequently exists 
irritability of the bowels and bladder, call- 
ing for repeated efforts at relief. When the 
bowels are very troublesome, and there is 
much involuntary straining, or, as it is call- 
ed, "tenesmus," nothing relieves more than 
a clyster consisting of half a wineglassful 
of gruel [or thin starch] with twenty drops 
of laudanum. At length, slight twinges of 
pain are experienced, either in the womb 



itself, or in the back, hips, and thighs, or in 
all together, and there is more or less dis- 
charge of slimy mucus, generally streaked 
with blood. Shivering, with nausea or vo- 
miting, are also frequent concomitants of 
the first accession of labour. 

As time advances the pains become more 
defined and regular ; and when these, the 
" grinding" pains, have fairly commenced, 
the first stage of labour may be considered 
as established. This stage lasts, on an 
average, from six to twelve hours, but may, 
of course, much exceed or fall short of this 
stated period : during its continuance, the 
mouth of the womb undergoes "dilatation," 
or full opening. Toward the close of the 
first or dilating stage of labour, the pains 
are altered in character, and become ex- 
pulsive, or, as they are popularly termed, 
"bearing down;" at first slightly so, but as 
the process advances their forcing character 
is more strongly marked, and, in most in- 
stances, the nearer the birth of the child, 
the more powerful and nearly connected 
are they, until at last the infant is expelled. 
Generally toward the middle of the expul- 
sive stage, the "waters" are discharged; 
the sudden gush sometimes causes alarm to 
the inexperienced, who ought on this account 
to be forewarned of the circumstance. The 
whole process of labour, in the case of first 
children, averages from twelve to thirty 
hours ; it is, however, not only as regards 
time, but in every other respect, liable to 
great variation. Attacks of spurious pain, 
resembling true labour, are not uncommon 
during the last month of pregnancy, but 
these may be known by the absence of the 
previous sinking, and of most of the other 
symptoms above enumerated, as character- 
istic of the real process. The attack is 
often the result of confined bowels, or of 
indigestion, and is removable by a table- 
spoonful of castor-oil with ten drops of 
laudanum, or by a dose of rhubarb and 
magnesia. Occasionally, active labour com- 
mences with a species of spurious spasmodic 
pains, which want the regularity of the 
true ones, and only tease and exhaust the 
patient, who is herself conscious that they 
are " doing no good." In such a case, the 
best treatment is to administer five-and- 
twenty drops of laudanum, and to keep the 
patient perfectly quiet, so that she may 
sleep if possible ; if she does so, in all pro- 
bability she wakes in a few hours with real 
labour in full activity. But sometimes even 
sleep does not intervene : the anodyne seems 
at once to convert the spasmodic into the 
real useful labour pain, and, contrary to its 
usual effect, actually to stimulate the pro- 



CHI 



101 



CH. 



gress of the case, Occasionally, when 
labour has reached a certain stage, pain 
becomes suspended without obvious cause, 
and continues so for a longer or shorter 
period : in such cases patience is the best 
resource, unless the cessation of pain ap- 
pears to be connected with some of the 
complications of child-birth to be hereafter 
noticed. The discharge of the waters is 
sometimes the first sign of the commence- 
ment of labour, or perhaps, more correctly, 
their discharge from imprudent exertions, 
such as shakes, jumps, &c. hurry on the pro- 
cess, which, in such cases, is often lingering. 
This premature discharge not unfrequently 
occurs when some other portion of the child 
than the head is first in the birth. It being 
presupposed, that every female in expecta- 
tion of her confinement, if inexperienced 
herself, will, under the advice and guidance 
of female friends, provide for and make 
those arrangements most suited to her indi- 
vidual case and circumstances, as soon as 
the first symptoms of approaching labour 
exhibit themselves, the female attendants 
ought certainly to be summoned ; but should 
a medical man be engaged, it is proper, be- 
fore sending for him, to feel assured that 
the process has commenced in earnest. 
When sinking pains, recurring regularly 
every ten minutes or quarter of an hour, 
are accompanied with slight " show," as 
the discharge of slimy mucus is termed, the 
medical attendant may be safely summoned, 
and he will, or ought to, see to all subse- 
quent details. 

When female attendance is trusted to, 
these details require to be carefully and 
judiciously insisted upon: 

A lying-in chamber ought to be as roomy, 
and, while free from draughts, as well ven- 
tilated as circumstances will permit. — See 
Bed-room. It ought too to have a fire- 
place, which it is ascertained beforehand 
can be used without half suffocating the 
patient with smoke, not an uncommon an- 
noyance. The bed should be of such mode- 
rate height that an attendant can con- 
veniently give assistance to the patient. 
A mattress is always preferable to feathers, 
and curtains, as in beds generally, are bet- 
ter dispensed with. In addition to the ordi- 
nary furniture, a night-chair and bed-pan 
should be provided ; and a vessel of some 
kind which can be used as a bath for 
the infant. Some waterproof material is 
requisite for " guarding" the bed against 
injury from moisture. Formerly, a pre- 
pared skin used to be the general material, 
but there are now many waterproof arti- 
cles, quite as well or better adapted for this 
i2 



purpose. Sheet gutta-percha or India rub- 
ber answers well, and is cheap. An easy 
chair, a bottle for pure water, a little bran- 
dy, a fan, and a bottle of smelling salts, 
cups and vessels, including a sick-feeder, 
(see Bed-room,) for administering either 
food or medicine, are all advantageous 
additions to the numerous little etceteras ; 
these are, sponge, washing-flannel, and 
starch-powder ; a little lard without salt, 
or cold cream, soft towels, and abundance 
of napkins or doubles ; four ties or 
ligatures, each six inches long, and com- 
posed severally of four plies of stout linen 
thread; a pair of blunt-pointed scissors 
that will cut, and a flannel receiver for the 
infant. A little laudanum and sal-volatile 
ought always to be at hand ; but when a 
medical man is in attendance, he more 
generally carries these with him. 

One female friend, and no more, in ad- 
dition to the nurse, should be present at 
the accouchement; but it is advisable to 
have another female in the house, though 
not actually present in the room, particu- 
larly if a midwife only has charge of the 
case. Mothers ought never to be present 
at the confinement of their daughters. 

As soon as labour commences, the cham- 
ber should be prepared, all extraneous 
articles removed, and whatever may be 
wanted put in order ; the guard placed 
upon the bed, and the latter so arranged, 
that when the patient lies upon her left 
side near the edge of it, there may be plenty 
of room for those about her to pass and act. 
The patient herself ought to be encouraged 
to walk about, and her mind kept occupied 
and cheerful by conversation ; light nourish- 
ment, such as a cup of tea or gruel, being 
given as desired, in small quantity at once ; 
at this time too, if the bowels are at all 
confined, they should be unloaded by a dose 
of castor-oil, or better still, by an enema, 
consisting of a pint of thin gruel, to which 
a tablespoonful of olive-oil is added. As 
time advances, and as soon as the pains ex- 
hibit signs of "bearing down," the patient, 
if not previously undressed, should now be 
so, and the folded binder (see Binder) placed 
on the abdomen, so as to give gentle and equa- 
ble support. The patient may still continue 
to walk about a little ; but as soon as the 
pains become decidedly expulsive, she must 
be placed in bed upon her left side, and 
remain so unless raised up for necessary 
purposes, until the infant is born. During 
all this time the room should be kept mode- 
rately cool — if regulated by a thermometer, 
about 55° Fahr. The patient, most likely, 
particularly toward the end of her labour, 



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will become extremely hot, and then the 
occasional and moderate use of the fan is 
very agreeable. She should be induced, from 
time to time, to take a few spoonfuls of gru- 
el ; but the stomach is not to be overloaded, 
and above all things, the pernicious and too 
prevalent custom of giving stimulants, bran- 
dy, rum, &c. is to be avoided. A case which 
really requires such aids requires also the 
presence of a medical man to sanction and 
regulate their use ; if given when not re- 
quired, feverish heat, headache, thirst, 
general uncomfortableness, and, it may be, 
after bad consequences, are the only results. 
Amid the poorer, and indeed among some 
of the better classes in the country, it is 
customary for patients to be "put to-bed" 
in their day-clothes. Independent of the 
uncleanliness of the proceeding, it is"not at 
all times free from danger, when, after the 
confinement is over, it becomes requisite to 
remove, these clothes and substitute the 
bed-dress. The usual excuse, that it is for 
the support given by the stays, is quite in- 
admissible when the binder is used, which 
amply supplies the place of the y^ove un- 
desirable articles ; besides, the presence of 
the stays and clothes may seriously inter- 
fere with measures which must be taken 
in some particular cases, such as those of 
flooding. Another practice which is often 
followed by midwives cannot be too strongly 
condemned : it is that of delivery being 
effected with the patient kneeling on the 
floor ; it is highly dangerous. Such atten- 
tion should always be given to the bladder, 
that it may be duly emptied ; although, in 
most instances, the sensations of the patient 
herself insure this point. 

When the last strong pains of labour are 
expelling the head of the child, the mid- 
wife who has, or who ought to have, suffi- 
cient experience to be aware of the pro- 
gress of the case, should elevate the upper 
knee during the occurrence of each pain, 
for the purpose of affording free space ; this 
mode of proceeding is preferable to the pil- 
low placed between the knees, which heats, 
and is always getting displaced. A towel or 
some such material is frequently attached to 
the bedpost or some fixed point, and many 
women appear to derive comfort from hold- 
ing it during the paroxysm of pain ; it may 
be permitted, if if does not encourage too 
great efforts at straining. The feet must 
be kept warm; cold feet may retard the 
frequency and force of the pains. 

It cannot be too strongly impressed upon 
the minds of all, that child-birth is a natu- 
ral process, and that nature is fully compe- 
tent in all ordinary cases — and in more ex- 



traordinary ones than might be imagined— 
to accomplish its end safely and unassisted. 
And it must and ought to be completed 
without assistance, or any attempt at assist- 
ance, as far as female attendance is con- 
cerned. 

As soon as the head of the infant is born, 
the attendant midwife ought to pass her 
fingers around its neck, to ascertain, as 
sometimes occurs, that the navel-cord is not 
twisted around it ; should it be so, she must 
endeavour gently to slip it over the head, 
otherwise the neck may be so strongly com- 
pressed as to occasion fatal strangulation. 
The cord may be coiled once, or two or 
three times around the neck. At this period 
also, the mouth and nostrils of the child — ■ 
if there is any delay in the passage of the 
body — should be kept as free as possible 
from the surrounding discharges, which 
may be drawn in by the efforts to breathe. 
Neither ought the body, or even the legs of 
the infant, to be drawn from the mother ; 
their expulsion should be left to the natural 
efforts of the womb; for if too suddenly 
emptied, its natural action becomes em- 
barrassed, and irregular contraction, accom- 
panied with unnecessary pain and discharge, 
may be the consequence. The infant being 
fully born, the navel-cord must be tied by 
the ligatures, which have been ready pro- 
vided ; the first being placed about three 
fingers' breadth from the body of the child, 
and the other about an inch and a half 
further ; the intervening portion of cord 
being divided by the scissors. The infant 
now separated from the mother is to be 
placed in the flannel, in the arms of the 
nurse, and put in a moderately warm situ- 
ation.— See Children. 

In tying the navel-cord, one or two 
cautions are requisite. The first ligature 
must not be placed nearer the body than 
the distance above-named; and before the 
second is put on, it is well — to prevent 
spurting — to squeeze the blood up toward 
the body of the mother, out of the inter- 
vening portion. For cutting the cord, a 
pair of blunt-pointed scissors should be 
used, and care taken at the moment that 
no other portion of the child is intruded 
between the blades ; it has occurred that 
a finger or toe has been lopped off by a 
careless attendant. After the cord is cut 
through, the cut extremity attached to the 
child must be carefully examined, to make 
certain that it does not bleed, particularly 
if the cord be thicker than usual, in which 
case the tying must be most carefully per- 
formed. From careless tying and neglect, 
infants have bled to death from the navel 



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vessels immediately after birth. Should 
the infant not appear to breathe as soon as 
born, it is well to delay the severance of 
the cord for a minute or two, while at the 
same time the mouth and nostrils are freed 
from all adhering mucus, and efforts are 
made to rouse, by blowing upon the face, or 
by two or three smart taps on the back. 
As soon as the infant is separated from the 
mother, it is proper to ascertain by the hand 
placed upon the abdomen that there is not a 
twin child ; if there be, the remaining bulk 
will indicate it in a way that can scarcely 
be mistaken ; and should it prove so, the 
recurrence of the pain which is to effect 
the expulsion of the second child, must 
be quietly waited for, unless hemorrhage, or 
some other occurrence, dictates a different 
course. In most cases of twin children, 
the second is quickly and easily born, after 
pain sets in. 

When labour is completed, the binder must 
be tightened up, so as to give gentle and com- 
fortable support to the now lax abdomen, 
and the patient left quiet until the accession 
of pain gives signal of the throwing off of the 
afterbirth. — See Afterbirth. When this is 
effected, the binder will again require slight 
tightening, and a warm napkin, sprinkled 
with brandy, should .be applied' to the 
mother. At this time, chilliness, succeeding 
the profuse perspiration, is often complained 
of, and should be counteracted by some ad- 
ditional covering. The female must now be 
allowed to remain quiet, but not left alone, 
and so far attended to that any symptoms 
of faintness or undue discharge of blood — ■ 
flooding — may be detected. If all goes well, 
a cupful of gruel or arrow-root maybe given, 
if desired, in the course of half an hour; 
in the course of another half-hour, a dry, 
warm, open, flannel skirt, and dry napkins 
should be substituted for those which have 
become wet ; but by this time every thing 
ought to be arranged and quiet for the pa- 
tient's repose. 

Such are the incidents of natural and 
regular labour ; and could we calculate upon 
the process following undeviatingly the same 
course in all cases, it might safely and at all 
times be left to the care of judicious and in- 
structed females. But, as too well known, 
accidents and difficulties of the most formi- 
dable nature will arise, which tax to the 
utmost the skill and nerve of the well-edu- 
cated practitioner; and with some, this is 
an argument why every case of confinement 
should be attended by a medical man — in 
many situations, at least, a physical impos- 
sibility. As, therefore, many cases must be 
left to female care, the foregoing directions 



will, it is trusted, lead to their safer and 
better management, while those which are 
to follow are intended to point out what cases 
ought never to be trusted to a female attendant, 
and what symptoms occurring in a case un- 
der female care, indicate the approach of 
such difficulty or danger as requires the at- 
tendance of the male accoucheur. 

As a general rule, in a first confinement, 
it is always desirable to have the attendance 
of a medical practitioner, and especially so 
should the female be the subject of any de- 
formity, such as curvature of the spine, 
should she in early life have suffered from 
any tendency to rickets, or been the subject 
of epileptic fits at any period of life. Also, 
if there exists any suspicion of heart or other 
organic disease. If a previous confinement 
has in any way been irregular, or has re- 
quired insti-umental or artificial delivery of 
any kind ; if convulsions have occurred ; or 
if there has been flooding, either from diffi- 
culty with the afterbirth, or any other 
cause, the woman ought never to trust her- 
self in the hands of a female. 

When a midwife, either professed or other- 
wise, is in attendance upon a case, fainting 
coming on at any period, any symptoms of 
wandering or delirium, or of convulsion, any 
unusual discharge of blood while the pro- 
cess is going on, should at once be the sig- 
nal for summoning medical assistance ; also, 
should the labour be more than usually pro- 
tracted, without obvious cause, provided the 
pains are regular, sufficiently numerous, or 
forcible ; should the navel-cord, or any thing 
unusual, such as the infant's hand, be felt 
protruding externally ; and lastly, if, after 
the child is born, there is any difficulty with 
the afterbirth, (see Afterbirth,) either with 
or without flooding. 

In the interval which must or may elapse 
in many cases before medical assistance can 
be obtained, should fainting come on, the 
female must be laid on the bed with the 
head on a level with the body, air should be 
freely admitted around her, and smelling- 
salts used to the nostrils, while brandy or 
sal-volatile is administered by the mouth. 
It ought to be ascertained whether there 
is any discharge of blood externally, and 
if so, cloths dipped in cold or iced-water 
are to be freely used to the lower part of the 
bowels. Wandering or delirium, or convul- 
sion, must be soothed by the most perfect 
quiet, and by the free use of cold applica- 
tions to the head, and mustard-plasters to 
the calves of the legs ; while if the person be 
of full habit, and if the face is full and flushed, 
from six to a dozen leeches are to be applied 
to the temples. In all cases of unusual dis- 



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charge of blood, the measures recommended 
tinder the article "Abortion" iire to be em- 
ployed; and it must be borne in mind, that 
if the accident occurs after the birth of the 
child, firm pads composed of folded napkins 
must be kept firmly bound over the situation 
of the womb — in other words, one or two 
inches below the navel — and kept there 
while cold is used to the external parts. In 
a case of sudden and profuse outward flood- 
ing after the birth of the child, occurring in 
a thin individual, much may be done to ar- 
rest it, by some one instantly pressing the 
hand firmly and steadily upon the belly — at 
the navel — until the pulsation of the great 
main artery, or aorta, is felt, and felt, as ar- 
rested by the pressure, to beat up to the 
hand, but not beyond it. 

It must, however, be kept in mind that 
alarming, and even fatal loss of blood — in- 
ternal hemorrhage, as it is called — may be 
going on within the womb, and yet be unma- 
nifested by any outward flow, the first signal 
of the mischief probably being faintness ; 
and if the abdomen is now examined, it will 
be found to have enlarged more or less since 
the birth of the child. This dangerous con- 
dition requires the most energetic and well- 
directed efforts of a medical man to save 
life, and not one moment should be lost in 
procuring his assistance. In the interval, 
the binder well spread over the bowels, and 
two or three folded napkins placed under- 
neath it to assist the pressure, is to be 
tightened well up, and in addition, firm 
pressure must be exercised with the ex- 
panded hands of an attendant on the outside 
of the binder. By this method, the ordinary 
attendants will do more to retard the further 
filling of the womb with blood ; at the same 
time cold is to be used to the lower part of 
the bowels, and stimulants given sparingly. 
The medical man, on his arrival, will take 
much more active measures which could not 
properly be employed by others. The above 
dangerous accident of the lying-in chamber 
will sometimes occur in spite of every care, 
but it frequently results from bad manage- 
ment, such as too sudden emptying of the 
womb by abstracting the child, instead of 
allowing the natural efforts to accomplish 
the entire process ; by impatience with the 
afterbirth, neglect in putting on the binder 
insufficiently, or not at all, or by moving too 
soon after delivery. The existence of cough 
has a tendency to promote its occurrence. 
The occurrence of internal flooding is some- 
times indicated by continued pain complained 
of in the bowels or back, different from the 
usual intermittent after-pain. 

Lastly, whatever accident may occur in the 



lying-in room, it should be the endeavour of 
those around to avoid the excited hurrying, 
which too often seeks to do every thing, and 
does every thing but what is right. This is one 
reason at least why it is proper to exclude all 
but the necessary attendants, and especially 
mothers, from the scene ; they communicate 
their own alarm to the patient, and aggra- 
vate the danger, if it exists, by so doing. 

When a female has enjoyed a few hours' 
repose after her delivery, if the bladder has 
not been relieved, it should now be so [but 
the patient should use a sheet or bed-pan, 
and not be allowed to rise or even sit up in 
bed] ; a little light nourishment, such as 
gruel, may then be taken, and the infant ap- 
plied to the breast, whether it appears to contain 
milk or not. — See Breast. If the confinement 
be a first one, the afterpains will scarcely give 
trouble. When they are severe, twenty drops 
of laudanum may be given in a little water. 
— See Afterpain. Perfect quietude is to be 
observed. 

It is not probable that the bowels will act 
of themselves, particularly if opium has been 
given ; it is therefore right on the morning 
of the third day after confinement to give an 
aperient. Castor-oil is almost universally 
prescribed ; but when the person is of full 
habit, and if there exists any tendency to 
fever, a common black draught is preferable. 
After the bowels have been moved, the pa- 
tient, if going on well, is to be allowed an 
improved diet; a little meat-soup, or light 
pudding ; and now, provided it can be done 
without putting the person in the erect pos- 
ture, the bed may be made, and the night- 
clothes changed. After the fourth day, ac- 
cording to the state of the patient, a little 
solid animal food is to be allowed ; but sti- 
mulants, whether immediately after the con- 
finement, or during the period of convales- 
cence, should never be taken unless for some 
special reason, such as great debility. At 
the end of the week, if all goes on well, the 
female may get on the sofa, toward the tenth 
day begin to get her feet to the ground, and 
gradually return to her usual mode of life. 
During the whole of the convalescence, there 
is no greater comfort, or more salutary prac- 
tice, than the free use of tepid water, so as 
to preserve the strictest cleanliness. By the 
use of gutta-percha sheeting, drawn under 
the patient, it may be fully employed with- 
out wetting the bed. 

When a confinement has been a moderately 
favourable one, if the foregoing directions 
are attended to, there are few cases that will 
not progress regularly to complete conva- 
lescence : it is true, that among the poor, 
some of the means and conveniences cannot 



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be carried out or procured as fully as could 
be wished ; but the most essential, fresh air 
and cleanliness, are mostly at command, 
and might be more freely taken advantage 
of than they are ; and in all cases something 
like moderate care ought to be observed — 
•which is too often not the case. As regards 
comforts and conveniences, in no way can the 
charity of the more fortunate be applied to 
the relief of their poorer sisters, than in the 
provision both of linen and diet suitable to 
a time of trial, when poverty is often so 
severely felt. 

But recovery after child-birth does not 
always preserve the smooth course. The 
accession of the milk may be accompanied 
with feverish excitement. This, if not ex- 
treme, is to be allayed by means of aperients, 
as castor-oil, black draught, or seidlitz pow- 
der, and effervescing saline draughts, to each 
of which may be added five grains of nitrate 
of potassa. Within the first few hours or 
days after delivery, the woman, if attacked 
with shivering, or rather shaking, so severe 
as to shake the bed, succeeded by heat of 
skin, thirst, delirium, with or without severe 
pain in the bowels, may be attacked with 
child-bed fever, and cannot be too quickly 
seen by a medical man ; in the mean time, 
the diet must be kept at the lowest ebb. If 
time must elapse before efficient aid can 
be got, there should at once be given a pill 
composed of one grain of opium and five 
grains of calomel, and this repeated regu- 
larly every six hours ; if pain is severe, a 
dozen of leeches at least, if they can be pro- 
cured, must be put on the' abdomen, and if 
not, light hot bran-poultices continually ap- 
plied. If the bowels have not been moved, 
they must be opened by an enema of gruel 
and castor or olive-oil, and the thirst be re- 
lieved by toast-water freely allowed. But 
the above active measures are not to be the 
substitutes for a medical attendant ; the 
attack threatens life, and may require all 
that skill can do for its removal ; if only a 
few hours are likely to elapse before aid is 
procured, the poultices, a single dose of 
calomel with opium, and the enema, should 
only be resorted to. 

If a woman, at any time during the first 
few weeks after her confinement, becomes 
excited and talkative, if she wanders slightly, 
if the eye becomes restless and wild-looking, 
and if sleep is absent, she requires imme- 
diate attention, for an attack of child-bed 
mania is probably impending. A medical 
man should be immediately summoned. In 
the mean while, the most perfect quiet is to 
be preserved around the patient, who should 
be placed in bed, in a room with the light 



slightly shaded ; cloths dipped in cold or 
iced- water be applied to the head, the feet 
kept perfectly warm, and the bowels, if con- 
fined, opened by a gentle aperient, but not 
purged. This, perhaps, is all that it is de- 
sirable should be done before the case is seen 
by a professional man ; but on an emergency 
it may be requisite, without this aid, to re- 
sort to the use of opium — Battley's sedative 
solution is the best — of that ten drops, or of 
laudanum fifteen drops, along with a grain 
of ipecacuanha powder, should be given in a 
little water, every half-hour, till quiet sleep 
is procured, or till at least four doses of 
either of the above have been administered. 

Occasionally, shortly after labour, the 
skin of the patient becomes covered with a 
"miliary" eruption, consisting of number- 
less points resembling minute blisters. This 
is generally the result of overheating or 
stimulating, and was much more frequently 
met with in former times than now, that a 
more cooling and rational system has been 
adopted. 

The principles to be kept in mind in the 
domestic management of child-birth, by 
those in attendance, are : — To have every 
thing in order and ready at hand ; to ex- 
clude all useless attendance ; to encourage 
the mind of the patient ; to preserve the 
moderate temperature of the room, and its 
free ventilation ; to abstain from giving 
stimulants, and from loading the stomach 
with food ; to have the bowels clear ; to 
avoid all meddling interference ; to summon 
medical assistance on the first appearance 
of any thing unusual ; lastly, let the patient 
be assured, that the process, though a 
painful, is a natural one, and He, who has 
ordered its marvellous arrangement and 
adaptations, will be present in the hour of 
travail. 

CHILD. — Infancy. — Childhood. — The 
period of childhood, including infancy, may 
be said to extend from birth to the thir- 
teenth or fourteenth year; and truly may it 
be said that the child is the father of the 
man; for upon the original constitution, and 
upon the physical and mental training of 
this most important epoch of human life, de- 
pends in great measure the usefulness, and 
consequently the happiness — it may be the 
eternal welfare — of the future man and wo- 
man. The subject of the management of 
childhood, all-important as it is, can, how- 
ever, be but briefly treated of in a work like 
the present ; and the reader who wishes fur- 
ther information than is to be found under 
the head of this article, is referred to the 
admirable work of the late Dr. Andrew 
Combe. 



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Infancy. — Continued from Child-birth. — 
When an infant is born, should it, in conse- 
quence of protracted labour or some other 
cause, not draw breath, and appear purple 
on the surface, it is advisable in the first 
place to pass the end of the finger, covered 
with a piece of thin calico or linen, into the 
mouth, for the purpose of clearing away the 
stringy mucus which not unfrequently ob- 
structs the passage of air into the lungs. 
If, under these circumstances, the navel- 
cord continues to pulsate, it should not be 
tied for at least two or three minutes, during 
which efforts are to be made to rouse the 
child, by blowing sharply on the face, or by 
one or two slight slaps on the back ; at the 
same time an attendant ought to be getting 
a warm bath — temperature 98° Fahr. — in 
readiness. If, after the lapse of time above 
mentioned, animation still seems suspended, 
the cord should be tied without further de- 
lay, and the infant at once removed and 
placed in the warm water up to the neck, 
the body being well supported, and the 
mouth and nostrils carefully kept from being 
accidentally submerged. The mouth and 
throat having been cleared from obstructing 
mucus as above directed, some one, while the 
nostrils of the infant are closed, should, by 
placing their mouth over that of the child, 
endeavour to inflate the lungs with their 
breath, and then withdrawing the mouth, to 
empty them by pressure exerted upon the 
abdomen and sides of the chest. The direct 
effort to inflate the lungs having been re- 
peated a few times, the artificial respiratory 
movements — alternately pressing upon the 
ribs and abdomen, and allowing them to 
recover by means of their own resiliency — 
should be persevered in for a considerable 
period. In these cases of suspended anima- 
tion in infants, electricity is unquestionably 
a powerful restorative ; but hitherto the 
difficulties attending its ready application 
just at the moment have rendered it almost 
unavailable ; now, however, the newly in- 
vented electric chains of Pulvermacher will 
probably place in the hands of the accou- 
cheur, and, from their simplicity, even of 
others, a readily applicable source of the 
above powerful stimulant. — See Electricity. 

When an infant exhibiting full signs of 
life is separated from the mother, and placed 
in the flannel receiver, it must not be covered 
up too closely — the caution is not superflu- 
ous, for infants have actually been smo- 
thered in this way by the extra carefulness 
of the nurse ; it must, too, be placed where 
it will be warm. As soon as the child can 
be attended to, it ought to be examined all 
over, to ascertain whether it be perfectly 



formed ; and the tying of the navel-cord 
should be seen to be secure. Washing with 
warm soft water — temperature 98° — soap, 
and soft flannel, is the next requisition. 
The skin of a newly-born infant is covered 
with a white unctuous matter, which is to 
be removed. This may be best accom- 
plished by greasing the skin thoroughly with 
lard or oil before washing it, and then rub- 
bing it as gently and effectually as possi- 
ble, without fraying the skin, the arm-pits 
and other folds of the body being particu- 
larly attended to. The child, after being 
washed, is often dried upon the receiver, 
placed on the nurse's knees ; a better plan 
is to have placed on the lap a moderately 
soft pillow, covered with two or three large 
warm napkins, on which to lay the child. 
The drying, which should be done in cold 
weather at a moderate distance from a fire, 
having been effected gently, without scrub- 
bing, a little starch-powder should be dusted 
into the folds of the groins and arm-pits, but 
not elsewhere, unless the skin appears 
frayed. The portion of the navel-cord re- 
maining attached to the child is now to be 
wrapped in a piece of soft linen, which is 
kept in place by a binder of fine flannel, five 
inches wide, and long enough to pass twice 
round the body of the child, so as to give 
support without pressure, and fastened by 
needle and thread — not by pins : if too firmly 
applied, the respiration of the infant is inter- 
fered with. The remainder of an infant's 
clothing is so much regulated by custom and 
other considerations, that it is unnecessary 
to mention it here, further than to impress 
the rule that it should be perfectly loose and 
easy, and fastened entirely by tying or sew- 
ing. A cap should never be placed upon a 
child's head, which is naturally hot enough 
to do without artificial covering. [This is 
the general practice of the present day, and 
is chiefly adopted by mothers as saving 
trouble ; but it is doubtful whether the cases 
of deafness and gatherings in the head, 
snuffles, and sore eyes, now so common among 
children, may not arise from this departure 
from the habits of our forefathers. A thin 
cap is a protection from sudden changes of 
temperature, and upon the bare head of an 
infant cannot do harm. Few adults even 
with a full head of hair sleep comfortably 
without covering the head.] When the in- 
fant has been dressed, it should be laid to 
rest in the cradle, or place prepared for it, 
perhaps beside its mother, but at all events 
where it will be sufficiently warm. It will 
probably sleep for some hours. It ought not 
to be fed for the first few hours after birth. 
As too frequently practised, the unfortunate 



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baby is dosed with "rue tea," " sugar and 
butter," or some such mess, or stuffed with 
soaked bread or gruel, and the first founda- 
tion laid of the disordered bowels, wind, 
screamings, &c. &c. which are so general 
in young infants. When the infant wakes 
from its first sleep, or, at all events, in the 
course of four or five hours after birth, it 
should be put to the breast ; even should 
there not be sufficient secretion of milk to 
satisfy the child, it is well both for it and 
the mother that it should be thus early in- 
duced to take the nipple. If, as may occur, 
the milk-flow is delayed, it will be necessary 
to give the infant the artificial support of 
cow's milk, unskimmed, but diluted with 
nearly half water, and very slightly sweet- 
ened : this may be given, either from a com- 
mon nursing-bottle, or by means of a spoon, 
but the former is preferable. On no account 
should any thing like bread, gruel, or the 
like, be allowed to pass the lips of a newly- 
born infant, unless under the pressure of 
extreme necessity, such as might happen on 
board ship, and then the powder of grated 
biscuit, or of twice-baked bread, softened in 
water, is the least hurtful substitute. The 
first milk of the mother is thin and serous, 
and is generally considered to exert an ape- 
rient action upon the infant's bowels, by 
which the slimy olive-green discharge named 
"meconium," which first occurs from them, 
is carried off. Should the bowels not act 
within twenty-four hours after birth, from six 
to eight drops of castor-oil should be given, 
mixed with a small quantity of moist sugar. 
Should this have no effe<5t, it may be re- 
peated ; but should the infant appear to 
make the straining effort to relieve the 
bowels, without its being effected, the vent 
ought to be carefully examined by a medical 
man, as it may happen that closure of the 
bowel, complete or partial, exists, but which 
may, nevertheless, be remediable. The 
case is not common, but its possibility is not 
to be forgotten. 

The majority of mothers are able, and ought, 
as a sacred duty, to nurse their own infants ; 
but cases occur in which, from illness suc- 
ceeding the confinement, or from general 
weakness of constitution, a female is unable 
to do so, either with benefit to herself or the 
child. When she cannot, it becomes a se- 
rious question, whether the duty of nursing 
is to be devolved upon another, or whether 
the infant is to be brought up by hand. 
The general voice says the former — the au- 
thor confidently asserts that the latter is 
preferable. In the first place, it is requi- 
site to provide a nurse whose own infant is 
of the age, or nearly so, of the infant to be 



wet-nursed ; it will not do to put a young 
infant to the breast which has been nursing 
for many weeks or months. This is the first 
but the lightest difficulty. [Children have 
often done perfectly well upon breast-milk 
eighteen months old, though that nearer the 
age of the child is certainly the best.] But 
there is a much more serious consideration. 
We have yet to learn the full measure of 
influence, both physical and mental, which 
may be exerted upon the child by the pecu- 
liar physical and mental constitution of the 
foster-mother from which it draws its first 
nourishment. It is true the physical de- 
velopment is generally rigorously scruti- 
nized, but how are passions and mental 
tendencies to be measured ? And we do know 
that the class from which wet-nurses are 
often selected are certainly not in the habit 
of controlling their appetites and passions ; 
and further we know, that the physical 
qualities at least of the milk are very liable 
to be affected by the mental emotions of the 
nurse : here at least is one source of danger, 
were we sure, which we are not, that there 
is no deeper, more lasting, life-felt influence 
exerted. And withal, it is quite possible that 
some physical taint, venereal perhaps, (it 
has happened and may happen,) has escaped 
the searching examination of the selecting 
physician. These are all serious consider- 
ations for a mother before she submits her 
child to draw its first nourishment from the 
body of a stranger ; one too, who must either 
be suffering from the intense grief which 
every mother feels who loses her infant from 
her breast, and whose milk must be affected 
by that grief, or who must have been com- 
pelled by poverty, and all its physical evils, 
to undertake the task ; or one whose mental 
constitution is so unscrupulous, that, with- 
out necessity, she will consent, for gain, to 
east aside her own infant, and, at the risk 
of its welfare, give its birthright to a stranger. 
Are any of these the qualifications which 
a mother will choose for the nurse of her 
child, even if she has the selfishness to 
tempt another to desert her own legitimate 
offspring ? Medical men often witness the 
painful sight of one infant declining away, 
while the mother is nourishing another into 
strength. The system and importance of 
wet-nursing has been much overrated ; 
for it is perfectly possible, if the care and 
trouble requisite will be incurred, to bring up 
a child by hand, as well and healthily as at 
the breast of a foster-mother. Care and 
trouble it does involve ; but if these are 
grudged, the child had better go to its grave 
at once. 
In bringing up a child by hand* milk 



CHI 



108 



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must be its only nourishment for the first 
three or four months. Ass's milk or goat's 
milk may be employed, but more generally 
cow's milk will be used, either with or 
without the cream removed, according to 
its richness, and according (as the first few 
days' experience will show) to its effect 
upon the infant. The milk is to be diluted 
with one-third water, and just perceptibly 
sweetened. It is not to be given by spoon, 
but by means of a common nursing-bottle, 
which should always be of glass. (See fig. 

Fig. xxxv. 




xxxv.) Of these bottles there should be two, 
both on account of accidents, and also, that 
unvarying and essential cleanliness may 
be observed. Without the most scrupulous 
care, (and on this depends the success of 
bringing a child up by hand,) the purity and 
wholesomeness of the food cannot be pre- 
served. The milk and water should be 
mixed fresh, at least twice a day, and, in 
summer, kept in vessels immersed in cold 
water ; it is to be given to the child at 
nearly the temperature of the body, about 
96°. The food is to be sucked from the 
bottle, and much care is requisite in the 
management of the artificial " sucks" which 
are used for the purpose, and which are of 
great variety : they are made of silver, 
caoutchouc, prepared teats, wash-leather, 
parchment, linen, muslin, &c. Whichever 
material is preferred, it should, without 
being too impervious, occasion the infant 
some exertion to draw the milk through it, 
if it does not, the child is apt to overfill 
the stomach, and loses the exercise which 
it has when it draws its nourishment from 
the breast of the mother. Silver is gene- 
rally too hard for the gums. India-rubber 
sucks of excellent quality are now made ; or 
wash-leather, or parchment, or double linen, 
or muslin will be found convenient, accord- 
ing to the strength of the infant. Which- 
ever is used, it must be made up into the 
form of a cone, or like a small jelly-bag, with 
a piece of sponge about the size of a large 
pea, to give a little substance, fastened inside 
by one or two stitches passed through. The 
suck must then be firmly tied to the end of 
the feeding-bottle, and will require changing 
every day, otherwise it becomes sour-smell- 
ing and unwholesome ; independent of 
which, wash-leather thickens and becomes 



impervious, and the other materials arc apt 
to wear through. Again it is repeated, that 
the most thorough cleanliness, in milk-can, 
bottle, and suck, is to be observed, and must, 
except in rare instances, be a mother's care. 
Another caution is requisite. In feeding 
children from the bottle, careless nurses 
may frequently be observed to incline it 
the wrong way, so that the infant goes on 
for a time sucking wind. For the first 
three or four months this milk-and-water 
food is all that is requisite, with the addi- 
tion, if at any time the bowels should be 
too much relaxed, of a portion of isinglass, 
from one to two small teaspoonfuls dis- 
solved in the half-pint of fluid. About the 
fourth or fifth month, a small portion of 
arrow-root or wheat-flour may be boiled in 
the water before it is added to the milk; 
and about the seventh or eighth month, the 
spoon may be used to give some of the more 
solid milk and farinaceous preparations. In 
bringing up by hand, the child will, as at 
the breast, require feeding about six or 
seven times in the four-and-twenty hours, 
for the first three months at least — about six 
tablespoonfuls, or one ounce and a half, on 
the average, being given at once, at first, 
and the amount gradually increased. Small, 
delicate children, however, will scarcely 
take half the amount above stated, and 
great care must be taken, both with them 
and others, not to allow the stomach to be 
overloaded. If an infant is habitually sick, 
[or has diarrhoea,] the quantity allowed at 
once must be reduced ; for, though happily 
the infant stomach relieves itself easily of 
superfluous food, it is better to avoid the 
superfluity than trust to the sickness, not- 
withstanding the popular fallacy that sick- 
ness is a sign of infant health. 

The system of rearing by hand is much 
more prevalent in some parts of Germany 
than in this country. The following pas- 
sage from the work of Dr. Andrew Combe, 
the substance of which he says he derived 
from the German work of Dr. Von Ammon, 
is so full of practical instruction, that the 
author makes no apology for quoting it at 
length : — 

" In some constitutions, however, cow's 
milk does not agree when merely diluted 
and sweetened ; but answers perfectly well 
when a large proportion of water and a 
small quantity of any well-prepared fari- 
naceous substance is added. In this case, 
it is a common custom in some parts of 
Germany to dilute the milk with a weak 
infusion of any light aromatic, such as - 
linden-tree flowers, instead of pure water. 
But after the first month or two, where 



CHI 



109 



CHI 



diluted milk does not agree, a small pro- 
portion of well-boiled arrow-root, grated 
Dutch rusk, or well-baked or toasted bread, 
sometimes forms a very useful addition 
wherewith to thicken the milk to the con- 
sistence of thin gruel. Briand, indeed, re- 
marks that milk diluted and boiled for a 
length of time with any light farinaceous 
substance, is more easily digested by some 
infants than pure milk ; and that when the 
use of milk alone is followed by white and 
curdy evacuations, a change to a bouilli, 
made of milk and farina, often restores 
them to a healthy colour and consistence. 
For this reason he recommends panada, 
made by boiling for a length of time in 
water, or milk and water, thin slices of 
bread, previously well dried in the oven. 
Another, of which he speaks highly, is the 
creme de pain, made by infusing in water 
for several hours well-baked bread, previ- 
ously dried in the oven in slices, and boil- 
ing it gently for some hours more, adding 
water from time to time to prevent it be- 
coming too thick. It is then strained and 
sweetened, and a few drops of orange- 
flower water are added. For infants a 
few months old, arrow-root, sago, or semo- 
lina may be used in the same way. The 
bouilli in common use in France, as the 
first food of infants, is made by gently 
roasting the best wheat-flour in an oven, 
then boiling it for a considerable time, 
either in water or in milk and water, and 
adding sugar to it. When carefully made, 
not too thick, and free from knots, it is 
considered an excellent food, especially 
where the use of milk excites a tendency to 
diarrhoea, or colicky pains. On changing 
to the bouilli, the digestion immediately im- 
proves, and the evacuations become healthy 
and unattended by pain. 

"In some instances, especially when the 
bowels are sluggish, barley-water or thin 
gruel, with or without the addition of weak 
chicken-tea or beef-tea, answers best ; and 
the grand rule ought to be to follow what 
seems best suited to the individual consti- 
tution. In soft, flabby children, the chicken 
or beef-tea is often most useful ; while in 
thin, active, and irritable infants, the milder 
milk and farinaceous diet answers best. 
But in trying the effect of any alteration 
we must not be too rash, and, because no 
advantage is apparent within a day or two, 
conclude that therefore it will not agree. 
In many instances, the effects of a partial 
change of diet show themselves so gradu- 
ally, that it is sometimes only after an in- 
terval of a week or two, or even longer, that 

K 



we can tell positively whether benefit will 
result from it or not." 

When the infant is to be nursed at the 
breast of its mother, it ought, as above di- 
rected, to be. put to it, unless some cogent 
reason forbids, within six hours after birth, 
and from that time it will require it every 
three or four hours for the first few months. 
It may be requisite, either from weakness of 
the child, or some other cause, (see Breast,) 
to have the nipple drawn out either by a 
stronger or older infant, or by some other 
means. Should the mother not be able to 
nurse her infant entirely, the extra feeding 
must be conducted upon the rules laid down 
for bringing up by hand. 

The first few weeks of an infant's life are 
spent principally in sleeping and taking 
nourishment ; movement is but little in- 
dulged in, and consequently the power of 
sustaining the animal temperature is but 
slight; for this reason care is always re- 
quisite that sufficient heat be preserved, 
both of clothing and of situation, during the 
day, and by the infant sleeping with its 
mother or nurse during the night, for the 
first few weeks of its life at least. Equally 
important with temperature, nay, even more 
so, is the purity of the atmosphere which a 
young child breathes ; errors in this respect 
have led to the most deplorable loss of 
infant life. One instance is sufficient to 
illustrate the point : it is the well-known 
one of the Lying-in Hospital of Dublin, in 
which, at one period, one child out of every 
six died within the first fortnight of exist- 
ence ; but by the adoption of proper means 
of ventilation, this very great mortality was 
at once reduced to one death for every nine- 
teen or twenty children born. It is unne- 
cessary here to repeat what has been said 
in the article, "Bed-room," upon the means 
of ventilation, &c, and to that article the 
reader is referred. The cradle or bassinet 
in which an infant sleeps should not be 
smothered up with curtains ; and it is bet- 
ter, for some time at least, without sheets, 
light blankets only being used. 

The mattress should be hair if possible ; 
but where economy is requisite, cotton-wool 
will answer the purpose ; it should be pro- 
tected from wet by means of waterproof 
material of some kind. A pillow too large 
and soft is not advisable, for, by allowing the 
head to sink into it, an injurious amount 
of heat and perspiration is promoted, and 
the child rendered susceptible of cold when 
taken up. The skin of an infant requires 
the most scrupulous care ; by its powerful 
agency it frees the body from matter which 



CHI 



110 



CIII 



must be noxious if retained, and which is 
especially apt to act injuriously upon the 
susceptible infant nervous system. The 
skin ought to be washed with tepid water 
and soap, night and morning, and, after 
each washing, reaction promoted by gentle 
friction with the hand for a few minutes. 
Care must always be taken that the situa- 
tion for washing is sufficiently warm, but 
not, as too often the case, before a scorch- 
ing fire ; draughts of air are especially to 
be guarded against. Before leaving this 
subject, it is requisite to notice the filthy 
custom, prevalent among the poor, of allow- 
ing the scurf, the oily secretion, and the 
dirt, to cake upon the skin of the head, 
under the idea that it preserves from cold. 
The habit is not only disgusting, but is pro- 
ductive of disease — perfect cleanliness is as 
requisite here as elsewhere. 

In fat children the creases or folds in 
the skin require extra attention, from the 
liability of the opposed surfaces to become 
inflamed, and to pour out an irritating 
moisture ; dusting with starch-powder, or 
the intervention of a piece of soft linen 
spread with simple cerate, may either of 
them be used as a remedy. The portion of 
navel-cord which is left attached to the child, 
will require attention. This separates by a 
kind of moist decay ; it may come off en- 
tirely by the fourth day, or take a fortnight 
to do so ; it must never be hurried. Gene- 
rally, when the navel separates, it leaves the 
puckered closing of the skin perfectly com- 
plete. It sometimes, however, occurs, that 
bleeding or inflammation and ulceration take 
place at the time of separation ; such cases 
ought at once to be placed under medical 
care. When actual bleeding occurs, the 
condition is all but hopeless. When the 
opening at the navel does not thoroughly 
close at birth, protrusion of a portion of 
the bowel takes place when the child cries. 
This state of things, apt to occur when the 
cord has been of more than average thick- 
ness, requires much attention, as the com- 
fort and safety of the individual, especially 
of a female, in after life, may be considerably 
interfered with if the malformation is not, 
as it may be, cured in childhood. The 
belly-band, or binder, has of course con- 
siderable power in preventing the protru- 
sion through the navel opening ; but in these 
cases it is not sufficient; and for the first 
few weeks, one or two graduated compresses, 
made of folded linen, should be placed over 
the navel underneath the binder ; and when 
the child is a month or six weeks old, the 
following apparatus must be used: — From 
a cork, the diameter of which is about half 



as large again as that of the protrusion, 
a slice the eighth of an inch thick is to be 
cut, flatly padded, covered with linen, and 
affixed to two cross-pieces of plaster by 
stitching. (See fig. xxxvi.) The plasters, 

Fig. xxxvi. 




being warmed before application, are used 
to retain the padded cork directly over the 
opening of the navel ; above all the binder 
is applied. The plasters will probably re- 
quire renewal every few days. It is better 
to trust to the linen pads alone, as long as 
any tendency to inflammation of the skin 
exists, using at the same time a plaster of 
simple cerate or goldbeater's leaf next the 
skin. Instead of either linen or cork pad, 
one of vulcanized India-rubber, filled with 
air, might be substituted. The treatment 
of navel protrusion, or hernia, in infants, 
and the management of the apparatus, in- 
volves some amount of care and trouble, 
but not more than the necessity and im- 
portance of the evil demands for its rectifi- 
cation. In such cases the infant should be 
kept from crying by all reasonable means, 
the best preventive being the careful atten- 
tion to the rules of health laid down in this 
article. 

Rupture at the groin may occur in chil- 
dren at birth, and may be suspected to 
exist when unusual fulness or swelling is 
observed in this situation ; and if the fulness 
and tension is increased when the child cries, 
the case should at once be seen by a medi- 
cal man. 

Any malformation with which an infant 
is born, ought as soon as possible to be sub- 
mitted to the judgment of the surgeon, so 
that he may have full opportunity of fixing 
the appropriate time for its rectification or 
removal. The operations for hare-lip, dis- 
torted joints, such as club-feet, are how 
performed at a much earlier period than 
they used to be formerly. In the case of 
vascular nsevus, or mother-mark, which 
often increases rapidly from a mere percep- 
tible point to a large size, surgical interfe- 
rence as early as possible is most important, 
These ngevi are composed of so thick a net- 



CHI 



111 



CHI 



work of capillary vessels as to be almost 
spongy, and, should they be accidentally 
■wounded, bleed freely, and if of any size, 
dangerously ; they vary in colour from 
bright re'd to purple ; if the finger be pressed 
upon a nsevus, it becomes emptied of blood, 
and pale; but the instant the pressure is 
removed the blood, and consequently the 
colour, instantly return. There are various 
methods employed for their removal ; but 
the one used in each case must depend upon 
the surgeon. A simple, painless, and fre- 
quently successful mode of cure, is vacci- 
nating upon the naevus, "which is cured by 
the inflammation which takes place in the 
progress of the cow-pox. The possibility 
of this being done is an additional reason 
why the disease should be seen as early as 
possible by a medical man. The continued 
use of the compound tincture of iodine to a 
nsevus, the surface being painted over with 
it night and morning, will, sometimes, if per- 
severingly adhered to, be successful in remov- 
ing it ; the application being intermitted for 
a few days should the skin become sore. 

Tongue-tying in infants is not uncom- 
mon ; it depends on too great prolongation 
of the "fraenum," or bridle which retains 
the tongue in place. It is easily rectified 
by a snip of the surgeon's blunt-pointed 
scissors. 

The time at which an infant may first be 
taken out of doors after birth must depend, 
of course, greatly upon the time of year ; in 
fine "warm summer weather, in the course 
of ten days or a fortnight, it will be safe to 
make the change ; in winter it can scarcely 
be prudent to do so for a month or six weeks, 
and then only on a fine day. In either case, 
free exposure in the house should first be 
practised, the first airing should not extend 
longer than twenty minutes, and the eyes, 
especially at first, must be shaded from the 
glare of the sunlight : of course, either the 
chill of morning or the damp of evening 
must be avoided. A young infant should 
not be taken. out during the prevalence of 
an east wind. 

The principal ailments, likely to come 
under domestic management, to which in- 
fants are liable, are thrush, red gum, colicky 
pains in the bowels, and diarrhoea. For 
the first — thrush — the reader is referred 
to the article " Aphtha." Red gum is a mild 
species of "papular" eruption, to -which 
many children are subject soon after birth. 
It is quite devoid of danger, and requires 
no treatment if the bowels are in good 
order ; if uot, a dose or two of castor-oil 
may be given. The usual friction after 
washing must be moderate during its con- 



tinuance. Inflammatory swelling of the 
breasts in infants is not unfrequent. — See 
Breast. Most infants are troubled, more or 
less, with wind, or colicky pains in the 
bowels, and not unfrequently with diarrhoea, 
but these are much aggravated by errors in 
feeding so universally prevalent, particu- 
larly among the poorer classes : sometimes, 
when the child is nursed entirely at the 
breast, particularly of a wet-nurse, they are 
caused by the nurse's transgressions in diet. 
Attention to the rules already laid down 
under the head of feeding will greatly pre- 
vent the above ailments ; but when they do 
occur they must be rectified as simply as 
possible, but never by the dangerous and 
baneful quack carminatives so extensively 
sold and used. Pain and wind in the bow- 
els in children are generally connected 
with superabundant acidity; for the cor- 
rection of the cause and its consequences, 
either of the two following mixtures may 
be used moderately, both with safety and 
good effect. No. 1. — Take of calcined mag- 
nesia twelve grains, dill [or anise-seed] 
water one ounce and a half. No. 2. — Take 
of prepared chalk ten grains, dill-water 
one ounce and a half. Of either of the 
above mixtures, a small teaspoonful may be 
given, and repeated if requisite. The first, 
No. 1, is to be selected, should the bowels 
be at all confined ; the second, No. 2, should 
they be too relaxed. It is not recommended 
that either of these medicines, simple as 
they are, or any others, are to be given too 
freely to infants, and on every slight occa- 
sion; but it is better to give them than to 
allow a child to suffer; they, or something 
similar, ought to be the substitutes in every 
nursery for the secret quack nostrums. It is 
true they will not either as quickly stop 
pain or put a child to sleep as mixtures 
which contain opium or poppy syrup ; but 
they cannot, like them, either put it into its 
last long sleep by an overdose, or injure 
not less fatally, when frequently used, even 
in small doses, by gradually disordering the 
brain and nervous system. When either of 
the mixtures above recommended are given 
to children, or indeed whenever magnesia 
or chalk is given habitually, it is always 
prudent to give an occasional dose of castor- 
oil, as cases have occurred in which concre- 
tions of the above antacids have accumulat- 
ed in the intestines. The dose of castor-oil 
for a young infant may be from ten drops to 
half a teaspoonful. In cases of diarrhoea, 
should the affection be slight, and the infant 
be a hand-nursed one, the addition of isin- 
glass to the milk food will, in most cases, 
stop the tendency at once, particularly if 



CHI 



112 



CHI 



assisted by a few doses of mixture No. 2, 
and by a warm bath for five or six minutes, 
at a temperature of 98°, regulated by a ther- 
mometer. Should the affection be more 
severe, the emulsion of castor-oil with yolk 
of egg (see Castor-oil) must be given. To 
one ounce and a half of the emulsion, made 
with a teaspoonful or drachm of castor-oil, 
two drops of laudanum are to be added, and 
one teaspoonful, or twelfth part, given once 
in six hours. And here the opportunity is 
taken to warn the reader respecting the 
administration of opiates to children. They 
are most susceptible of the influence of the 
drug, and accidents are continually occur- 
ring — more frequently perhaps than comes 
to light — from its effects : a single drop of 
laudanum has been known to prove fatal to 
a young infant. The above treatment is 
given, not as an inducement for parents, 
who can readily procure medical aid, to 
take the treatment of their children, when 
ill, into their own hands, but it is because it 
may be of service in situations when skilled 
assistance is not readily procurable. Many 
of the diseases of children commence in- 
sidiously, but after attaining a certain 
stage, run their course rapidly. No parent, 
therefore, who either values his child's life 
or his own peace of mind, should delay pro- 
curing medical assistance when real illness 
shows itself; but at the same time, the very 
same reason ought to induce every parent 
to inform himself upon the nature of the 
symptoms which most generally usher in 
real illness in children, and also how and 
by what means the illness which these 
symptoms indicate is to be most effectually 
retarded and obviated. More upon this 
head will be given when the diseases of 
childhood generally are touched upon. 
Within the first five months of an infant 's life, 
vaccination ought to be performed, that is, 
before the constitution is liable to suffer 
from the irritation of teething. — See Vacci- 
nation. 

The period of teething varies extremely, 
and not less so in the manner in which it 
affects children. For information upon the 
mode in which the teeth are developed, the 
reader is referred to the article " Teeth." 
Some children cut the two front teeth of 
the lower jaw — which always appear first 
— as early as the .fourth or fifth month, 
while others, apparently equally strong, 
do not have them developed within the 
year. The usual and popularly received 
sign of approaching tooth-cutting is water- 
ing of the mouth; but this may continue 
for many weeks before the teeth appear. 
Before the teeth come through, the gums 



flatten on the top, look semi-transparent 
and full, and are sometimes extremely 
swelled and inflamed. The constitution of 
the child always sympathizes more or less 
with the cutting of the teeth — most simply 
and beneficially so by the occurrence of mild 
diarrhoea, which is always — unless it goes 
to an undue extent — a safeguard, and is 
better not interfered with. When the gums 
are much swollen and inflamed, and must 
be very painful, the susceptible brain and 
nervous system of the child is strongly and 
injuriously affected by the irritation. The 
little sufferer is fevered, flushed in the 
cheeks, and peevish ; sleep is disturbed 
with moaning and starting, and the fingers 
are constantly in the mouth, or the lower 
jaw is moved from side to side. In such 
cases, lancing the gums thoroughly, warm 
baths, and aperients if the bowels are not 
relaxed, are the remedies, the first especially, 
without which the others are useless or 
nearly so. The popular idea, that lancing 
the gums is beneficial, by assisting the 
passage of the teeth through them, is quite 
erroneous, and may lead to an erroneous 
method of performing this simple little 
operation, which every parent who lives at 
a distance from medical assistance, and par- 
ticularly in emigrant life, ought to know 
how to do. The real benefit is derived from 
the relief which the incisions afford to the 
tense and distended gum, and from the 
slight flow of blood which follows ; and on 
this account it is advisable, not only to cut 
the upper surface, but also the side of the 
gum, so as to divide the vessels freely. The 
operation is most conveniently and safely 
done by a "gum lancet" made for the pur- 
pose, (see fig. xxxvii.,) but a common pen- 
Pig, xxxyii. 




knife may be employed on emergency, the 
blade being wrapped with a piece of linen, 
to within a short distance of the point, to 
prevent any chance cut to the lips. It is 
superfluous to describe this simple proceed- 
ing : it should be seen done once, or at least 
the method shown. It is not recommended, 
of course, that the gums are to be lanced 
for every slight irritation of teething ; but 
when the child exhibits the graver symp- 
toms above described, it ought to be done at 
once, and, if requisite, repeated again and 
again. In addition to lancing the gums, a 
warm bath for ten minutes will be found 



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eminently serviceable in soothing the Irri- 
tated system, and aperients should be given — 
a couple of grains of gray powder at night, 
followed by a small teaspoonful of castor- 
oil in the morning ; or if stronger action be 
thought requisite, a powder composed of 
one grain of calomel to two of powdered 
scammony is to be given at bedtime to a 
child of six or eight months old. If the 
irritation attendant on teething produces 
convulsion, medical aid must be had as soon 
as possible, and, in the mean time, those 
remedies employed which are suitable. — See 
Convulsion. 

In judging of the diseases of children, it 
ought to be borne in mind that the pulse of 
an infant is always quick, averaging from 
120 to 130 in the minute, and that at the 
end of the first year its average is still con- 
siderably above 100. — See Pulse. 

The regulation of the exercise of young 
children is of much importance. At first 
the mere respiratory movements, occasional 
crying, and the effort of sucking, are exer- 
cise sufficient, if gentle nursing movements 
be employed : but gentle they must be ; 
the system so often adopted of jerking 
infants about is much to be condemned, 
and may be extremely hurtful. In the 
course of a few weeks after birth, the infant 
begins to show signs of increased power of 
movement, and evidently experiences phy- 
sical pleasure in the exercise of its limbs. 
As time goes on, its next effort is to sit up 
in the nurse's arms, till, if a vigorous 
healthy child, at about fourteen months, 
it generally tries to walk. All these move- 
ments will come spontaneously to the child, 
when its frame and muscular powers are 
adequate to the exertion, but- they should 
never be forced. It is astonishing what an 
amount of practical ignorance prevails on 
the above point ; children are put to sit in 
chairs, held upon their feet, or put in go- 
carts of various construction, long before 
the bones are fit to bear the weight — and 
curved spines and distorted legs are the 
consequences. Again it is repeated, every 
advance of the child toward walking and 
the upright posture can only be safe when 
spontaneous. When a child first commences 
to walk it must get falls, but it is sur- 
prising how little material injury the head, 
which most generally suffers, seems to 
receive. At the same time, in families in 
which a tendency to head affection exists, 
extra care must be taken ; a padded band 
round the head is a useful protection, and 
one frequently employed. 

When a child begins to walk, and to at- 
tempt to talk, the period of infancy may be 
k2 



considered as ended, and childhood begun. 
Many of the directions applicable to the 
former are equally so, in a modified degree, 
to the latter, and vice versa; but "child- 
hood" requires further remark. When dis- 
tinct nursing is no longer requisite, the child 
becomes more truly the inhabitant of the 
nursery, and much of its health and hap- 
piness for the next few years of its life 
will depend upon the proper regulation of 
this important department of the household. 

Whatever is said respecting the necessity 
for pure air and proper ventilation, either 
in this article or in any other, such as 
"Bed-room," applies of course to the nur- 
sery, or rather nui'series ; for every parent, 
whose means will admit, should provide a 
night and a day nursery for his children, 
in neither of which should such operations 
as washing clothes, cooking, &c. &c. ever 
be carried on. The double room will allow 
all necessary airings, washings of floors, 
&c. to be perfectly carried out without 
the health or comfort of the children being 
interfered with. Should one nursery only 
be available, the children should be taken 
out of it in the morning as soon as possible 
after rising, the windows thrown wide open, 
and all necessary cleaning performed before 
they again enter it ; and, both now, and at 
every period of the day, all kinds of slops 
should be removed. Should any action of 
the bowels take place during the night, 
the receptacle should be put out of the 
room at once. The observations respecting 
the sanitary regulation of the nursery are 
more particularly applicable in the case 
of the middle classes, who want the abun- 
dant accommodation of the wealthy, and 
whose children, in towns at least, do not 
have the same free access to the open air 
as those of their poorer neighbours. The 
situation of a nursery in the house is import- 
ant ; it must, if possible, be in the upper 
stories, it should have a south aspect, and 
be abundantly supplied with light : the 
latter is a most necessary consideration. 
A guarded open fire-place is the best means 
of warmth, and the heat, regulated by a 
thermometer, should be kept as near 60° as 
possible. 

But however salubrious the nursery ar- 
rangements, children must have as much 
open air as possible ; and when the exercise 
can be taken as play, in summer, upon the 
grass, or otherwise, it is certainly the most 
beneficial. When weather and other con- 
siderations forbid, and walking is had re- 
course to, it must not go to the extent of 
real fatigue. At all times it adds much to 
the beneficial effect of exercise, if the mind 



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be engaged pleasurably in it, and there- 
fore all active plays, either in doors or out, 
are preferable to the mere walk, which few 
children enjoy. The clothing during the 
whole period of childhood, in a changeable 
climate, requires much attention ; woollen 
textures next the skin, both winter and sum- 
mer, is indispensable for health. During 
the former season, it should cover the chest 
and abdomen, and come at least halfway 
down the thighs ; but in the latter, it may 
be a lighter material, and not extend so far 
over the chest. Woollen stockings extend- 
ing over the knees ought always to be worn 
in winter ; and at all times should the entire 
clothing be such as will keep the surface 
of the skin comfortably warm. There is no 
greater or more fatal error than that which 
exposes children lightly clad to the influences 
of a variable climate, with the view of hard- 
ening them. 

Thorough purification of the skin must 
be maintained. A child should be washed 
all over with soap and water at least once 
a day. In the case of strong children the 
water may be cold, in the weaker, tepid, 
and in both friction with a tolerably rough 
towel should be used after the bath, both to 
cleanse and to promote reaction. If a child 
continues chilled and cold-looking, and ap- 
pears languid after a cold bath, it is a sign 
it does not agree, and the temperature of 
the water should be raised, or the washing 
should first be performed in tepid water: 
and then just at the last, a little cold water 
dashed over the body. 

The food in childhood claims care, equally 
with air, clothing, exercise, and cleanliness ; 
its regulation in infancy has already been 
sufficiently noticed. For strong healthy 
children, particularly those inclined to full 
or gross habits, the milk and farinaceous 
diet, such as rice, sago, bread, &c. cannot 
be exchanged for a better, for the first four- 
teen months at least ; but if children are 
delicate, and incline to the lymphatic con- 
stitution, the use of animal broths ought to 
be commenced even as early as the sixth 
month. The broth made from fowl, mut- 
ton, beef, or veal, should not be too strong, 
should be .free from fat, and is better 
thickened with arrow-root or sago for a 
young child, or with rice or bread crumb 
for an older one. Toward the twelfth 
month, a lightly boiled egg may be given ; 
but the best method of giving the powerful 
nutriment of egg to children is. to break 
the saw egg into some one of the milk 
preparations, while the latter is quite hot, 
and to beat up together. In this way, 
the albumen is sufficiently cooked but not 



hardened. When the teeth of a child are 
sufficiently advanced to masticate it, ani- 
mal food in the solid form may be given, 
but the quantity and frequency must en- 
tirely depend upon the constitution of the 
child. Strong ruddy children are better 
with it only twice or three times a week, 
weaker children should have it once a day 
at least, and in the more advanced stages 
of childhood, perhaps twice ; but this is a 
point which should be settled by a medical 
adviser. ' Potatoes, and the more whole- 
some vegetables, ripe fruits in their season, 
may all be allowed to children, in modera- 
tion, after the first eighteen months, and 
particularly should there be a tendency to 
costiveness, or to eruptions on the skin, and 
other affections depending upon gross habit 
of body ; weaker children may also partake 
of them, but more moderately, and provided 
they do not become substituted for more 
indispensably nourishing food. Children 
at any age are better without baked pastry 
of any kind, but boiled paste puddings are 
not unwholesome ; cheese, and all sorts of 
spiced and seasoned dishes, are quite objec- 
tionable. A healthy child should never 
have an alcoholic stimulant within its lips ; 
and tea or coffee, if allowed, should be very 
weak, and made with much milk : but there 
are some delicate children, nay infants, 
who may derive much benefit from a portion 
of alcoholic stimulant, carefully given as 
medicine, and as medicine requiring so 
much care and consideration, that it should 
only be employed when and as advised by 
a medical man. Children should not be 
made to wait long without some nourish- 
ment in the morning: the rapid changes 
which go on in their systems render them 
peculiarly sensitive to any, even temporary, 
want of nourishment. Eegularity in meals i 
is important even from the earliest period 
of existence ; it is always advisable that 
the principal meal be taken early in the day. 
Physical training, however, and the closest 
attention to physical regulations, require 
the addition of mental training to carry out 
thoroughly even the physical education of 
a child. For the infant a cheerful nurse- 
is most valuable. As childhood advances, 
whatever may depress or frighten ought 
especially to be guarded against, and all 
threats or practices which excite undefined 
terror especially avoided. Affection of the 
brain may be the result. Undue precocity 
in a child should always be regarded, if not 
with alarm, at least with suspicion. Many 
scrofulous children are unusually precocious; 
and as a general rule in such instances, the 
brain is more prone to disease, which may 



CHI 



115 



CHI 



end life, or predispose to mental affection. 
In such cases it is of the highest importance 
not only to avoid every thing which can 
stimulate to mental effort, but to excite 
them to such moderate and regular physical 
exertion as will in some degree draw off 
from the brain itself both the activity of 
the circulation and the nervous energy. 

There are some diseases which are more 
particularly considered as those of child- 
hood ; such are measles, hooping-cough, 
scarlet fever, small-pox at times, and chick- 
en-pox ; not that they do not occur in adults. 
but being most generally passed through 
only once, it is in the earlier years of life. 
In addition to the above, such affections of 
the brain as acute inflammation ending in 
effusion of water, convulsive disease, croup, 
inflammation of the lungs, and diarrhoea, 
are the most common acute affections of 
children. They and other diseases may be 
referred, to under their proper heads. 
Children quickly exhibit the general symp- 
toms of illness, but it often requires much 
more tact and discrimination to make out 
its exact seat and nature than it does in the 
case of adults ; it is, therefore, always de- 
sirable to place them under proper medical 
care as quickly as possible. At the same 
time, the following ought to be some guide 
as to the site of the affection, and to its 
provisional treatment. 

When in a child complaining of illness, 
or appearing ill, the eyes look heavy, and 
are wholly or partially closed against the 
light, if the brow is contracted, and if with 
these symptoms there is' general fever, some 
acute affection of the head is to be dreaded, 
and the indications should not be neglected 
for an hour ; if sickness is present with the 
above, so much the worse. Oppression of the 
breathing, along with general appearance of 
depression, is often the forerunner of severe 
inflammatory affection of the chest, which 
may be considered as established, if heat of 
skin, general fever, rapid breathing, and 
cough succeed. In the chest affections of 
children, the movements of the nostrils are 
much affected. Constipation, which can 
scarcely be classed as a disease, is almost 
natural to some children, but requires cor- 
rection, and this should be effected if possi- 
ble by food. Coarse bread should always be 
employed, and fruits, either cooked or ripe, 
such as roasted apples, given in moderation ; 
honey or treacle are useful, but nothing is 
more so than the daily use of porridge made 
from Scotch or other oatmeal. When the ten- 
dency to constipation in children cannot be 
overcome by diet, the next best remedy is 
the use of a small enema of gruel simply, 



or medicated with castor-oil, senna, or any 
simple aperient, or made with soap-water ; 
but the simple gruel ought always to be 
tried first. Dr. Marshall Hall considers, 
that in children especially, the use of warm 
enemas exerts a peculiarly beneficial effect 
in stimulating the liver. An enema for a 
child of six years old should not exceed 
twelve ounces, and ought to be administered 
slowly. When medicine must be given, as 
general aperients, castor-oil or infusion of 
senna are most useful: caution must, how- 
ever, be exerted in forcing the former me- 
dicine (as sometimes must be the case) 
upon very young children ; death has been 
occasioned from its getting into the wind- 
pipe. Rhubarb is a most excellent and 
safe aperient for children, but its bulk and 
nauseousness frequently make it difficult to 
get it taken satisfactorily ; magnesia is 
easily given in milk, and may be useful 
either in the solid or fluid form where 
active effects are not required, but the 
former especially ought not to be long con- 
tinued. Calomel and gray powder, alone, 
are too much employed for their aperient 
action ; they should not be administered 
except under medical sanction. 

As a general rule, in giving medicine to 
children, deception should not be practised; 
but while the child knows that it is medi- 
cine which it takes, it ought to have it in as 
palatable a form as may be, without inter- 
fering with the efficacy of the drug. 

Refer to Bed-room — Breast — Clothing — 
Diet — Electricily — Exercise — Milk — Rupture — 
Skin — Teeth — Vaccination — Ventilation — and 
to the articles on diseases and medicines gene- 
rally. 

CHILBLAIN.— A chilblain is an inflam- 
matory affection of the skin, more particu- 
larly of the fingers or toes, caused by alter- 
nations of cold and heat, and is characterized 
rather by irritating and troublesome itching 
than by pain. Persons of fine skin, scrofu- 
lous constitution, or languid circulation are 
most liable to suffer from chilblains, and old 
people and children more than those of mid- 
dle life. The sudden exposure of the skin 
when very cold to a high temperature is 
generally and justly considered to be an 
exciting cause of the affection ; but one 
quite as frequent is keeping the surface in 
a state of artificial warmth by the use of 
sleeping-socks and hot applications in bed, 
or of fur-lined shoes and foot-warmers in the 
day time. All these applications keep the 
skin in a continual state of unnatural per- 
spiration, weaken its tone, and so render it 
more susceptible of the effects of cold when 
exposed to it. To prevent chilblains, in the 



CHI 



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CHL 



predisposed, the feet ought to be regularly 
bathed with cold, or, (in the case of the aged, ) 
tepid water, or salt water, every morning, 
and afterward well rubbed with a rough 
towel, exercise being employed to preserve 
the warmth of the extremities rather than ar- 
tificial heat. When chilblains have formed 
and the skin is unbroken, stimulating appli- 
cations are requisite ; many different ones are 
used; spirit, such as brandy, camphorated 
spirit, paregoric, or turpentine, will any of 
them be of service, applied by means of a 
piece of linen, or gently rubbed on. When 
the skin of a chilblain breaks, an ulcer is the 
consequence, which discharges a thin slimy 
fluid, and is often difficult to heal. In this 
case, the inflammation should be subdued 
in the first place by means of a poultice, and 
afterward an ointment used, made either 
with forty drops of Goulard, or ten grains 
of red precipitate, to the ounce of lard. Of 
course all friction or pressure from boots or 
shoes must be guarded against. 

CHIMNEY. — A chimney, by intention the 
channel through which the smoke and fumes 
of fire are conveyed away, also performs 
the no less important but slightly (until 
of late) estimated office of a ventilator.— 
In former times, when the chimney formed 
almost a separate chamber, in which per- 
sons sat round the fire, or indeed as long as 
it retained its ample dimensions, the people 
enjoyed an efficient means of ventilation, 
although in ignorance of the benefit. By 
change of fashion, the chimney has been 
gradually contracted and lowered to the mo- 
del of the present modern fire-place. While 
this has been done, from ignorance of the 
necessity for pure air, no provision has been 
made to supply the loss of the efficient ven- 
tilating power of the old-fashioned construc- 
tion, and health must consequently have 
suffered and does suffer materially from the 
omission ; although it is to be hoped that the 
diffusion of popular knowledge upon this 
and other points of sanitary regulation will 
not allow such to be the case much longer. 
The chimney, however, is a notable instance 
of society enjoying ignorantly an arrange- 
ment conducive to health; and that igno- 
rance, while making alterations more con- 
sistent with comfort and convenience, doing 
away with one great advantage, of which it 
remains for science to point out both the loss 
and the means of reparation. As whatever 
goes up, or ought to go up, the chimney, are 
vapours and gases which cannot remain 
down without injury to health, it is a matter 
of importance that the chimneys of a house 
draw well — more especially those of bed- 
rooms in which fire is used. As a means of 



ventilation simply, independent of the fire, the 
importance of a chimney is so great, that 
rooms in this climate which are destitute of 
one cannot be considered healthy, although 
it must be confessed that this secondary 
office appended to the original intention is 
rather a clumsy method of effecting so im- 
portant an end. It is one, however, of which 
it is requisite to make the most, and there- 
fore chimneys ought to have a thorough 
draught for smoke, ought never to be stopped 
up when not in use, unless other means of 
efficient ventilation are possessed, and, when 
possible, should be fitted with some efficient 
mechanical contrivance for increasing their 
ventilating power. — See Bed-room, Ventila- 
tion, fyc. 

CHIN-COUGH.— See Hooping-Cough. 

CHLORINE — Is a gas of a green colour. 
It is an important agent in manufactures, 
on account of its bleaching properties ; and 
its powers as a disinfectant, or destroyer of 
the noxious emanations from decomposing 
bodies, whether vegetable or animal, render 
it a most valuable assistant in sanitary ar- 
rangements. When undiluted, it exerts an 
extremely irritating effect upon the lining 
membrane of the respiratory organs ; and as 
serious and even fatal accidents have occur- 
red from this cause, caution is requisite in 
its use. A small proportion of chlorine gas 
diffused through the atmosphere, very quick- 
ly and thoroughly destroys not only the 
smell, but the injurious properties of float- 
ing emanations, which are capable of engen- 
dering disease. Chlorine gas is obtained 
in various ways, but the great magazine for 
its supply is common salt, which is composed 
of chlorine and sodium. For sanitary pur- 
poses, various preparations calculated to 
yield chlorine simply and easily have been 
used ; of these the chloride of lime is the 
best known. This and most of the prepara- 
tions, however, have the disadvantage of, 
when alone, yielding the gas too slowly and 
sparingly to be of much service, and, when 
mixed with an acid, of pouring it out in 
quantity so great as to affect disagreeably or 
injuriously any persons exposed to its influ- 
ence, particularly the sick. Other prepara- 
tions require sprinkling about the place to 
be purified ; and as this is often done in 
ignorance of its colour-destroying powers, 
much damage is done to furniture, &c. A 
late preparation — Collins's disinfecting pow- 
der — seems to be free from the above objec- 
tions ; when a portion of it is exposed to the 
atmosphere, it keeps up a certain but suffi- 
cient exhalation of chlorine for some days, 
as it continues to absorb moisture. It is the 
best, most effective, and agreeable method 



DHL 



ir 



CHL 



for employing chlorine in the chambers of the 
sick which the author has met with. In no 
case of continued sickness, whether of an in- 
fectious character or not, ought chlorine 
fumigation to be neglected. 

The principal preparations used in medi- 
cine into the composition of which chlorine 
enters are chloride of sodium or common salt, 
(see Soda,) chlorate of potass, (see Potassa,) 
chloride of zinc, (see Zinc,) and hydro-chloric 
acid. Hydro-chloric acid is a gaseous com- 
pound of chlorine with hydrogen gas, but is 
usually met with in solution of a yellow co- 
lour, when it is generally called muriatic 
acid or spirit of salt. It is of course a pow- 
erful corrosive poison when swallowed alone ; 
its antidotes are the carbonates of potassa, 
chalk, or magnesia in any form, or milk, or 
white of egg, whichever is first at hand, un- 
til the antacids are procured. In the ab- 
sence of any of these, soap-water may be 
given ; but, in poisoning with any acid, it 
should be remembered that mortar or white- 
wash, rubbed up finely with water or milk, 
may be used on emergency as an antidote ; 
the lime neutralizing the acid. Of course 
the other antacids, particularly magnesia, 
are to be employed if procurable at once. 
Of the latter, a dessertspoonful may be 
given every ten minutes, and repeated ac- 
cording to the effect and probable amount 
of acid swallowed. 

Muriatic acid is used in medicine as an 
unstimulating tonic, particularly in diseases 
such as malignant scarlatina, which are ac- 
companied with tendency to putrescency ; it 
is also used as a mouth-wash or gargle in 
the same disease. Muriatic acid is given in 
doses of ten drops, in a wineglassful of wa- 
ter sweetened with sugar ; or it may, if pre- 
ferred, be taken much more largely diluted, 
and then forms a pleasant drink. It may be 
used as a gargle, in the proportion of two 
drachms to the pint of water. As in the 
case of acids generally, unless largely di- 
luted, the doses should be sucked through a 
quill or glass tube, to preserve the teeth 
from corrosion ; and it is likewise a useful 
precaution, for the same purpose, to rinse 
the mouth with a diluted solution of carbon- 
ate of soda. In the absence of means for 
procuring chlorine, if fumigation is required, 
muriatic acid gas may be used as a substi- 
tute, as it is disengaged by mixing equal 
weights of common salt and oil of vitriol, 
(sulphuric acid,) care being taken against 
inhaling its irritating fumes in too concen- 
trated a state. 

CHLOROFORM— Is a fluid ; it is transpa- 
rent, heavy, colourless, and possesses an 
agreeable etherial smell. Its power of pro- 



ducing " antesthesia," or insensibility U 
pain, when inhaled, is now too universally 
known to require comment. It is, however, 
too potent an agent to be trusted in unpro- 
fessional hands, except, indeed, under di- 
rect medical sanction and direction in each 
particular case. In the more painful and 
larger operations of surgery it is one of 
the greatest boons conferred upon suffering 
humanity, and its use tends to diminish the 
average mortality after them. In the case 
of minor operations, however, such as tooth- 
drawing, it becomes a question whether its 
employment is advisable. Fatal cases have 
followed its inhalation ; and although these 
have been in very small proportion com- 
pared with the numbers in which it is daily 
and hourly administered, still the fact of 
their having occurred is sufficient to make 
us pause before incurring even the remote 
chance of so serious a result, for the sake 
of avoiding a momentary though sharp pain, 
[especially when ether is as good an anaes- 
thetic, and is perfectly safe in the hands of 
a medical man.] In some cases very disa- 
greeable effects, such as headache, sickness, 
hysteria, &c. &c. have succeeded the use of 
chloroform. No one should, therefore, ever 
be tempted to inhale this agent, without 
being certain beforehand that no tendency 
to organic disease exists, especially of the 
heart or lungs. 

Although not suited for domestic use as 
inhaled, chloroform may be employed with 
perfect safety and much advantage as an 
external application in painful affections, of 
the nerves especially, such as neuralgia and 
toothache. For this purpose a piece of 
linen or lint, of a size proportioned to the 
part affected, is to be soaked in the fluid, ap- 
plied to the skin, and then covered with some 
material, such as oiled silk, to prevent quick 
evaporation. It destroys the silk ; and in 
the course of a few seconds produces an in- 
tense but scarcely disagreeable burning sen- 
sation, which continues until the fluid is all 
dispersed. In many cases the neuralgic 
pain disappears at once. When the cover- 
ing is removed, the portion of skin to which 
the chloroform has been applied is found 
much reddened, sometimes slightly blistered. 
A small portion of cotton wool soaked in 
chloroform will, if placed in the cavity, some- 
times allay the pain of toothache. Chlo- 
roform, taken into the stomach, has been 
found useful in spasmodic diseases, as asth- 
ma, hysteria, &c. and might be adminis- 
tered, in the absence of other remedies, in 
doses of from six to ten drops, along with a 
teaspoonful of brandy in three tablespoon- 
fuls of water. 



CHL 



118 



CHO 



CHLOROSIS.— See Anjemia. 

CHOCOLATE.— See Cocoa. 

CHOKE-DAMP.— See Carbonic Acid. 

CHOLERA — Asiatic ok Malignant. — 
The modern pestilence which first visited 
England in the year 1832, and again in 1849, 
in which latter visitation it carried off, in 
London alone, 15,000 people, and in the en- 
tire kingdom, not less perhaps than 80,000. 
At present, we know the disease but in its 
symptoms ; its true nature and seat, not- 
withstanding numerous investigations and 
hypotheses, are still undetermined, and as 
regards the best mode of treatment there is 
nearly equal uncertainty. Happily, such is 
not the case with respect to those conditions 
of body, and still more with respect to the 
external circumstances, which favour the 
attacks of the scourge and foster it into 
activity. Dirt, bad air, bad water, bad 
food, insufficient clothing, and irregular and 
vicious habits, are all the favourers of cho- 
lera; and were it not for these, singly or 
combined, it would, in all probability, pass 
comparatively lightly over our land. We 
know not how, in future times, the Almighty 
may order the mysterious agency of Asiatic 
cholera to fulfil his own good purposes ; but 
we have every reason to calculate, that by 
a more diligent observance of those organic 
laws with which he has linked our material 
existence, we may be enabled to break the 
force of another, it may be more fearful 
visitation than the last. If the compara- 
tively healthy homes, the habits of cleanli- 
ness, the sufficient food and clothing of the 
higher classes have hitherto protected them 
from the sweeping virulence of the disease, 
as it has been shown in the less advantage- 
ously placed families of the poor, it gives 
confidence to suppose that the elevation of 
the sanitary status of the whole mass of the 
people will have an equally good effect. It 
is not supposition — it is certainty — that such 
would be the case ; certainty, that, whatever 
the virulence or the mildness of the next 
visitation of Asiatic cholera, the suffering- 
will be proportionally commensurate with 
the sanitary condition of the people when 
it comes. And yet this was eqrially well 
known after the warning of 1832 as it is 
now; and, after a respite of seventeen years, 
the pestilence came again and found us un- 
prepared as regards our own safety, but 
prepared to nourish and foster its myste- 
rious germs in the foetid, stagnant air of 
city, town, and village, unventilated and 
undrained, half supplied in water or not 
supplied at all, or tainted with decomposi- 
tion of every kind, from human excrement 
upward; and such will be the case again, 



unless the people themselves stir — and to 
them this is addressed. Governments cer- 
tainly may do much, vastly more than they 
now do, but they cannot do all ; the people 
themselves must be fully awakened to the 
necessity of observing the laws of health, 
now so well ascertained — awakened to the 
sin before God of neglecting them. The 
teachers of the people, and especially the 
clergy and the higher orders, must be more 
conversant with the laws which regulate the 
existence, and on which depend the health 
of their own bodies and of those of their 
less favoured brethren — must be able to de- 
tect and point out those sanitary deficiencies 
which must so often come before them, and 
which they have it in their power to rectify. 
While resignation to the will of God is re- 
quired from all, surely it is not true resig- 
nation, but sinful ignorance and apathy, to 
submit the mind, while the cause remains, 
to the loss of husband or child carried off 
by cholera or by fever, generated by the 
unhealthy habitation or the stagnant pool. 
For, whether it be cholera or fever — and 
they both inhabit the same localities — or 
the slow undermining of the health, or scro- 
fula, or consumption, they are too often 
looked upon as the direct visitations of God, 
when they are due to the sinful neglect of 
those laws with which he has connected the 
health and soundness of our material body, 
the healthy and happy working of our minds, 
both for our own good and that of our fel- 
low-men. This may perhaps be deemed a 
digression from the main subject of this 
article, but the subject itself is one which 
arrests men's attention, and will do so still 
more should the pestilence again threaten 
our shores; it has, therefore, been seized 
as another opportunity for reiterating the 
advantage, the necessity, the religious duty 
of attention to sanitary regulation, to sup- 
plies of light, pure air, and pure water in 
abundance ; to regular and temperate habits, 
and to their usual attendants in this land, 
good food and sufficient clothing. It is a 
privilege to be able to afford relief to sick- 
ness and suffering in the hour of need — and 
to further that end the present work is in 
part devoted ; but more important still is 
the enforcement of those measures which 
will, under Providence, ward off or modify 
disease, 

The first commencement of Asiatic cholera 
is traced to the year 1817, when it took its 
rise in a swampy district at the mouth of the 
Ganges, from whence it spread over India 
to various parts of Asia and Europe, and 
finally reached England in the year 1831, 
where it continued till the end of 1832, dis- 



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appeared for seventeen years, and re-ap- 
peared, in a more virulent form than before, 
in the year 1849. [In Canada and the United 
States cholera first appeared in 1832, and 
again in 1850. It has also prevailed along 
the Mississippi and other rivers since that 
period.] The mode of propagation of cho- 
lera is undetermined ; it exhibits the most 
apparent capriciousness in the course it 
follows ; but one thing is certain, that those 
unhealthy external conditions already al- 
luded to, almost, as it were, seem to attract 
the disease. 

The violence of its symptoms, and the 
fearful rapidity with which it often termi- 
nates life, render cholera one of our most 
alarming diseases. Occasionally, but more 
frequently in hot climates than in temperate 
ones, persons are, as it were, prostrated at 
once by the cholera-poison, and die, perhaps 
within an hour of the first attach, without 
any other symptom than total collapse of 
the powers of life. More generally the 
seizure is not so sudden : probably there has 
been slight diarrhoea, or rumbling move- 
ments of the bowels, with sinking sensation 
at the stomach, for some days previously ; 
or, at all events, the person has felt unwell. 
When the disease sets in earnestly, which 
in the larger proportion of cases it does 
during the night, the patient vomits, and is 
purged with more or less frequency and 
violence, the evacuations quickly coming to 
resemble thin gruel or rice-water; cramps 
of the limbs succeed, the surface becomes 
cold, blue, bathed in sweat, and has, par- 
ticularly the fingers, a peculiar shrunken, 
sodden appearance; the' tongue is cold, the 
pulse imperceptible; the urine is suppressed, 
and the voice acquires a peculiar pitch of 
tone. Many die in this, the collapse stage 
of the disease ; but if it is passed through, 
reaction comes on, the surface gets warm, 
the thirst continues, the quick pulse becomes 
perceptible, the tongue is dry and brown, 
and delirium is present; in short, fever is 
established, and may end either in recovery 
or death. 

During the prevalence of cholera, many 
err in making material changes in their or- 
dinary modes of living, and, by so disorder- 
ing the regularity of the functions, lay 
themselves open to attacks of the disease. 
Of course, if a man is aware that he is 
habitually indulging in practices injurious to 
health, such as intemperance, debauchery, 
&c. &c. he only acts wisely as regards his 
physical safety in changing those habits ; 
but it is hazardous to alter regular modes 
of living, which have hitherto been found 



compatible with good health — it being un- 
derstood that whatever tends to lower the 
standard of health favours the attack of the 
disease. There is, however, one important 
precaution which ought to be observed, at 
all times indeed, but more particularly 
during the epidemic of cholera : the perfect 
purity of the drinking-water should be ascer- 
tained, and its freedom from all decomposing 
organic matters made certain. Care is also 
to be observed not to take active purgatives, 
particularly salines, which produce watery 
evacuation; if aperient medicine is required, 
it ought to be of a warm character, such as 
magnesia and rhubarb, with some aromatic ; 
for whatever produces free action of the 
bowels apparently increases the suscepti- 
bility to attack. For this reason, too, the 
slightest tendency to diarrhoea should at once be 
arrested by the aromatic confection or chalk- 
mixture, repeated as often as requisite, with 
the addition of from five to ten drops of lau- 
danum [and tincture of camphor] to each 
dose, and the use of milk, and farinaceous 
preparations containing gelatine, for food. 
The speedy adoption of these measures, in 
places distant from medical assistance, and 
their enforcement, by the clergyman or some 
intelligent individual, might do much to 
check the disease. Should the astringents 
above recommended fail, three or four doses 
of acetate of lead and opium might be given 
by a careful person. 

With regard to the actual treatment of 
the disease itself, when fully established, 
many different methods have been proposed 
and practised, and few of them, perhaps, 
without apparent advantage in some cases ; 
but as yet no treatment which can be called 
decidedly successful (a cure) has been dis- 
covered. Of course, in so formidable a dis- 
ease, proper medical assistance ought to be 
obtained as quickly as possible ; but as far 
as our present knowledge extends, those 
around the patient would be fully justified 
in using every possible method of hot ap- 
plication to maintain the temperature of 
the body, and in permitting the gratification 
of the intense thirst to the full, by cold 
water, alone, or containing one drachm of 
common salt, one drachm of carbonate of 
soda, and twenty grains of chlorate of po- 
tassa, in every quart. In doing this there 
will be at least the consolation that the 
comfort of the patient is promoted ; every 
thing further must be left to medical judg- 
ment. We must live in hope, that before 
the scourge again visits us, which it pro- 
bably will do, particularly if the present 
sanitary evils are permitted to remain, me- 



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dical science will have some more efficient 
method of cure to offer than we at present 
possess. 

The consecutive fever of cholera requires 
the treatment of fever generally. 

CHOLERA, BRITISH.— See Bilious Cho- 
lera. 

CHOLERA.— See St. Vitus's Dance. 

CHRONIC. — A term applied to diseases 
of slow progress, in contradistinction to 
''Acute." — See Acute. 

CHYLE— Is the milk-like fluid which is 
separated from the chyme, or digested food 
mass, after it has passed from the stomach 
and become mixed in the small intestines 
with the bile and pancreatic fluid. The 
vessels by which the chyle is absorbed 
from the intestine have been named lac- 
teal, from the milk-like or white appear- 
ance of this fluid, which they contain 
abundantly after a full meal ; the charac- 
teristic whiteness being more particularly 
apparent if the food has contained much 
fat. 

Refer to Absorbents — Chyme — Digestion — 
Pancreas. 

CHYLOPOIETIC— Is a term applied to 
the viscera which assist in the formation of 
the chyle. 

CHYME — Is the pultaceous, gray-looking 
acid substance, to which food is reduced by 
digestion in the stomach, before it passes — 
in the healthy state at least — into the small 
intestines. 

CICATRIX— Is the scar or mark left 
upon the skin or upon an internal organ, at 
the place where separation of substance, 
either from violence or ulceration, has been 
healed. 

CIDER. — The well-known fermented drink 
made from apples. Its characteristic prin- 
ciple is malic acid. It contains but little 
alcohol, not above 9 per cent., and is gene- 
rally considered wholesome ; but to its use 
has sometimes been attributed a form of 
dry belly-ache, resembling painter's colic, 
which occurs in cider districts. There ap- 
pears, however, to be some doubt whether 
this is not owing to accidental impregnation 
with lead, which readily combines with the 
malic acid of the cider. 

CINNAMON — The well-known spice, is 
the bark of a tree. It is brought from 
Ceylon and the islands of the Indian Archi- 
pelago. It is largely used in medicine for 
the same purposes as other stimulant aro- 
matics ; chiefly as an addition to correct 
the nauseant, or add to the stimulant pro- 
perties of other more active medicines. The 
distilled water is well known. In conse- 
quence of the high price of true cinnamon, 



a coarser description, the cassia bark, is 
very generally sold in place of it in this 
country, and, though not so fine in flavour 
as the true bark, is equally well adapted for 
medicinal use. True cinnamon is thinner, 
lighter in colour, and consists of more quills 
one within another, than cassia bark. 

CIRCOCELE. — An enlargement or vari- 
cose condition of the veins of the testicle. 

CIRCULATION OF THE BLOOD.— By 
this is understood the entire course of that 
fluid from its leaving the heart to its return 
to that organ. In man, and in warm-blood- 
ed animals generally, including birds, there 
are two complete systems of circulation, 
(see fig. xxxviii.,) the one through the body 

Fig. xxxviii. 




at large, the other through the lungs ; and 
this double circulation involves the presence 
of a double propelling organ, that is, a heart 
consisting of four cavities. 

The structure and requirements of our 
animated bodies, as they have been consti- 
tuted by the Creator, depend for their main- 
tenance in healthy existence and action 
upon the continual passage of arterial blood 
throughout every portion of their structure 
— for this the circulation provides. The 
heart, which is muscular, consists of four 
cavities, two auricles and two ventricles ; of 
these, the left ventricle, (Gr,) which gives 
the first propulsion to the arterial wave of 
blood, is considerably the most powerful. 
When it contracts, the blood contained with- 
in it at the moment is forcibly propelled 



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into the aorta (A) or main blood-vessel of 
the body, from which it diverges into the 
secondary branches, until at last, by the 
division and subdivision of the vessel, it is 
conducted into the capillaries, (C,) in which 
it comes into more intimate connection with 
the elementary components of the body, and 
undergoes such chemical change that when 
it emerges it is an altered fluid ; instead of 
the bright red arterial, it is the dark black- 
looking venous blood, unfit for the mainte- 
nance of the vital functions. It is now col- 
lected by the veins (V) and conducted back 
to the heart, the right auricle of which it 
enters ; from this cavity it passes into the 
right ventricle, (D,) and is propelled by its 
muscular power into the pulmonary artery 
(B) and through the lungs ; in its passage 
through which it is brought into contact 
with atmospheric air, casts off the carbonic 
acid with which it has been laden, absorbs 
oxygen, and, being chemically changed, is 
once more the bright arterial fluid, which, 
returning through the pulmonary vein (E) 
up to the left auricle of the heart, (H) is 
transmitted by it to the left ventricle, to be 
sent once more upon its mission of life. 

Although the forces which circulate the 
blood, namely, the muscular propelling 
power of the heart, the muscular and elastic 
contractility of the arterial coats, and the 
suction power exerted within the chest, are 
sufficient of themselves, during health, to 
maintain the vital current, which flows, and 
must flow, from the first moment of life until 
death, — their power and efficiency is much 
assisted by the muscular movements of the 
body by exercise, which, quickening the 
respiration and the action of the heart, 
sends the blood with increased force and 
frequency throughout the frame, and stimu- 
lates every function to increased action. 
Thus provision has been made by the Crea- 
tor, that while the powers which circulate 
the blood can, of themselves, carry on that 
necessary process sufficiently to preserve 
life, high health and vigour can only be at- 
tained by the active exercise of our limbs. 
In the aged, and in those exhausted by 
disease, who are long confined to a horizon- 
tal posture, the circulating powers become 
too feeble to overcome the force of gravity, 
and the blood tends to accumulate, more 
particularly in the lungs, in the most de- 
pendent part ; for this reason, change of 
posture is advisable. — See Bed. 

Refer to Artery — Blood — Heart — Respira- 
tion, §c. 

CITRATE OF IRON— Is a compound of 
iron and citric acid, introduced into medical 
practice within the last few years. It is an 



elegant and pleasant form, and maybe given 
in solution in water in one or two grain 
doses. It becomes moist if exposed to the 
action of the air. 

CITRATE OF QUININE AND IRON— Is 
a compound of iron, citric acid, and quinine, 
and is an elegant and highly useful form of 
tonic ; it may be given in a similar way, and 
in doses similar to the above. 

CITRINE OINTMENT— Is a mercurial 
preparation much used by some in skin dis- 
eases. [It is also often employed in the form 
of sore eyes attended by redness of the edges 
of the lids, and by a disposition in them to 
stick together in the morning. It should be 
applied at the roots of the eyelashes at night, 
so that it cannot get into the eye, and the 
part should be washed in the morning with 
warm water. An application every other 
night is sufficient to create a change in the 
action of the part, and thus cure the com- 
plaint.] In its ordinary form the ointment 
is too strong, and should be mixed with once 
or twice its weight of lard. Iron utensils or 
spatulas must not be used in its manipula- 
tion. It is an ointment which very quickly 
spoils, [as may be told by its decided green 
colour or hardened condition.] 

CLARET — Is one of the most wholesome 
of the light wines. It contains 15-10 per 
cent, of alcohol. In convalescence from 
acute febrile disease in which wine is ad- 
missible, but where there exists a tendency 
to febrile action from slight causes, claret is 
most useful, and preferable to the stronger 
and heavier wines. In diabetes, claret has 
been recommended as superior to every 
other form of stimulant. 

CLAVICLE. — The Collar-bone — extends 
from the upper part of the breast-bone to the 
point of the shoulder. It is particularly liable 
to fracture from falls upon the shoulder : the 
accident is easily detected. — See Fracture. 

CLERGYMAN'S SORE-THROAT— Is a 
peculiar affection of the throat and organs 
of voice to which public speakers are liable. 
According to Mr. Macready, actors, who 
have to assume feigned tones, are more liable 
to it from that cause. The seat of the dis- 
ease is the mucous follicles scattered over 
the membrane of the throat, larynx, &c. 
being extended to the latter from the former. 
The commencement of the disease is insidi- 
ous ; it begins with an uneasy sensation, as 
if there was something in the throat which 
required to be hawked up or swallowed 
down; at the same time the mucus secre- 
tion is viscid. As the larynx becomes af- 
fected the voice is changed, becomes hoarse, 
unequal in tone, or quite extinguished ; there 
may be slight pain about the parts, but not 



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much cough in the earlier stage of the dis- 
ease. All the symptoms become aggravated 
by cold, by vicissitudes of temperature, or 
by exertion of the voice in reading, speak- 
ing, &c. The above sources of aggravation 
are of course to be guarded against, and 
the general health attended to ; but the cure 
of the disease, which consists chiefly in the 
repeated application of a strong solution of 
lunar caustic to the parts affected, must 
only be intrusted to the medical man. Dr. 
Green, of New York, has the credit of first 
accurately describing the disease, and of 
prescribing the treatment above mentioned, 
which is very successful. 

CLIFTON— Lies within a mile of Bristol. 
Sir James Clark speaks highly of its climate. 
"In its local advantages and geographical 
position it yields, perhaps, to no place in the 
kingdom as a residence for a large class of 
invalids. Within its own limits it affords a 
sheltered winter, and an open airy summer 
residence ; while it is surrounded by nume- 
rous places of agreeable resort in the fine 
season, suited to the various classes of per- 
sons who may seek its shelter during the 
winter. Compared with the south and south- 
west coasts, the spring is the period of the 
year in which this climate appears to the 
greatest advantage. For consumptive pa- 
tients, and those labouring under irritable 
affections of the bronchial membrane, the 
softer and more humid air of Devon will be 
found more soothing, while for invalids whose 
constitutions have suffered from long-con- 
tinued derangement of the digestive organs, 
or a congested state of the mucous mem- 
brane, with copious secretion, and also for 
young scrofulous persons, and those of re- 
laxed habits of body, generally, Clifton will 
prove a preferable climate." 

" The spring termed Hotwell rises at the 
base of the lofty St. Vincent's Rock, and is 
said to yield as much as forty gallons of 
water in a minute. * ; * * The temper- 
ature of the water is 76° Fahr. Like the 
springs of Bath and Buxton, the salts of lime 
predominate. The following table will ex- 
hibit the proportion of the saline constituents 
in a gallon of water : — 

Grains. 

Muriate of magnesia 7-25 

Muriate of lime 3-80 

Sulphate of lime 7-5 

Sulphate of soda 16-15 

Carbonate of lime 13-5 

47-30 
"A gallon also contains, according to Dr. 
Carrick, thirty cubic inches of carbonic acid 
gas. 



" The water emits a few gas bubbles when 
drawn into a glass. Taken internally, it 
generally acts upon the kidneys, and occa- 
sionally produces vertigo and headache. It 
is recommended in various states of deranged 
health. The baths are not much used. The 
internal use of the water is considered to be 
very efficacious in cases of dyspepsia with 
acidity, in affections of the kidneys, as dia- 
betes, gravel, and tendency to stone." 

CLIMACTERIC DISEASE— Is a sudden 
giving way of the vital powers in persons of 
advanced life, without any definite disease 
to account for the change. The affection 
seldom occurs before fifty years of age, and 
is more common in men than women ; for one 
reason, probably, that its most frequent ex- 
citing cause is over-work and anxiety of the 
mind in business. The person who is be- 
coming the subject of climacteric disease, 
complains of weakness coming on gradually, 
the appetite gives way, sleep is deficient, the 
bowels sluggish, the pulse quick, and the 
tongue furred ; the flesh falls away, and the 
altered countenance assumes an aged look 
in a short period: in other words, the "con- 
stitution is breaking up," and the individual's 
friends remark that "he ages very fast." 
Swelling of the limbs, eruptions of the skin, 
and mental apathy are further concomitants 
of the disease, which, if unchecked, may run 
on to a speedy, fatal termination ; while it 
also renders the patient liable to sink easily 
under any attack of acute illness, even of a 
common cold, which too, it may be observed, 
is often the first traceable commencement 
of the attack of climacteric. Another very 
frequent cause is grief caused by the loss 
of friends or relatives, who have been much 
mingled in the affections and habits of daily 
life. 

When an aged person exhibits the symp- 
toms described above, they should imme- 
diately be attended to : the case must be put 
under medical management, and will require 
tonic treatment, generous living, complete 
relaxation from the cares and anxiety of 
business, and, if possible, change of climate. 

CLIMATE — Is the condition of the atmo- 
sphere which generally prevails over any 
particular tract of country, a condition which 
is of course regulated and modified by a 
great variety of circumstances. The lati- 
tude, the elevation, the proximity to or 
distance from the sea; the soil, the absence 
or presence of water, including the drain- 
age, the amount of wood, and the shelter or 
otherwise from prevailing winds, all exert 
important influences upon the characteristic 
climate of any locality, and have to be con- 
sidered in the recommendation given, or 



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plan of action resorted to by invalids. The 
subject is quite too extensive to admit of 
profitable consideration in this work ; and 
the decision respecting the climate, resort 
to which is likely to benefit each individual 
case, is so much matter of judgment, and is 
really so important, that medical opinion 
ought always to be taken when change of 
air or climate is seriously sought as a re- 
medy in illness. Very much precious time 
is often lost, and real injury inflicted, from 
want of due care upon this head, and from 
persons acting upon their own ideas, or 
upon insufficient advice. Those who desire 
to get for themselves the most complete in- 
formation upon the subject of climate, will 
find it in the valuable work of Sir James 
Clark. 

There are few diseases, perhaps, which do 
not derive either temporary or permanent 
relief from change of air and climate, but 
some are more strikingly benefited than 
others ; they are particularly diseases of a 
neuralgic, intermittent, or spasmodic cha- 
racter, of which hooping-cough and asthma 
are good examples. Chronic rheumatism, 
scrofula, weakness of the constitution gene- 
rally, including pulmonary consumption and 
dyspepsia, may also be mentioned. As a 
general rule, benefit appears to result from 
change to a climate presenting characters 
which contrast with those of the one in 
which the individual is or has been gene- 
rally resident ; the dyspeptic or consumptive 
patient will derive advantage by removing 
from the colder to the mere genial region; 
the fever-stricken resident of the sultry 
or vaporous plain will regain health and 
strength in the bracing air of the hills ; and 
even the country child, in whose constitu- 
tion hooping-cough lingers, will probably 
lose it if transferred to city air for a short 
period. Perhaps no air exerts such uni- 
versally tonic effects as that of the sea, but 
to some it is too stimulating in some particu- 
lar localities, though not so in others ; but, 
in fact, the differences in climate, and its 
effects, are so numerous and varied that it 
is impossible here to pass beyond the general 
consideration of the subject. Unquestion- 
ably some amount of the beneficial influence 
of the change of climate is due to the stimu- 
lant effect upon the mind which excitement 
and change of scene produce, this being 
more particularly the case if the condition 
of the individual permits or calls for the 
continued change of travelling from place to 
place. 

The error is frequently committed of re- 
sorting to the change of climate as a last 
resource, which, if earlier had recourse to, 



might have proved of essential or real ser- 
vice. Another error is trusting too much 
to the curative power of climate ; and inva- 
lids, by throwing aside the restraints of the 
regimen to which they have been previously 
subjected, and neglecting the other acces- 
sory adjuncts to recovery, fail to derive the 
full measure of benefit which they ought ; 
and this more especially if they do not con- 
sider and endeavour to accommodate them- 
selves to the modes of living and other 
requirements adapted to the climate in 
which they are resident for the time. 

Sir James Clark divides the "mild region 
of England" into four districts or groups of 
climate ; that of the south coast, compre- 
hending the tract of coast between Hastings 
and Portland Island ; the south-west coast, 
from the latter point to Cornwall ; the dis- 
trict of the Land's End; and the western 
group. In Scotland, the island of Bute, 
situated in the Frith of Clyde on the west 
coast, is a remarkable instance of climate 
modified by situation : surrounded by sea- 
water and sheltered by lofty hills, its cli- 
mate is remarkably mild and equable — so 
much so, that snow rarely lies above a few 
hours. It is much to be regretted that the 
beneficial effects of change of air are so little 
attainable by the poor, particularly in re- 
covery from acute illness, when it is fre- 
quently all that is requisite to re-establish 
firm health, and to hasten an otherwise lin- 
gering convalescence. The establishment 
and support of convalescent stations for the 
poor would constitute a truly useful end for 
charitable support. 

Refer to Atmosphere — Convalescence, §c. 

CLOTHING.— The protection of the body 
from the influences of climate, by means of 
clothing, is most intimately connected with 
health, more especially in any climate sub- 
ject to the numerous and sudden vicissitudes 
of temperature, moisture, &c. The form of 
clothing must ever vary with fashion ; the 
principle ought always to continue the same, 
that is, it should involve complete and tho- 
rough protection of the surface of the body, 
and especially of the cavities of the chest and 
abdomen, from cold or sudden chill. This is 
best insured by a covering of woollen mate- 
rial next the skin ; the habit should be com- 
menced from the earliest childhood, and con- 
tinue through life in every season of the 
year, varying only the thickness of the flan- 
nel, or other woollen texture, according to 
the average temperature. No outward 
clothing can be so uniformly efficacious as 
the inner one of wool, as a protection against 
a variable climate ; and yet very many there 
are who, both in their own persons and in 



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those of their children, neglect this real 
preservative of health, and therefore this real 
economy, although the cost at first may seem 
much to the poor. In addition to the inner 
clothing, the outer ought of course to be suf- 
ficient, and, in winter, an addition made on 
going from the warmth of the house into the 
open air. In this respect, men are generally 
better provided, under all circumstances, 
than women and children. Women, from 
the nature of their dress, and from the per- 
nicious custom of occasionally exposing the 
chest and arms — which would be less hurt- 
ful if constantly done — suffer much from 
errors in clothing; they subject themselves 
to the extremes of fur and thick shawls in 
the morning, and of thin dresses at night ; 
added to which there is often exposure to 
currents of air when heated, and without 
any protection against their effects. Any 
article of clothing, such as fur, which keeps 
up a more than average degree of heat, and 
even induces perspiration, and which is 
liable to be thrown off or put on easily and 
as fancy dictates, is hazardous and inju- 
rious. Children are in many cases most 
insufficiently protected from the weather; 
numbers are without a single article of 
woollen under-clothing, either in consequence 
of carelessness, or from the erroneous idea 
of rendering them hardy ; a system which 
may answer in the offspring of hardy pa- 
rents, whose- children are hardy in every 
other respect, but which can only be pro- 
ductive of injury to health in those who 
spend most of their time in warm, perhaps 
too warm, rooms and nurseries. The surface 
of a child, from the neck downward, ought to be 
kept warm by clothing; exposed chests, bare legs, 
and thin insufficient coverings, are synonymous 
•with croup, inflammation of the lungs, and scro- 
fula. For the same reason that boas, &c. 
are unsafe articles of dress for women, com- 
forters and woollen neck-wrappers are not 
advisable, except under particular circum- 
stances, for boys : they heat the neck, and, 
if thrown off carelessly, predispose to cold 
or bronchitic affection. 

The clothing of the feet is a matter of the 
highest importance to all; dryness and 
warmth must be attended to by those who 
value health. On the other hand, the head 
is often, especially in infants and children, 
kept too hot [by wadded caps, &c] 

CLOVES — Are the undeveloped flower- 
buds of a tree originally a native of the Mo- 
lucca Islands, but which is now cultivated 
in various parts of the tropics. They are 
well known as a spice, and used as a stimu- 
lant aromatic in medicine, their properties 
depending upon the volatile oil, which is in- 



tensely acrid. Cloves are rarely used in 
medicine alone. 

CLUB-FOOT.— See Deformity. 

CLYSTER, Enema, or Injection — Are all 
names for the same useful adjunct to medi- 
cal treatment — the mechanical injection of 
fluid into the bowels by the fundament and 
rectum. Clysters are most commonly em- 
ployed as aperients, but they are also used 
as anodynes, or antispasmodics, for the pur- 
pose of dispelling wind, or as internal fo- 
mentations, or as styptics. In illness they 
are generally administered to the patient by 
others, but instruments are constructed to 
facilitate their self-administration, which is 
of course preferable when, as frequently 
occurs, they are often required in ordinary 
health. 

The mechanical means used for the ad- 
ministration of clysters are very numerous ; 
the most useful are the self-injecting syringe, 
(fig. xxxix.,) and the vulcanized India-rubber 

Fig. xxxix. 




bag, (fig. xl.) The pipe and bladder, which 
was formerly the only method used, is still 
employed in country districts, and though 
clumsy, may be had recourse to on an emer- 
gency. 

The injection-syringe, or pump, is most 
useful when the clyster to be administered 
much exceeds half a pint in quantity, when 
it is used as an aperient, and requires to be 
forcibly injected. When the clyster does 
not exceed half a pint, as in the case of chil- 
dren, or when used as an anodyne or styp- 
tic, the vulcanized India-rubber bag (fig. xl.) 
is quite the most convenient mechanical 
agent, from its simplicity, and the ease with 
which any one may use it. Either instru- 
ment may be procured good from any re- 



CL Y 



125 



CLY 



spectable maker of surgical instruments, and 
directions are, or ought to be, given with 
them. When a clyster is administered to 
the sick, the patient may either be laid on 
the face or on the left side, near the edge 
of the bed, "with the knees drawn up. The 
metal or bone pipe which is introduced into 
the bowel should be well oiled or greased, 
and its introduction should be effected with 
perfect gentleness, not straight up, but in a 
direction slightly inclined toward the back 
bone, care being taken that no abrasion or 
scratching of the parts be occasioned : this 
is a most necessary caution in all cases, but 
more especially in those in which repeated 
use of the remedy will probably be required. 
Even with the greatest care, the parts are 
liable to become sore, causing the patient 
both to dread and suffer each time the in- 
strument is used, and even to be unable to 
bear a continuance of the practice. In all 
cases a clyster should be given slowly and 
gently, and care taken that air is not thrown 
up into the bowel as well as fluid ; with the 
syringe, this is to be avoided by pumping it 
full of fluid before it is applied to the pa- 
tient, and by not continuing the operation 
when the fluid used gets so low in the basin 
as to allow air to be drawn in ; with the bag 
care should be taken that the pipe-end is 
always held the lowest. When the bag is 
used, air is less likely to be introduced if 
the patient is laid on the face. When the 
syringe is used, if the flexible tubes have 
been kept bent in one position, they should 
be slightly warmed before any attempt is 
made to straighten them for use ; otherwise, 
especially in cold weather, they are apt to 
crack. If an instrument has been used for 
any thing but simple water, it ought always 
to be well washed out with warm water be- 
fore putting by. When taken to pieces it 
must always be unscrewed by the hand hold- 
ing the metal mountings. 

Clysters can only be conveniently self- 
administered by means of the syringe, (fig. 
xxxix.) 

Aperient clysters may be simply mecha- 
nical, of water, gruel, and the like, either 
cold, tepid, or warm, or they may be medi- 
cinal. There is an objection to clysters of 
simple water, that in some cases they are apt 
to wash off the natural protecting mucus of 
the bowel, and therefore it is perhaps better 
as a general rule, and where the remedy is 
often or habitually used, to employ a demul- 
cent, such as gruel or barley-water. Cold 
clysters, though sometimes useful, ought 
never to be resorted to except by medical 
direction ; the fluid about the temperature 
of 90° will generally be found most appro- 
l2 



priate, and when used simply, about a quart 
thrown up slowly, but with sufficient force, 
be found a suitable amount for the generali- 
ty of adults. Some use a much larger quan- 
tity, as much as two or three quarts ; this, 
in certain cases of illness, may be a useful 
measure, but as an habitual thing it is bad ; 
the frequent over-distension with so large a 
quantity of warm fluid produces want of 
tone, which aggravates the torpid tendency 
of the bowels, and favours faecal accumula- 
tion. For a child six years of age, half a 
pint of simple gruel clyster is ample. These 
simple clysters act by stimulating the bowel 
by their mechanical bulk ; when a medicinal 
clyster is used, the object is in some degree 
to avoid this, so that the medical agent may 
not be expelled before it has time to exert 
its peculiar agency. The medical clyster 
ought, therefore, as a general rule, not to ex- 
ceed one-half the quantity of the simple one. 

The simplest and readiest medicinal clys- 
ter is made, either with a tablespoonful of 
common salt in a pint of gruel, or with a 
piece of brown soap, the size of a hazel-nut, 
rubbed down into a pint of warm water ; or 
instead of these, from half an ounce to an 
ounce of Epsom salts, or tAvo ounces of olive- 
oil, or half that quantity of castor-oil ; or 
infusion of senna, half an ounce of leaves to 
the pint, may be employed. Stronger clys- 
ters, with turpentine, croton-oil, &c. are 
also used by medical men. 

Anodyne clysters ought always to be so 
small in bulk — not exceeding three fluid 
ounces — ^as not to stimulate the bowel to 
expel them, which from the nature of the 
cases in which they are usually given, it is 
apt to do. In all cases, anodyne clysters 
are most conveniently administered by 
means of the vulcanized bag, and the best 
form is from fifteen to twenty-five drops of 
laudanum in three [or two] ounces of mode- 
rately thin starch. This clyster is of course 
to be retained in the bowel if possible. One of 
the most useful clysters for dispersing flatu- 
lence is made with two drachms of tincture 
of assafoetida to half a pint of gruel, to 
which, if there is much pain, ten or fifteen 
drops of laudanum may be added ; or the 
same quantity of assafoetida tincture may, 
if required, be added to an aperient clyster. 
A useful domestic clyster, in the country, for 
the same purpose, is half a pint to a pint 
of strong " rue tea," or infusion of rue. 

Clysters used for the purposes of internal 
fomentation, may be given to the amount 
of a quart, and of a temperature of 98° 
or 100° Fahr. 

In hemorrhage from the lower bowel, 
when it is proper to interfere with it, a two 



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126 



COC 



or three-ounce cold styptic clyster may be 
used, made with sulphate of zinc four grains, 
or sulphate of iron one grain, to the ounce 
of fluid. 

COAGULATION— Is the conversion of the 
whole of a fluid, or of some of its constitu- 
ents, into a solid. The solidification of the 
white of an egg by heat is an instance of 
the former ; that of the clot in blood, or of 
the curd in milk, of the latter. The coagu- 
lating power of the blood is the great safe- 
guard in bleeding, which could not be per- 
manently stopped by any appliances, without 
this property of the vital fluid ; and it is 
the loss of this property that gives rise 
to the occasional cases of danger or death 
from bleeding, in consequence of com- 
paratively slight wounds, such as those 
from leech bites, or from the extraction of a 
tooth. 

COAL-GAS. — See Carburetted Hydrogen. 

COB-WEB— Employed as a styptic, to 
arrest bleeding from simple flesh-wounds 
or from leech-bites, is often used in the 
country. The web of the black spider, 
which builds in out-houses, &c. has been 
used with much success as a medicine in 
ague, given in doses of ten grains, in the 
form of pills, every two hours, commencing 
six hours before the return of the paroxysm. 
The fact is worthy of remembrance. — Refer 
to Ague. 

COCCULUS INDICUS— Is the fruit of an 
East Indian tree. It resembles a large 
brown shrivelled pea in outward appear- 
ance. The kernel is intensely bitter, and 
on this account is sometimes used fraudu- 
lently in the manufacture of beer, instead 
of the hop ; also with the view of increasing 
the intoxicating power of the beverage. In 
some districts, a deleterious, but rapidly in- 
toxicating ale, named "tear-brain," sup- 
posed to contain cocculusindicus, is, or used 
to be, consumed by regular drinkers, on 
account of the smaller quantity of it, com- 
pared with ordinary ale, which produces 
intoxication, or rather stupefaction. This 
power of stupefying has occasioned coccu- 
lus indicus to be popularly used as a fish 
poison. 

COCHINEAL— An insect which yields the 
well-known colouring matter carmine, is 
brought from Mexico, being gathered from 
various species of cacti, on which it feeds. 
It is used chiefly as a colouring agent ; but 
has been employed especially as a domestic 
remedy in hooping-cough. Its powers are 
very doubtful. 

Refer to Hooping-cough. 
COCOA— CHOCOLATE.— Cocoa is pre- 
pared from the seeds or beans of a tree— 



the Theobroma cacao — cultivated chiefly in 
the West Indies and South America. The 
beans are roasted to develop the aroma 
and free them from the husks, which are 
comparatively innutritious, though frequent- 
ly mixed up with the prepared cocoas of 
commerce. Cocoa, when genuine and pro- 
perly prepared, is a wholesome and nutri- 
tious article of diet; it contains a consi- 
derable quantity of oily or fatty matter, 
starch, &c. &c. and a peculiar principle, 
"the obromine," which, according to Liebig, 
nearly approaches theine and caffeine — 
the characteristic principles of tea and 
coffee — in composition ; cocoa does not, 
however, affect the nervous system in the 
same manner as these beverages, and may 
therefore be taken in cases when they are 
inadmissible. Cocoa, as a beverage, ought 
to be prepared only from the crushed bean3 
themselves, or "nibs," as they are called, 
for there is no certainty as regards the 
purity of the various artificial preparations 
sold under the names of "flake," "rock," 
"granulated," "homoeopathic" cocoa, &c. 
&c. &c. In the recent investigations of the 
"Lancet Sanitary Commission," more espe- 
cially, these often puffed-off compounds 
have been found to be made up of cocoa, 
sugar, starch or flour, husks of the cocoa 
bean, &c. &c. and sometimes with fats and 
oils of various kinds, and earthy and colour- 
ing matters. 

Chocolate is professedly a manufactured 
article, and should be made with the kernels 
of the cocoa bean, perfectly free from husks 
and reduced to a smooth uniform paste with 
sugar, and starch of some kind, such as 
arrow-root ; vanilla or cinnamon being used 
to impart flavour. Such a preparation as 
chocolate is of course liable to many adul- 
terations, of which the most deleterious 
are those with ochre, red lead, vermilion, 
sulphate of lime, chalk, &c. &c. ; tallow is 
sometimes used in the preparation of the 
cheap forms. It need scarcely be said that 
those who make use of chocolate ought 
always to procure it from dealers on whom 
they can depend. That of French make is 
generally to be preferred. As an article of 
diet, chocolate is extremely nutritious, but, 
on account of the oil it contains, is apt to 
disagree with weak stomachs, particularly 
if too great heat be used in preparing; 
moreover, the addition of vanilla is apt still 
more to increase its indigestibility, and, 
according to Dr. Paris, to occasion nervous 
disorder. 

COCOA-NUT— The well-known fruit of 
the palm, is, in its ordinary state, extremely 
indigestible, from the same cause that most 



COG 



127 



COF 



other nut-kernels are so — the solidity of the 
structure and the oily constitution, a com- 
bination which strongly resists the digestive 
powers. The reduction into paste or flour 
probably remedies the objection. 

CODLIVER-OIL— Is obtained from the 
liver of the common codfish and other allied 
species ; it was formerly employed in medi- 
cine in this country, fell into disuse, was 
revived as a remedy in Germany, and again 
brought into public notice in Britain, by 
Dr. Hughes Bennett, of Edinburgh, in 1841, 
since which time it has advanced rapidly 
and deservedly in the estimation both of 
the profession and of the public. It had 
never, however, been entirely abandoned as 
a domestic remedy in rheumatism ; and 
among the sailors, particularly those con- 
nected with the northern fisheries, had been 
regularly used both internally and exter- 
nally in the above disease. Now, however, 
it is principally employed and celebrated 
for its curative powers, especially in pul- 
monary consumption, in scrofula, and in 
all diseases connected with the scrofulous 
constitution, or depending on general de- 
bility. In the atrophy or wasting of the 
flesh in young children, connected with 
enlarged glands in the belly, which is tumid 
and hard, feels knotty, and with the veins of 
the surface enlarged, codliver-oil, given 
internally, a teaspoonful twice a day, and 
well rubbed into the skin of the belly two 
or three times a day, will in many cases 
cure, in a way which no other remedy we 
are acquainted with could do. 

For some time, the jlark, heavy, strong 
oil was considered to be the most efficacious ; 
but now, especially since more care has 
been bestowed on the manufacture, the 
purer and lighter oil, of the colour of light 
mahogany, is as good as any that can be 
used. The dose for an adult is generally 
one tablespoonful twice or three times a 
day ; it is however by some given much 
more largely. It is always advisable at 
first to begin with smaller, such as tea- 
spoonful doses, till the patient and the 
stomach become accustomed to the remedy, 
which even children quickly do, although 
sickness is sometimes produced at first. 
Tastes differ much as to the best method of 
taking codliver-oil ; floated in a little bitter 
beer [or beat up with the froth of porter] 
answers well, or the dose may be shaken up 
with half the quantity of syrup of marsh- 
mallow, and swallowed at once, or it may 
be taken in water, simple or aromatic. 
With many, codliver-oil acts slightly upon 
the bowels. In some cases of chest affec- 
tion, the breathing is certainly apt to 



become more difficult for the first few days 
of its use, and it has been said to induce 
spitting of blood. There cannot be stronger 
evidence of the nutritious power of cod- 
liver-oil, than the way in which its omission 
is felt by patients who have taken it regu- 
larly for some time : neither wine nor any- 
thing else appears to be a sufficient substi- 
tute. 

Refer to Scrofula, §c. 

COFFEE. — Active principle, Caffeine. 
— Coffee is the berry of a shrub, the Coffea 
arabica, indigenous to Arabia, and now 
cultivated in the East and West Indies, in 
America, &c. &c. It contains a consider- 
able amount of essential oil, and a peculiar 
principle, caffeine, which is identical with 
" theine," the characteristic principle of tea. 
The berry requires roasting to develop the 
well-known fragrant aroma. 

As an article of diet, coffee is for most 
persons wholesome and stimulating, but 
when there exists any tendency to head 
affection, or when the biliary secretion is 
apt to be over-abundant, it ought not to be 
used. Dr. Paris remarks that coffee, "if 
taken after a meal, is not found to cause 
that disturbance in its digestion which has 
been noticed as the occasional consequence 
of tea ; that, on the contrary, it accelerates 
the operations of the stomach." When 
strong, it most undoubtedly exerts much 
influence over the brain and nervous sys- 
tem, producing watchfulness and feverish 
symptoms ; it is thought, too, to affect the 
skin, and the sallow hue of the Parisians 
has been ascribed to the excessive use of 
coffee. The nutrient power of coffee is con- 
sidered greater than that of tea, although 
this cannot be great in either, irrespective 
of the characteristic principles — theine and 
caffeine — above mentioned, which, probably, 
are peculiarly beneficial to those who, either 
from necessity or inclination, consume much 
non-azotized, or vegetable food. In such 
individuals, who are often of sedentary ha- 
bits, a deficient consumption of animal diet, 
and inactivity together, render the biliary 
secretion deficient, and these principles of 
tea and coffee are, according to Liebig, "in 
virtue of their composition, better adapted" 
to supply the otherwise deficient "biliary 
azotized principles than all other nitro- 
genized vegetable principles." It is sin- 
gular that the above is supported by what 
we might almost call an instinctive habit 
among many of the poor in our own country 
who are unable to procure animal, that is 
azotized food, but who will make every effort 
to procure tea and coffee ; the custom is, 
and is no doubt felt to be, salutary. Coffee 



COL 



128 



COL 



is more suitable, for most persons, for the 
morning meal than tea, Avhich is more likely 
to affect the nervous functions. A cup of 
strong coffee, taken immediately after rising, 
is considered a good protective from the 
effects of malaria. In poisoning by opium, 
coffee is one of the most useful antidotes, 
but in this case ought to be fresh, pure, and 
strong, and taken without milk or sugar. 
The infusion of one ounce, taken every twen- 
ty minutes, is considered a suitable dose. 

Coffee should always be infused, never 
boiled ; when made with half milk, it is 
more nutritious for the weak, if it agrees 
with the stomach in this form. The adul- 
terations of coffee are numerous ; for that 
with chicory, which is the most prevalent, 
the reader is referred to the article "chi- 
cory." According to the "Lancet," roasted 
wheat-flour, and beans, mangel-wurzel, 
acorns, potato-flour, and a "coffee colourer," 
made with coarse burnt sugar, are likewise 
used. From what has been said respecting 
the properties of pure coffee, it is evident 
that none of the above additions or adulte- 
rations, although they may give the ap- 
pearance of it, can add real strength to the 
infusion, or be in any way substitutes for 
coffee itself; indeed, it would be much 
cheaper, and more nutritious and whole- 
some, for the poor to make and drink good 
toast-water, than to spend their money on 
coffee so called, which in reality is half, or 
more than half chicory, or something worse ; 
for the chicory itself is very greatly adul- 
terated. Coffee sold in "air-tight" canis- 
ters is always to be suspected. The only 
real security at present is for persons to 
grind their own coffee, not too much at 
once, and to preserve both the whole berry 
and the powder in canisters, or wide- 
mouthed, well-closed bottles. In the West 
Indies an infusion of raw coffee is used by 
the negroes, and found serviceable in pro- 
moting the flow of urine. 

Refer to Diet — Tea, $c. 

COLCHICUM. — Colchicum autumnale is 
the botanical name for the " autumnal cro- 
cus," found wild in many parts of England 
south of the Trent. The root and bulb and 
the seeds are both used in medicine, par- 
ticularly in gout and rheumatism ; but the 
drug requires too much care, and its im- 
proper use is too liable to produce evil 
consequences, to make it a safe domestic 
remedy, unless previously sanctioned by 
medical authority. In some persons par- 
ticularly, it acts most powerfully upon the 
bowels, even in small doses. The prepa- 
rations chiefly used are the tincture, the 
wine, and the vinegar. According to Dr. 



Christison, two drachms, or teaspoonfuls, 
of the wine of colchicum has proved a fatal 
dose. The symptoms produced by an over- 
dose of colchicum are vomiting, purging, 
colic, heat in the throat and abdomen, ge- 
neral depression, headache, and stupor or 
delirium. The remedies to be used until 
medical assistance is procured are diluents, 
such as barley-water, linseed-tea, or thin 
gruel, and laudanum or opium in some 
form. 

Refer to Opium. 

COLD — Is generally considered to be a 
negative result of the absence of heat rather 
than an active principle ; in consequence, 
however, of its energetic influence upon the 
living body, either in health or disease, it is 
usually spoken of as an active agent. The 
animated human frame is endowed with the 
power of maintaining a certain average tem- 
perature, which — except in rare instances 
— is higher than that of the surrounding 
medium, and this power is adequate to re- 
sist all ordinary impressions of cold ; but 
when, from great intensity, or long continu- 
ance, and especially when combined with 
moisture, the depressing action of cold is 
irmch augmented, the powers of life sink, 
and disease or death is the consequence. 
This power of the living body to resist cold, 
is in great measure dependent upon the 
supply and proper assimilation of a suffi- 
ciency of nourishment; the ill-fed and the 
dyspeptic always suffer most from the effects 
of cold. But in order that full benefit may - 
be derived from the power of food to protect 
against low temperature, particularly when 
at all severe or long continued, it is requisite 
•that more or less muscular exercise — accord- 
ing to circumstances — be engaged in, for the 
purpose of quickening the functions of re- 
spiration, circulation, and metamorphosis 
of tissue ; in other words, for the purpose of 
increasing the supply of oxygen taken into 
the system, and thereby facilitating the con- 
sumption of the internal fuel, (see Animal 
Heat,) either obtained directly from the food, 
or from the compounds carbon and hydro- 
gen already existing in the body. This is 
no more than common experience testifies ; 
for all know that, of two men exposed to a 
continued degree of intense cold, even if 
equal in other respects, should one perse- 
vere in muscular exertion, and the other 
give way to indolence or torpor, the former 
will be much more likely to survive the 
effects than the latter. And even under 
exposure to cold not so immediately dan- 
gerous to life, and especially if combined 
with moisture, the most ignorant are aware 
that "as long as they keep moving" there 



COL 



129 



COL 



is comparatively little danger of those bad 
consequences ■which almost invariably re- 
sult if rest is indulged in. In fact, as long 
as the muscular movement is kept up, the 
circulation, respiration, and change of tissue 
goes on with sufficient activity to maintain 
temperature adequate to resist the cold, 
which, however, prevails as soon as inac- 
tivity permits the cessation of the resisting 
forces. Thus we have a point of every-day 
experience confirmed and its rationale ex- 
plained by the researches of modern science. 

In northern latitudes, however, the inter- 
nal means of resisting cold are of them- 
selves insufficient for the purpose, and, 
therefore, clothing, shelter, or habitations, 
and the production of artificial heat, are re- 
sorted to, and these, indeed in some degree, 
stand in the place of nourishment; for the 
man who is sufficiently well protected from 
the effects of cold certainly requires a less 
supply of food to maintain health than he 
who is not. As regards food, habitations, 
and fuel, most who have it in their power 
are inclined to use their protecting influ- 
ences sufficiently. It is in clothing that the 
chief errors and negligences are met with, 
and the reader is referred to the subject 
itself for their exposition. There may, cer- 
tainly, be such over-precaution in guarding 
against cold, that it is impossible to keep 
up the protection on all occasions, so that 
an accidental omission in dress, or expo- 
sure, after being habituated to air of too 
high a temperature, at once gives rise to 
disease. But the abuse is no argument for 
the non-employment of ► sufficient rational 
protection against the influences of weather, 
especially in latitudes like our own, in which 
a low temperature frequently prevails, and 
that, too, combined with moisture, while, at 
the same time, the vicissitudes from heat to 
cold are often extreme and violent. It may 
safely be asserted that a large proportion 
of the diseases to which the inhabitants of 
this country are liable are, either directly 
or indirectly, the result of cold. It is suf- 
ficient to mention inflammatory attacks, 
general and local, apoplexy and paralysis, 
rheumatism and neuralgia, scrofula with 
its long train of disease, and consumption, 
as diseases, among many others, traceable 
to the influences of low temperature, to 
convince the most careless of the necessity 
of due protection against an agent so potent 
for evil. In many warm climates the prin- 
cipal danger from cold is incurred by ex- 
posure to the chill dews of evening, after 
hot days. 

The effect of extremely low temperature 
acting upon a limited portion of the body is 



rigidity of the muscles, blistering of the skin, 
particularly from grasping metallic bodies 
with the bare hand, and frost-bite or death 
of the part affected. The general effect of 
extreme continued cold is depression of 
the nervous system, of the functions of the 
respiratory organs and skin, deterioration of 
the blood, torpor, insuperable drowsiness, 
and death. In case of frost-bite, as of the 
fingers or toes, although the part may ap- 
pear quite lifeless, pale, and shrivelled, it 
may often be saved by proper treatment ; 
and the principal thing to be attended to 
is, that the temperature be not suddenly 
raised ; circulation, nervous power, and 
heat, must be very gradually restored ; and 
probably the method followed in countries 
in which this accident is common, will be 
found safest and best, that is, continued 
friction of the part affected with snow, till 
reaction is established : at all events,friction 
should be used ; after inflammation may be 
soothed by tepid poultices. 

When, in consequence of long exposure to 
external cold, drowsiness comes on, both 
mind and body must be exerted te keep off 
the influence ; to indulge it is death ; mus- 
cular motion must be kept up : if the in- 
dividual is alone, and has a supply of alco- 
holic stimulant, brandy or wine, it ought 
to be resorted to when it is felt that other- 
wise the powers must give way ; then, 
it may give strength to reach safety and 
shelter ; but the greatest caution is requisite 
before those who are exposed to severe con- 
tinued cold have recourse to these stimu- 
lants ; as a last resource they are invalu- 
able, but their aid must be unsought as long 
as possible, for if resorted to too soon, the 
after depression adds fatal facility to the 
further depressing power of a low tempera- 
ture. Experience proves that those who 
are likely to be exposed to great continued 
cold should provide abundant nourishment, 
particularly of a fat or oily character ; they 
should never be without a flask of spirits, 
but never have recourse to it except as a 
last resource. The sudden application of 
cold, even if it be not intense, may be very 
serious, in case the nervous powers are at 
all exhausted. Of this, the cramp to which 
bathers are subject is an example, and like- 
wise the fatal accidents so frequent during 
harvest, from persons drinking largely of 
cold water. The fatal effect is usually 
ascribed to the heated state of the body, 
but much is also due to the shock commu- 
nicated to the stomach and its numerous 
nervous connections, while the system gene- 
rally is exhausted. The effect of cold, not 
extreme, but long continued, especially if 



COL 



130 



COL 



combined with moisture, is one of the most 
fertile sources of diseases, some of which 
have been already enumerated. The young 
and the aged are more peculiarly liable to 
suffer, and for this reason require especial 
protection. The partial application of cold, 
particularly by a moving current of air, 
most generally produces disease of a neu- 
ralgic or rheumatic character, partial para- 
lysis, especially of the face, or erysipelas. 
All these injurious influences are more 
readily exerted if the body is at the time in 
a state of heated excitement, combined with 
nervous exhaustion, the result of previous 
exertion, and at rest. 

The partial application of cold and wet 
may produce inflammatory action in the 
immediate vicinity of the part exposed, or, 
as in the case of wet feet, in some distant 
organ. 

The most effectual remedy for the effects 
of " a chill," is warmth with moisture, in 
the form of bath, vapour or warm, or of 
hot bran bags, and the free use of warm 
diluent drinks, such as tea, gruel, &c. and, 
in case of much depression, warm wine and 
water. 

The use of cold as an hygienic agent, or 
in the treatment of disease, is invaluable. 
When, either as cold air or cold water, it is 
adapted in intensity and continuance to 
the resisting power of the constitution, it is 
a most admirable tonic. When used to 
subdue certain forms of excited and inflam- 
matory action, the temperature must of 
course be suited to the case, but ice-cold is 
most generally useful — care being taken, 
in the application of ice itself, that the 
part is not, as has happened, actually 
frozen or killed. Various forms of evapo- 
rating lotions, made with spirit, &c. are 
employed, but as the additions are made 
simply to increase the cold by increasing 
the evaporation, if a sufficient supply of 
sufficiently cold water can be procured, it is 
all that is requisite. The best mode of ap- 
plication is by cloths dipped in the cold 
fluid, and renewed again and again by a 
careful nurse. When, from circumstances, 
this cannot be done, the next best method is 
to keep up a continued system of irrigation, 
by means of a vessel of cold water placed a 
little higher than the part to be cooled, the 
fluid being conducted from the vessel to the 
part by bundles of woollen thread, or thin 
strips of flannel — care being taken, by means 
of waterproof material of some kind placed 
underneath, to carry off the superfluous 
water ; in this way the head or a broken 
limb may be kept constantly under the in- 
fluence of a stream of cold water, without 



the necessity for constant attendance. There 
has always been considerable difficulty in 
the application of cold to the back of the 
head in a person confined to bed ; this is 
now completely removed by the use of the 
vulcanized [India-rubber] cushions, which 
can be filled and refilled with ice-cold water 
as often as required, without disturbing the 
patient. 

Refer to Animal Heat. 

COLD IN THE HEAD, or Coryza— Is 
an inflammatory affection of the membrane 
lining the nostrils ; it is accompanied with 
more or less fever. It commences with a 
sense of dry fulness or obstruction of one or 
both nostrils, which is quickly succeeded 
by watery discharge of an acrid character, 
and there is frequent sneezing. The mem- 
brane of the eyes and their lids, being con- 
tinuous with that of the nose, is also affected ; 
and/from a similar cause, extension of the 
irritation to the membrane lining the frontal 
sinus, there is more or less headache. If 
simple cold in the head be not renewed, 
which it is extremely apt to be, it gradually 
subsides within the week ; more generally, 
however, as it leaves the nostrils, it travels 
downward into the lungs, and ends in ca- 
tarrh, cough, &c. &c. Coryza is a concomi- 
tant of some other diseases, such as measles 
and influenza. 

From its tendency to recur, and also to 
produce and keep up irritation of the lungs, 
coryza is not only not to be neglected, but 
should be checked at first, if possible, and 
for this purpose various methods of treat- 
ment are recommended. The injection of a 
solution of sulphate of zinc, five grains to 
the ounce, into the nostrils, at the very com- 
mencement of the disorder, has been said to 
stop it without fail. A dose of opium, either 
in the form of a large teaspoonful of pare- 
goric, of six or eight grains of Dover's 
powder, or quarter of a grain of muriate of 
morphia, when taken at bedtime, will often 
check a cold in the head at once ; and the 
usual system of hot foot-baths, confinement 
to bed, low diet, and diluent drinks, along 
with diaphoretic medicines, such as spirit 
of mindererus, antimonial wine, &c. &c, is 
certainly calculated to mitigate the disorder, 
and may be followed with advantage. The 
following mode of treatment comes recom- 
mended by the high authority of Dr. C. J. 
B. Williams. He says, "It is the common 
practice to drink copiously of tea, gruel, or 
some other diluent during a cold ;' as long 
as this promotes perspiration it is of some 
utility, and although it augments the flow 
from the pituitary or nasal membrane, it 
has the effect of diminishing its acrimony 



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COT 



by dilution. It is the acrimony of this dis- 
charge which reacting on the membrane, 
keeps up the inflammation, and its accompa- 
nying disagreeable symptoms. On this cir- 
cumstance depends the efficacy of a measure 
directly opposed to that just noticed, but to 
the success of which we can bear decided 
testimony — we mean a total abstinence from 
liquids. To those who have the resolution 
to bear the feelings of thirst for thirty-six 
or forty-eight hours, we can promise a 
pretty certain and complete riddance of 
their colds, and what is, perhaps, more im- 
portant, a prevention of those coughs which 
commonly succeed to them. Nor is the suf- 
fering from thirst nearly so great as might 
be expected. This method of cure operates 
by diminishing the mass of fluid in the body 
to such a degree that it will no longer supply 
the diseased secretion. Any thing that will 
contribute to reduce the quantity of fluid in 
the body will assist in the plan of cure and 
shorten the time necessary for it to take 
effect. It is, therefore, expedient to begin 
the treatment with an aperient, followed by 
a diaphoretic, as is usual, and this is 
the more necessary when any fever attends ; 
but beyond this no further care need be 
taken, and the individual can devote him- 
self to his usual employments with much 
greater impunity than under the ordinary 
treatment. The coryza begins to be dried 
up about twelve hours after leaving off 
liquids ; from that time the flowing to the 
eyes and fulness in the head become less 
and less troublesome; the secretion becomes 
gelatinous, and between 'the thirtieth and 
the thirty-sixth hour ceases altogether : the 
whole period of abstinence need scarcely 
ever to exceed forty-eight hours. It is 
then as well to return to the moderate use 
of liquids, as the first indulgence is apt to 
be excessive. It is not necessary to limit 
the solid food any more than to that which 
is plain and simple, except where there is 
an acceleration of the pulse, or gastric irri- 
tation, in which cases animal food should 
be proscribed. For the sake of comfort in 
mastication, the food should not be of the 
driest kind. Thick puddings and vegetables, 
with or without meat, will be the best din- 
ner; and toasted bread or biscuit merely 
moistened with tea or other liquid for other 
meals. A single cup of tea is sufficient to 
bring back the coryza immediately, after 
twelve hours' abstinence has removed it. 
"We doubt not that it will be said that this 
plan of cure is worse than the disease, and 
so it may be in "some instances. It may be 
called always a choice of evils ; but we do 
not believe that any one who is liable to 



severe colds, after once experiencing the 
amount of good and evil resulting from this 
method, would hesitate between them, and 
it is for them that we make it known. 

"We have never witnessed any evil from 
this abstinence from liquids for the time 
prescribed: but it is not unlikely that it 
may do harm in persons with irritable sto- 
machs, or in those liable to urinary disor- 
ders. Moderation in liquid food, which may 
be assumed as a corollary from what has 
been already said, is one of the best pre- 
ventives against the bad effects of exposure 
to cold. When there is a large quantity of 
liquid in the system there must be increased 
perspiration, and therefore greater risk from 
the effects of cold." 

If coryza be not in itself a disease of im- 
portance, its tendency to frequent renewal, 
and, as often as it is renewed, to the repro- 
duction of irritation in the lungs, renders it 
really a disease of consequence, and one not 
to be neglected. Moreover, those individuals 
who are most susceptible to repeated attacks 
of coryza are those who are most likely to 
suffer from frequent or continued irritation 
within the chest. 

Refer to Catarrh — Cold, $c. 

COLD CREAM — Is a pleasant cooling 
ointment, made by melting four ounces of 
white wax in a pound of almond-oil, by 
means of gentle heat, and mixing gradu- 
ally with a pint of rose-water in a warm 
mortar. 

COLIC — Is the painful spasmodic con- 
traction of the muscular fibres of the bowels, 
particularly of the colon, occasioned by the 
presence of an undue amount of wind, or of 
some irritating matter, such as accumulated 
faeces, undigested food, acrid bile, over-doses 
of strong purgatives, or poison ; it may also 
be brought on by exposure to cold. The 
pain of colic comes on and goes off suddenly, 
is of a rolling or twisting character, is re- 
ferred chiefly to the umbilical or navel region, 
and is relieved by pressure ; there may or 
may not be vomiting. In some cases of 
colic, the spasmodic contraction of the bowel 
is so complete and permanent, that inverted 
action takes place, and the faecal contents 
are vomited ; to this form the name of ileus, 
or iliac passion, has been given. The above 
symptoms distinguish colic from inflamma- 
tion, the pain of which is of a more persist- 
ent, burning character, and is aggravated 
rather than relieved by pressure ; in the 
latter case, too, febrile symptoms are present 
from the commencement. The distinction 
is, of course, requisite for active medical 
treatment, but many remedies which may 
be used safely and effectually to relieve the 



COL 



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COM 



one will also be beneficial in the other, and, 
indeed, in other spasmodic or inflammatory 
attacks within the abdomen, which might 
be mistaken for colic. 

The sudden accession of an attack of 
colic, its peculiarly painful character, and 
the danger that, if continued, it may pass on 
to one of inflammation, renders immediate 
relief imperative. The first remedy is heat, 
either locally to the abdomen by bran-bags 
or similar applications, as hot as they can be 
borne, or by the hot bath of the temperature 
of 100°, if not undesirable on other accounts. 
The use of heat, if promptly and effectually 
carried out, will often of itself relieve the 
attack at once, particularly if it is the result 
of cold ; but even should it do so, it will be 
well to give a dose of castor-oil, or rhubarb 
and magnesia, to insure the freedom of the 
bowels from irritating matter ; a few drops 
of laudanum being added to either medicine 
should the spasm show a tendency to return. 
Should the pain not be relieved by the 
employment of external heat, as recom- 
mended, a warm clyster, temperature 102°, 
should be administered, and a cup of tea or 
of some unstimulating fluid taken as hot as 
it can be swallowed. If the pain still re- 
mains, ten drops of laudanum must now be 
given, and repeated every quarter of an 
hour until relief is obtained, or until forty 
drops, or even more, have been administered. 
If the case is violent, a clyster containing 
twenty drops of laudanum may be given. 
These means, if thoroughly carried out, will 
scarcely fail to afford relief until the arrival 
of medical assistance, which should always 
be procured, if the case is at all severe 
or continued ; it may depend on causes 
which a medical man alone can discover or 
remove. Alcoholic stimulants are scarcely 
to be recommended for use in non-medical 
hands, not because they are not serviceable 
in colic, but because, should the case be 
mistaken, and prove one of inflammation, 
they would prove most injurious, which the 
remedies above prescribed could not. Still, 
in a case in which no doubt could exist, a 
tablespoonful of undiluted tincture of rhu- 
barb, or a glass of hot brandy and water, 
with or without laudanum, are either of 
them good remedies. 

Painter's colic, or dry belly-ache, is a dis- 
ease to which persons are subject who work 
much among lead ; it is said also to be oc- 
casioned by new cider, &c. &c. It is severe 
colic, accompanied with obstinate constipa- 
tion. The disease, either in itself or from 
concomitant constitutional affection, may 
prove fatal, and should always be treated 
by a medical man if possible. The treatment 



is much the same as that for common colic as 
far as allaying pain goes, but the obstinate 
constipation which accompanies it, requires 
the laudanum and other means to be com- 
bined with active purgatives, castor-oil, 
senna, compound colocynth pill, &c. Alum 
has been strongly recommended as a remedy 
in painter's colic. Much might be done by 
those engaged in employments connected 
with lead, to avoid not only this, but other 
bad effects, by due attention to cleanliness, 
particularly of the hands at meal-times. 
The use of lemonade, acidulated slightly with 
sulphuric acid, or of aromatic sulphuric 
acid, in water, would probably be additional 
protection. Lead colic has been induced in 
whole families, by the use of water which 
acted strongly upon leaden pipes or cisterns. 

Those who have once suffered from an 
attack of colic should pay particular atten- 
tion to the bowels. A pill composed of one 
grain of extract of henbane, with two of 
compound colocynth and rhubarb pill, will 
be found a most suitable aperient. 

Refer to Alum — Lead — Water — Sulphuric 
Acid, §c. 

COLLAPSE. — The term applied to a state 
of sinking or prostration of the powers of 
life. 

COLLAR-BONE.— See Clavicle. 

COLLIQUATIVE.— A term applied to any 
profuse exhausting evacuation, more par- 
ticularly the diarrhoea and perspirations of 
pulmonary consumption. 

COLLYRIUM.— A lotion for the eyes.— 
See Eye. 

COLOCYNTH, or Bitter Apple— Is the 
fruit of a creeping plant, and is brought to 
this country chiefly from the shores of the 
Mediterranean. An extract made from the 
dried pulp is used in medicine. It is a 
powerful irritating purgative, never used 
alone, and only likely to be employed domes- 
tically in its well-known combination, the 
compound colocynth pill, one of the most 
universally useful purgatives we possess, 
of which the dose is from five to ten grains. 
Refer to Pill. 

COLON. — The large bowel.— See Ali- 
mentary Canal. 

COMA. — A state of insensibility, resem- 
bling sound sleep, from which the person 
either cannot be roused at all, or only to 
partial consciousness. The condition is 
generally the result of pressure on the brain, 
either from injury to the skull, or from effu- 
sion of blood or watery fluid, or of matter, 
within the head. In apoplexy, poisoning 
by narcotic drugs, and complete alcoholic 
intoxication, the comatose condition exists ; 
it may also be owing to exhaustion of the 



COM 



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CON 



brain. In coma the action of the heart con- 
tinues sufficiently perceptible ; in fainting it 
does not. — Refer to Apoplexy, §c. 

COMPLEXION.— The hue of the face. 
Much information may frequently be ob- 
tained of the existing constitutional condi- 
tion, by observation of the complexion; but 
in judging, it is requisite to consider the 
original temperament and the family descent 
of the individual. In fair races, such as the 
Anglo-Saxon, a certain amount of colour is 
usually associated with our ideas of health, 
and in some respects truly so ; the reverse, 
a perfectly pallid face, can scarcely be con- 
sistent with a sound bodily condition. But 
colour may be too high at all times ; and the 
capillary vessels of the face, partaking of the 
fulness of those of the body generally, may 
indicate that from some cause, such as over- 
feeding, or indolence, combined with good 
digestive powers, the system of the individual 
is too full of blood; for the colour is not 
confined to the parts naturally tinged, but 
is diffused over the face generally, and even 
the white of the eye is covered with distended 
vessels. Such a state is one of danger ; it 
is often accompanied with headache, giddi- 
ness, confusion of thought, sleepiness ; and 
when these occur, apoplexy may be dreaded. 
A high or brilliant colour may also accom- 
pany the consumptive constitution ; but in 
this it is very generally associated with a 
fine skin, and often with light or red hair, 
with freckles, and also with a pearly or 
bluish appearance of the white of the eye. 
This appearance of high health is apt to de- 
ceive the inexperienced,; but the colour is 
generally not equal or persistent. It varies 
much, being easily heightened by excite- 
ment, or depressed by the reverse, and it 
continues to add beauty even to the last 
stages of the hectic of consumption. In the 
dark-haired, and dark-complexioned, colour 
is less commonly developed. The complet- 
ion of disorder or disease is very varied ; it 
may be muddy, pallid, pasty, white, sallow, 
cachectic, yellowish-green, and purple. 

The muddy complexion may be the natural 
one of the skin, but it frequently accompanies 
dyspeptic ailments, and is directly depend- 
ent on depressed nervous power and languid 
circulation of blood : it is most strongly 
marked in the dark depressions underneath 
the eyes. Whatever lowers or exhausts the 
nervous power will produce this complexion, 
which may be seen in perfection when the 
light of morning shines in, either upon the 
votaries of a too protracted dance, or upon 
the weary watcher beside the bed of sick- 
ness. Sleep is the best restorer of the ex- 
haustion of nervous power indicated by this 
M 



condition of complexion ; but if rest is im- 
possible, it is one of those cases in which 
stimulants, hot tea or coffee first, and then 
alcoholic stimulants, is perfectly requisite. 
The pallid complexion is often the result of 
too close confinement to the house, and 
especially of deficient exposure to diffused 
daylight — it is well marked in miners. The 
pasty complexion accompanies the lymphatic 
constitution, and general laxity of the solids. 
The subjects of it require a good allowance 
of animal food, in preference to milk and 
grain preparations, puddings, &c, of which 
they are often too fond. They almost in- 
variably derive benefit from preparations 
of iron. A marked white complexion not 
natural to the individual is often indica- 
tive of serious disease, probably of the 
kidneys or heart, and when it appears 
in persons advanced in life, the case ought 
most certainly to be investigated by a medi- 
cal man. The sallow complexion is very 
generally a natural one. The cachectic 
accompanies a diseased state of the system, 
and often of the abdominal organs ; it is 
muddy, and accompanies emaciation of the 
features. The yellow complexion may be 
the bright hue of jaundice, or the muddy 
yellow associated with malignant disease, 
especially cancer. In the greenish-yellow 
skin of chlorosis or green sickness, there is 
also extreme pallor of parts usually coloured 
— such as the lips. A purple complexion is 
indicative of deficient oxygenation of the 
blood, either from disease of the heart or 
lungs ; generally of the former. 

Refer to Skin, Countenance, §c. 

CONCRETION— Is a term applied to the 
unusual aggregation of any substance or 
substances within the body — most generally 
to intestinal concretions. Persons who have 
been in the habit of taking large and re- 
peated doses of magnesia have not unfre- 
quently suffered from its concretion into 
hard lumps or balls in the stomach or in- 
testines. Any substance which possesses 
the power of felting or matting together 
is liable to form a concretion in the bowels. 
One has been found of ends of thread matted 
together, which a female had been in the 
habit of biting off and swallowing when at 
work; but perhaps the most common cause 
of the intestinal concretion is the felting of 
the bran of the oatmeal, as used in Scotland, 
when too exclusively employed as food, and 
in too dry a state. Good boiling and di- 
luting, or the mingling of other articles of 
food, particularly those of an oily nature, is 
the best preventive. 
^ CONCUSSION.— A term applied in medi- 
cine to the effects of a severe blow over some 



CON 



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CON 



of the more important organs of the body, 
or on the body generally. 

For Concussion of the Brain, see Brain. 

Severe concussion of the chest affecting 
the heart, or over the region of the sto- 
mach, may prove fatal immediately, or at 
least produce much alarming faintncss and 
collapse. In the latter case the use of stimu- 
lants, such as ammonia or spirit internally, 
or stimulant clysters, and the dashing of a 
jug of cold water over the chest and face, 
immediately following it by hot applications, 
mustard, &c, would be the most appropriate 
treatment. 

CONDIMENTS— Are substances which are 
not of themselves nourishing, but which are 
taken along with food as seasoning, and to 
promote its digestion. Salt is the most ex- 
tensively used, and also the most whole- 
some condiment. To civilized man its use is 
second nature, and very many of the lower 
animals are not only fond of it, but seek it 
instinctively as a necessity, and improve in 
health and appearance when they have ac- 
cess to it. The vegetable acids, vinegar, &c. 
are useful and wholesome in moderation, 
particularly with oily food. The aromatics 
and spices, such as cayenne, white or black 
pepper, ginger, &c, can scarcely be called 
injurious to healthy individuals, if used in 
moderation ; in debility of the stomach they 
are often of service, and they seem espe- 
cially adapted to counteract the effects of 
a warm climate upon the digestive organs, 
and also to the constitution, acquired or 
otherwise, of the inhabitants. They are, 
however, generally used along with vege- 
table productions. 

Refer to Salt — Vinegar — Aromatics, §c. 

CONDYLE.— The extended extremity of a 
bone which forms the joint. 

CONFECTION.— A term applied to me- 
dicinal preparations generally made with 
sugar. The most useful are almond confec- 
tion, aromatic confection, cassia, rose, and 
senna confections. Of these, the aromatic 
confection is the most useful and generally 
used preparation. It is thus made : — Take 
of cinnamon, nutmeg, saffron, of each two 
ounces ; cloves one ounce, cardamons half 
an ounce ; prepared chalk sixteen ounces. 
Reduce these materials, when dry, to a fine 
powder, and keep them in a close vessel. 
Sugar, to the extent of six ounces, may or 
may not be added to the preparation. 

Refer to Almond — Rose — Senna, fyc. 

CONFECTIONARY— Literally, " things 
made up," — is not necessarily unwholesome, 
if used in moderation ; it is, however, too 
often deleterious if made with much butter, 
or when made of bad materials, or mingled 



with poisonous ingredients. Baked confec- 
tionary, in which the butter or grease is 
rendered empyreumatic and acrid by the 
heat employed in its preparation, is always 
liable to disagree, and especially so when, 
as often happens, bad materials are em- 
ployed and disguised with flavours of va- 
rious kinds, which are often in themselves 
unwholesome, particularly those so largely 
used, such as the oil of bitter almond, peach- 
kernel, and laurel flavouring, which are 
actual poisons, when taken even in not 
very large quantity. Another flavouring in- 
gredient, recently introduced, but already 
largely used, called "jargonelle pear," is 
not devoid of danger, and has been known 
to produce dangerous head symptoms in a 
child. It is made from the fussel-oil ob- 
tained in distillation from grain, potatoes, 
&c. But perhaps the most numerous cases 
of injury have arisen from coloured confec- 
tionary and sweetmeats, a large proportion 
of which are tinged with deleterious sub- 
stances ; the greens with arsenite of copper 
or Scheele's green, verdigris, or a mixture 
of chrome and prussian blue ; the yellows 
by chromate of lead ; the reds by vermi- 
lion, a compound of mercury, or by oxide 
of iron ; and the whites by carbonate of 
lead, oxide or carbonate of zinc, chalk, 
or sulphate of baryta. The frosting of 
cakes and the white-sugar comfits often con- 
tain a large percentage of plaster of Paris. 
These facts ought to be sufficient to make 
people very cautious in the use of such 
articles, particularly with children ; and, in 
case of sudden unaccountable illnesses, they 
should not forget the possibility of such 
causes. The colour of a sweetmeat would 
afford some clue to the nature of the poison, 
and reference to the proper article in this 
work will show the measures proper to be 
adopted in the interval of procuring medi- 
cal assistance. 

CONGESTION.— A morbid accumulation 
of fluid, such as blood, in its own proper 
vessels. 

CONJUNCTIVA— Is the membrane which 
lines thg eyelids, and is folded from them 
upon the forepart of the eyeball, which it 
covers, extending over both the white and 
the clear portion, or cornea. In its ordinary 
healthy condition the conjunctiva is a trans- 
parent membrane, with, perhaps, one or two 
tortuous vessels seen upon it. 

Refer to Cornea — Eye, §c. 

CONSERVE — Is a compound of some 
fresh vegetable substance with sugar. The 
conserves are now classed with the con- 
fections. 

CONSTIPATION.— See Costiveness. 



CON 



135 



CON 



CONSUMPTION, or Pulmonary Con- 
sumption — As its name implies, is a disease 
of the lungs, or at least one in which the 
lungs are more prominently affected than 
any other organ. In Britain [and in the 
United States] its fatality and frequency 
render it but too familiar, as year by year 
it numbers for its victims the young, the 
good, and the fairest in the land. 

Consumption is a portion only of a con- 
stitutional malady, which very frequently 
develops its intensity in the organs of respi- 
ration, but may do so in other modes and 
in other organs of the body. Its constitu- 
tional nature requires to be impressed upon 
the mind of people in general ; for, regarded 
only as a disease of the lungs, alarm is not 
taken, nor are remedies generally resorted 
to, until its effects upon these organs be- 
come manifest; the antecedent period, in 
which the constitution is giving way, is 
overlooked, and that time is lost in which 
the first indications of disease might have 
been successfully attended to. 

The causes of pulmonary consumption 
are all those which occasion debility gene- 
rally, not excepting the most frequent of all, 
hereditai'y predisposition, or that tendency 
to the disease which exists so strongly in 
some families, that no care or precaution can 
ward it off, nor prevent it seizing in succes- 
sion member after member of a household. 
Fortunately, this intensity of hereditary 
transmission is not so very frequent, but 
there are few families in this country in 
which the tendency does not more or less 
exist ; there are few which cannot number 
amid their deceased relatives some victim 
of consumption. With a susceptibility so 
widely diffused, it becomes a serious con- 
sideration with all by what this tendency is 
encouraged, and how it may be diminished. 
The first consideration that presents is mar- 
riage. There can be no question, that from 
errors in the contraction of this great en- 
gagement of life, much of the hereditary 
tendency to consumption is developed, and 
especially when the union is betwen parties 
nearly related by blood ; doubly so if the 
predisposition already exists in the family. 
Delicacy of either parent, particularly of 
the father, is very apt to entail consumptive 
tendencies upon the children ; and the same 
follows if the parents are either too young, 
or if the father be advanced in life. The 
mistake is a very common one, that mar- 
riage and child-bearing act as a check upon 
the progress of consumption, and the step 
is often advised even to the comparatively 
young with this view. The error is a serious 
one ; nothing can be more trying even to a 



healthy female, in this country, than having 
a family before the constitution is formed ; 
and most certainly it is so to the weak. It 
is true, apparent temporary amendment of 
consumptive symptoms sometimes occurs, 
but the powers of life are sapped by the 
too early call on their exertions. In the 
management of the children of even the 
most healthy parents — doubly so of those 
who are the reverse — much may be done 
either to weaken or to fortify the constitu- 
tion, to pull down the one to the level of 
the scrofulous diathesis which ripens into 
consumption, or to infuse into the other 
such strength and vigour that it may resist 
during a long life any development of the 
disease. For information respecting the 
management of children, the reader is re- 
ferred to the article itself. 

As the period of puberty approaches, 
care is required with all, but doubly so in 
the case of those who have displayed any 
scrofulous or consumptive tendency. The 
development of the body which is going on 
requires a full supply of the most nutritious 
food, animal food particularly. The secre- 
tions should, if possible, be kept in healthy 
activity, and, more especially, all sources 
of exhaustion most strictly avoided. Youths 
especially must be warned against the evil 
of prolonged physical exertion ; and not less 
so against the mental efforts, which those 
especially, who partake of the nervous and 
excitable constitution of the hereditary con- 
sumptive, are apt to give way to, in compe- 
titions at school or college. 

At any period of life, mental anxiety or 
over-exertion, intemperance or dissipation, 
the habitual breathing of vitiated air, low 
damp situation, insufficient clothing, and 
exposure to the weather, or peculiarity of 
employment, particularly that which neces- 
sitates the inhalation of irritating matters, 
or any continued drain upon the powers of 
the constitution, such as suckling, may any 
of them develop or induce consumption. 

Two very opposite conditions of physical 
development are found to exist along with 
the consumptive tendency. In the one, there 
is the fair fine skin and bright red com- 
plexion, the fair hair, the light eye, with its 
pearly looking white, and the tapering 
fingers ; in the other, the dark hair and 
skin, the latter almost dirty-looking, and the 
swollen-looking upper lip. Consumption 
varies much in its initiatory stage ; some- 
times it steals upon the patient most slowly 
and imperceptibly; at others, developed 
probably by some acute attack, it appears 
to start at once into activity. Generally, 
for a considerable period before marked 



CON 



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CON 



symptoms — or at least symptoms which 
attract general attention — show themselves, 
the person has felt weak, languid, and com- 
plained much of cold, probably has sunk in 
flesh, and a short dry cough has come on, 
apparently without cause, or there has 
been continued dyspepsia. If the patient is 
a female, the monthly discharge has become 
irregular, or stopped. It may be that these 
symptoms have been aggravated during 
winter, and disappeared partially or entire- 
ly with the advent of warm weather. Such 
symptoms may go on for a longer or shorter 
period, ebbing and flowing, but still gaining 
ground, or they may progress more unre- 
mittingly, though still slowly, or become 
suddenly aggravated by some adventitious 
circumstance, such as taking cold, some 
unusual fatigue, or the like. The emacia- 
tion becomes too evident to escape notice, 
the cough is unabated and becomes trouble- 
some, the voice assumes a peculiar hollow 
sound, the breathing is quickened, and it 
may be that spitting of blood, profuse night 
perspirations, or even diarrhoea, have set in 
before the patient's condition excites either 
alarm in their own mind or in that of their 
friends. Indeed it very frequently happens 
that the patient is the last to take the 
alarm, the last to entertain the idea of the 
fatality of the disease, of which this hope- 
fulness of recovery is a well-marked symp- 
tom. 

Threatened consumption is no disease for 
domestic treatment. On the first suspicion 
of its presence, the person should at once 
be examined medically. The above symp- 
toms may excite alarm, may afford most 
grave ground for suspicion, not only to the 
friends, but also in the mind of any medical 
man, but their certainty cannot possibly be 
pronounced upon without the physical exa- 
mination of the chest, which well-educated 
medical practitioners only can conduct. By 
that, the case may very generally be de- 
cided, groundless fears dispelled, or just 
apprehensions confirmed and acted upon, 
while yet there is time to save or prolong 
life. 

As regards the prospect of recovery from 
consumption — for recovery does undoubt- 
edly take place— much depends upon the 
original and existing constitution and 
the habits, past or present, of the indi- 
vidual, and the worldly means within his 
power. 

If the disease has become established in 
an individual of strong hereditary tendency 
to it, or in one who has broken down his 
constitution by dissipation or intemperance, 
or who is the subject of some other debi- 



litating disease, hope of amendment can be 
but small. If, on the contrary, the affection 
is more probably induced, and rather acci- 
dental than the result of original constitu- 
tional tendency, the probability is that 
under proper management, and with the aid 
of the great curative powers of cod-liver- 
oil, not only amendment, but permanent 
recovery, may be obtained. When consump- 
tion has advanced beyond its first stage, all 
the symptoms already mentioned are in- 
creased, the cough and perspiration parti- 
cularly become more distressing, and the ten- 
dency to diarrhoea, (frequently with severe 
spasmodic pain in the bowels,) notably in- 
creased ; expectoration is often difficult, 
either from weakness, or from viscidity of 
the expectorated matter ; the hair falls off, 
progressive emaciation continues, and be- 
fore death the skin of the most prominent 
portions of the back is apt to become ulcer- 
ated. The disease, however, may be termi- 
nated earlier by sudden bleeding from the 
lungs, by an acute inflammatory attack, or 
by giving way of a weak constitution. Its 
ordinary duration is about nine months. 
Amid the other symptoms of advanced con- 
sumption, a peculiar broadening — " club- 
bing" — of the extremities of the fingers, with 
incurvature of the nails, is often observable ; 
and recent observations have been directed 
to the occurrence of a peculiar pink-looking 
marginal line at the junction of the gums 
with the teeth, which occurs in some cases. 
The prevention of so fatal a disease as 
consumption is a more important subject, in 
a work like the present, than its treatment ; 
and in those predisposed, the preventive 
or "prophylactic" system must be continued 
life through, even into old age. It is a 
popular error, that by the time middle life is 
reached the liability to consumption is over. 
Such is not the case, for even the "three 
score and ten" is sometimes terminated by 
the disease. According to the tables of 
Sir James Clark, it appears "that the 
greatest number of deaths from phthisis 
(consumption) happens between the ages of 
20 and 30 ; the next greatest number from 
30 to .40 ; the next from 40 to 50, and many 
even up to 70 years of age ; more women 
than men, Gn the average, dying from the 
disease. It has already been remarked 
what a potent influence hereditary predispo- 
sition toward consumption exerts, and how 
strongly this predisposition may be deve- 
loped or increased in a family by marriage 
union. People will marry, whatever their 
constitutional predisposition ; but if either 
their own constitution or that of their family 
generally is at all consumptive, it ought 



CON 



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to be a very weighty consideration with 
them that the union should be with one 
as little inclined toward the disease as 
possible. When the children in a family 
evidently inherit or display consumptive 
tendencies, in addition to the precautionary 
measures already enumerated in the article 
" Children," it should become a question, 
how far permanent removal to a more genial 
and dryer climate might be desirable. To 
the rich, who have it in their power to 
change their residence as and when they 
may, the consideration is perhaps of less 
immediate consequence ; but to the labourer, 
the mechanic, or the man of small income, 
it must be a question of paramount import- 
ance, whether, by emigration to such a 
climate as that of Australia, he may not 
only save himself the constant sorrow, 
actual and anticipated, of seeing his family 
drop one by one into their early graves, but 
also save the constant pull-back upon his 
exertions and drain upon his resources 
which a sickly family necessarily entails. 
But, indeed, in any condition of life, the 
question of tendency or not to consumptive 
disease should always influence the choice 
of field for exertion, and not only of field, 
but also of the nature of the business of life. 
Any occupation which renders the inhala- 
tion of irritating substances unavoidable, is 
to be eschewed by the consumptively in- 
clined man ; and not less so, that which 
involves confinement in a constrained posi- 
tion or in a close room. Of the former 
class, grinding or polishing of metal or 
stone, especially if dry," flour-grinding, &c. 
are examples ; of the latter, the occupation 
of the tailor, the shoemaker, the seamstress, 
or the compositor. The most eligible em- 
ployments are those which require muscular 
exertion of not too exhausting a kind, and 
without too great exposure to the weather ; 
the gardener, the carpenter, the butcher, 
the farm-servant, are all less likely to be the 
victims of the disease. In whatever situa- 
tion or grade of life, however, a person may 
be placed who is predisposed to consump- 
tion, much may be done to keep up the 
powers of resistance, by keeping up the ge- 
neral health to the highest possible standard, 
by diet, early hours, attention to the skin, 
[by thorough and daily washing of the whole 
body,] and avoidance of all kinds of dissi- 
pation and intemperance. Smoking tobacco 
should be shunned as particularly injurious. 
Regular exercise is to be taken — [especially 
in the open air, when the weather is not too 
damp. A distinguished physician of Phila- 
delphia prolonged his life thirty years by con- 
stant exercise, though at one period ad- 
m 2 



vanced in consumption. He never remained 
in-doors except when it rained.] The chest 
and shoulders should be bathed every 
morning with cold salt-water, and rubbed 
afterward to promote reaction. Cheerful- 
ness of mind and moderate mental exertion 
are important, while perfect temperance in 
the use of alcoholic stimuli is indispensable ; 
but any change to their total disuse cannot 
be made in many cases without danger. All 
the usual sources from which "cold is 
taken" are to be shunned, particularly wet 
feet, sitting in damp clothes, crowded ball- 
rooms, and public assemblies ; and, lastly, 
when exposure to cold air, especially to east 
winds, or to the foggy atmosphere of night, 
is unavoidable, the protection of a respirator 
of some description should be resorted to. 

The question is often mooted with respect 
to the communicability of consumption from 
one person to another. That it is not ge- 
nerally communicable is certain; that it 
has been thought to be so under circum- 
stances of predisposition, and when there has 
been close communication between two per- 
sons, should be sufficient to caution other 
members of a consumptive family from 
hanging too much over one affected with 
the disease ; and certainly, in any case, for- 
bid the occupation of the same bed. 

With respect to the treatment of consump- 
tion, little remains to be said. It can never be 
an emergency, and the first suspicious symp- 
toms should be the signal for obtaining pro- 
per medical advice ; if the disease is really 
threatened, the well-conducted treatment 
of a competent medical man can alone be 
trusted to. In the progress of consump- 
tion, however, there are many painful symp- 
toms which may be alleviated by measures 
independent of the treatment of the dis- 
ease properly so called. 

As regards diet, there is the greatest 
variation, some patients being most com- 
fortable with a milk or farinaceous diet 
alone, while others require the constant use 
of stimuli, wine or porter, and consume ani- 
mal food in good quantity. For allaying the 
troublesome cough, demulcents of various 
kinds may be tried, with or without the ad- 
dition of small doses of morphia, laudanum, 
paregoric, or Battley's sedative solution. 
When a tendency to perspiration exists, and 
there is no diarrhoea, the following is a very 
useful and palatable mixture, which allays 
both nervous irritability and cough : — Take 
of muriatic acid thirty drops, muriate of 
morphia one grain, refined sugar two 
drachms, water six ounces ; of this mixture, 
a tablespoonful may be given every few 
hours. In the later stages, when the cough 



CON 



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is partly spasmodic, and expectoration diffi- 
cult, much relief is often experienced by the 
inhalation of steam, along with the vapour 
from a few drops of sulphuric ether put in 
the boiling water. The perspirations may 
be kept in check by fifteen-drop doses of 
dilute sulphuric acid in a wineglassful of 
water ; but when diarrhoea is present, this 
cannot be persevered in. To relieve diar- 
rhoea, the abundant use of isinglass or gela- 
tine will be found serviceable, also chalk 
mixture with opium ; five-grain doses of the 
oxide of bismuth, with a quarter of a grain 
of powdered opium, is often a useful remedy. 
Acetate of lead, gallic acid, &c. are also 
used, but scarcely likely to be so domestic- 
ally. In case of sudden bleeding from the 
lungs, refer to Hemorrhage. 

Refer to Chest — Children — Lungs — Respira- 
tion — Respirator — Scrofula — Temperament, $c. 

CONTAGION — Is sometimes used to ex- 
press the actual agent by which disease is 
propagated ; but more generally the propa- 
gation itself. Properly speaking, the term 
ought to be confined to the propagation of 
disease by actual contact, in contra-distinc- 
tion to infection ; but it is now used in the 
more extended sense of "infection" like- 
wise. Contagious diseases may be commu- 
nicated only by actual contact of individuals, 
as in the case of itch, &c. ; by inoculation, 
as in the case of cow-pox ; or in addition to 
both or either of these modes of transmis- 
sion, through the atmosphere by infection, 
as in the case of small-pox, &c. 

This power of propagation through the 
atmosphere, however, does not, independent 
of epidemic and endemic influences, extend 
far from the patient. Certain circumstances 
influence the extent of contagious diffusion. 
Of these, the most distinctly ascertained are 
atmospheric impurities ; for it is ever ob- 
served, and we believe it may be predicated 
of every disease possessing the property of 
remote contagion, that its contagious matter 
is propagated to greater distances in a dirty, 
crowded, and ill-ventilated apartment, than in 
one of which the air is pure. The same prin- 
ciple applies to articles of dress and furni- 
ture ; those which are contaminated by 
animal secretions and effluvia being much 
more readily impregnated with contagious 
matter than those which are clean. Peculiar 
atmospheric conditions certainly, also fa- 
vour the propagation of disease by conta- 
gion ; sometimes these conditions are inap- 
preciable, at others they are evidently con- 
nected with a superabundance of warmth 
and moisture ; and also, we have good rea- 
son to conclude, with certain states of 
electrical disturbance. The discovery of 



the new agent, or modification of the known 
existing agent oxygen — named ozone — may 
probably shed some new light upon the sub- 
ject of contagion. Actual contact, however, 
or even immediate vicinage, to a person 
labouring under a contagious disease, is not 
requisite for its propagation to others. This 
may be effected by means of substances to 
which the contagious matter clings. These 
substances, which go by the name of fomites, 
are more generally clothing and stuff furni- 
ture which have been about or near the 
bodies of those labouring under the disorder. 
These fomites are apt to be impregnated 
with the poison in a very concentrated con- 
dition, and are capable, not only of retain- 
ing it for a long period, but of transporting 
it from place to place. A sofa on which a 
patient labouring under scarlet fever had 
lain has been known to propagate the 
disease six months afterward ; and clothes 
which have been about the sick are con- 
stantly ascertained to have been the media 
of conveying fever, &c. to distant localities. 
Wool and cotton seem particularly apt to 
attract and retain contagious emanations ; 
but, indeed, all loose textures appear to have 
the property ; while on the other hand, 
polished and hard surfaces and substances 
are much less likely to act as fomites, if 
they do so at all. Every thing of unneces- 
sary drapery or clothing should be removed 
from the chambers of those sick of contagious 
maladies, or indeed of any malady; for a 
sick chamber must always, in a lesser or 
greater degree, have an atmosphere con- 
taining unhealthy emanations, which it is 
expedient, both for the good of the patient 
and of others, should find no unnecessary 
attractions or lodgments. Further, it is 
advisable to have the furniture as much as 
possible of hard and polished substances ; 
and the dresses of those in attendance upon 
the sick, especially if habitually so, might 
with advantage be made with a glazed sur- 
face. Those substances which have neces- 
sarily become the fomites of contagious 
matter ought to be scrupulously freed from 
it by complete and lengthened exposure to 
the open air, by washing, or by exposure to 
the fumes of chlorine in a close apartment ; 
or by all three, the chlorine fumigation be- 
ing first resorted to. Indeed those persons 
under whose management a case of conta- 
gious disease has occurred, ought, as a 
Christian duty, to make sure that every ar- 
ticle of stuff, furniture, clothing, &c. has been 
fully and carefully purified before others, 
either in the way of social intercourse or 
in occupation, particularly that of the wash- 
erwoman, come in contact with them. The 



CON 



139 



CON 



following systematic course of action should 
be pursued when the generation of contagious 
matter has ceased in an apartment, either 
by the death or recovery of the patient, 
premising, of course, that throughout the 
illness measures have been (or ought to have 
been) resorted to to preserve purity. During 
the day, the door being shut, the windows 
should be open to their full extent, and the 
infected articles freely exposed to the air ; 
during the night, the windows and door be- 
ing closed, chlorine should be well diffused 
through the apartment. This having been re- 
peated, if possible, for two days and nights, 
all textile fabrics and the like should be re- 
moved; those that are capable of being wash- 
ed put into cold water, and the others placed 
in the open air. All articles of furniture left 
in the room, also the floor and oil-painted 
wood-work, should be well scoured. If the 
chamber be a white-washed or coloured one, 
it should be "re-done;" if papered, it is 
only a safe precaution to repaper it. The 
bed requires the greatest amount of care ; 
if of wool, it is better destroyed altogether; 
if of hair or feathers, these should be exposed 
to the heat of rebaking, that is, at least to 
a temperature of 210° Fahr. ; and the tick- 
ing either thoroughly fumigated and washed, 
or entirely renewed. These directions may 
appear minute and troublesome, but they 
are far from being too much so when put in 
comparison with the fearful scourge of a 
contagious disease which has established 
itself in a household or community, and 
which perhaps might have been checked at 
the outset by the adoption of prompt and 
vigorous measures. The poor and the 
ignorant cannot or will not adopt, in most 
instances, effective precautions ; it remains 
for the rich, for the well-infoi'med, to point 
out their necessity, and lend a helping hand 
to their fulfilment, not only as an act of 
Christian charity, but as a means of safety 
for themselves. The disease which takes its 
origin in the cellar of Lazarus, not unfre- 
quently ends by establishing itself in the 
mansion of Dives. It is not a necessary 
character of contagious disease that it has 
itself sprung from contagion; some of the 
most virulent and spreading fevers, such as 
those of the ship, or of the old jails, had no 
such commencement, but had their origin 
in the decomposing emanations from the 
bodies of numbers of individuals confined 
in unventilated and insufficient spaces. In 
addition to the disinfectants already men- 
tioned, air, water, and chlorine, many others 
are and have been used, such as the vapour of 
vinegar, of pitch, or of tobacco or camphor, 
[or roasted coffee] ; large fires also used to 



be a favourite method ; but none of these last- 
mentioned are to be solely depended upon. 
The vapour of muriatic acid and the absorb- 
ing properties of newly slaked lime may be 
resorted to, in the absence of chlorine, with 
advantage. In many instances, particularly 
| in the case of clothes and other textures 
> which will not wash, heat might be used more 
extensively than it is at present as a disinfect- 
ant. The experiments of the late Dr. Henry, 
of Manchester, proved that while the various 
textile fabrics might be exposed to a heat of 
at least 215°Fahr. without injury,their power 
as fomites, or of propagating contagious 
disease, after having absorbed the emana- 
| tions, is destroyed by the high temperature. 
Refer to Air — Bed-room — Chlorine, §c. 
CONTUSION.— See Bruise and Concus- 
sion. 

CONVALESCENCE— Is the transition pe- 
riod between the cure or cessation of severe 
, disease, whether acute or chronic, and the 
! re-establishment of health. The commence- 
! ment of convalescence, or the point at which 
' the characteristic symptoms of disease cease, 
j is sometimes distinctly marked, more espe- 
cially after acute disorders; frequently, how- 
ever, the tendency toward health, particularly 
I after chronic disease, is much more insen- 
i sibly established. In the latter case, too, 
l the progress of the convalescence is slower 
I than it is in the former. Its rapidity or pro- 
\ traction, moreover, is much influenced by 
: age, and the nature and treatment of the 
1 previous malady. Children convalesce ra- 
pidly, old people the reverse ; but in all cases 
I the natural power of resiliency of the consti- 
I tution exerts much effect. In no case, per- 
[ haps, is convalescence more tardy and un- 
' satisfactory than after illness in which much 
j loss of blood, or of its constituents, has taken 
j place, either as a consequence of the disease 
or of blood-letting in the treatment of it. 
j Since, however, the practice of abstracting 
i blood in a large quantity by the lancet has 
j been modified, there are fewer cases of pro- 
tracted convalescence from this cause. 

When convalescence from acute disease 
commences, the previously quick pulse falls 
to the natural standard, the tongue begins 
to clear, the skin becomes cool, sleep is re- 
freshing, the mind acquires a more healthy 
and hopeful tone, and the person looks better. 
There is nothing which more assures a me- 
dical man of the condition of his patient 
than the look, the expression of the counte- 
nance, to which the first glance, as he enters 
the room of sickness, is almost instinctively 
directed. The look of convalescence is tran- 
quil and placid, not the heightened colour and 
bright eye of hectic, which so often deceives 



CON 



140 



CON 



the inexperienced with delusive hopes. 
When the brain has been much affected, 
however, the condition of the mind, and 
consequently the countenance, assumes its 
natural look more slowly. 

The management of convalescence is ex- 
tremely important. Errors in this respect 
frequently expose the already weakened 
patient to attacks of other disorders, or in- 
duce relapses to the diseased actions which 
had just been cast off. The convalescence 
after some particular diseases is more liable 
to such accidents than it is in others. That 
after fever is peculiarly so ; and after scarlet 
fever, the tendency to cold and its conse- 
quences, dropsical swelling, and affection 
of the kidneys, is so very common, and so 
frequently fatal, that the greatest possible 
care is requisite. During convalescence 
from acute disease, and especially of an 
eruptive character, many of the disorders 
characteristic of the scrofulous constitution 
show themselves : the eyes become the seat 
of chronic inflammation, purulent discharge 
from the ears occurs, and chronic eruptions 
show themselves upon the skin, of the head 
especially. Moreover, these disorders, now, 
perhaps, for the first time apparent, are apt 
to continue even after convalescence, pro- 
perly so called, is over. Further, relapse 
in convalescence often occurs from too soon 
employing actively the previously affected 
organ ; the liability to this mishap must be 
evident to the common sense of every one. 
In the case of the eye, it is evident to the 
senses, after inflammation of that organ, its 
undue exercise, or even its exposure to full 
daylight, will often be followed by a return 
of the disease. Such is the case elsewhere ; 
and whether it be the eye, or the brain, or 
the stomach which has been affected, re- 
turn to the ordinary exertions of health 
must be made with the greatest caution. 

The clothing of a convalescent patient re- 
quires particular attention ; there is much 
susceptibility to cold and to atmospheric 
vicissitudes. For the requisite informa- 
tion the reader is referred to the article 
"Clothing." General exercise is to be 
resumed cautiously, and should never be 
carried to the extent of fatigue. Diet, how- 
ever, is the great source both of error and 
mischief — the greatest difficulty which the 
medical man has to contend with ; that is, 
in getting it properly attended to, and his 
orders properly carried out, particularly 
among the poor. While a disease is in pro- 
gress and alarm is felt, directions are tole- 
rably well, or indeed strictly, obeyed; but 
no sooner does the patient begin to get 
better, than irregularities commence. The 



popular idea seems to be that convalescence 
must advance in proportion to the amount, 
and often to the stimulant qualities, of the 
food given ; and many a hopeful case sinks 
back into fatal relapse from the wilful and 
injudicious kindness of friends. The point 
is one which requires to be strongly en- 
forced, not only on the minds of the poorer 
and more ignorant, but on those of people 
generally, that in diet, as in every thing else, 
convalescence must be gradual, and that 
nothing is more dangerous, more likely to 
induce relapse, than the injudicious use of 
solid animal food or of stimulants. Milk, 
and the various farinaceous preparations 
with which it is usually combined, such as 
arrow-root, sago, rice, bread, &c. is perhaps 
the most generally useful article of diet in 
convalescence ; next come the broths made 
from fowl, mutton, veal, or beef, alone, or 
mixed with some of the farinacea ; next in 
succession, are eggs lightly boiled ; and, 
lastly, solid meats, of which tender mutton 
is probably the best, are to be permitted. 
Ripe fruits in their season, if not contra- 
indicated by the nature of the previous 
disease, and if they do not occasion flatu- 
lence or diarrhoea, are both grateful and 
serviceable. If alcoholic stimulants can be 
dispensed with, it is the safer plan, and 
when requisite, the time of their employ- 
ment, and the kind used, is best left to a 
medical attendant. A good deal must de- 
pend upon the previous habits of the person. 
Gin, in cases in which the urinary secre- 
tion is deficient, is most suitable ; or light 
sherry, if the circulation is excitable ; and 
port wine or porter in extreme debility. 
One of the most useful of the alcoholic 
stimuli, in convalescence, is the bitter India 
beer or pale ale ; the amount of alcohol it 
contains is not large, its bitter exerts a 
beneficial tonic effect upon the stomach, 
while the narcotic principle of the hop 
tranquillizes the nervous system, often so 
painfully irritable. In whatever form nour- 
ishment is given to the convalescent, it 
should be in small quantity at a time, but as 
frequently repeated as the natural appetite 
requires. The atmospheric purity of the 
chambers occupied by persons recovering 
from sickness requires great attention, 
and the temperature ought to be kept as 
nearly as possible about 58° Fahr. Lastly, 
when convalescence has reached a certain 
point, there is no remedy which so surely 
promotes perfect recovery and confirms 
health as change of air. Almost any 
change is beneficial, but in many cases 
much more advantage would be derived if 
persons thus seeking health acted upon 



CON 



141 



CON 



competent medical. advice. It is to be re- 
gretted, that so many of the accessories 
which promote speedy and certain conva- 
lescence have hitherto been unattainable 
by the poorer classes in this country. Care 
and good nursing and the highest medical 
skill in the country are bestowed upon the 
poor inmate of the hospital up to a certain 
point, and convalescence is barely esta- 
blished, when too often the patient has, in 
order to make room for others, to leave the 
comfortable home of his sickness, with all 
its nourishing food and its comforts, and 
return to scanty nourishment, exposure to 
weather, and to an unhealthy home. In a 
climate like that of Britain, [as well as in 
the United States,] the point is one which 
requires more attention than it has hitherto 
received. Proposals for the establishment 
of convalescent villages have certainly been 
made, and some steps have been taken to- 
ward providing convalescent stations; but 
an immense deal requires to be done before 
the want is supplied, and charitable bequests 
and donations might be worse directed than 
into such a channel. 

Refer to Air — Bed-room — Clothing — Cook- 
ery — Diet, $c. 

CONVULSION— Is a state of alternate 
violent contraction and relaxation of the 
muscles, independent of the influence of the 
will ; those under its direct control are most 
frequently affected, but not invariably so. 
The muscular fibres of the stomach and 
other involuntary muscles are often the 
seat of convulsion, but in this case the term 
spasm is generally applied to the disorder. 
Convulsions are classed by medical men as 
"tonic," or those in which the state of con- 
traction is maintained for a considerable 
period without alternation with relaxation, 
and as " clonic," or those in which the two 
states succeed one another with more or less 
rapidity. When the relaxations and con- 
tractions are very slight and very rapid, the 
condition is tremour. The first of these, or 
the tonic convulsion, occurs in lock-jaw in 
its most perfect form ; the second, or clonic, 
in hysteria ; the third is seen in the persons 
of hard drinkers when not under the in- 
fluence of their stimulant. % 

Convulsions may be either general or 
partial, affecting only the muscles of the 
eyes or eyelids, of the face, or of one of the 
extremities, or of one side of the body ; or 
they may shake the whole frame in convul- 
sive agitation, such as occur in epilepsy. 
Some of the most characteristic local con- 
vulsive actions occur in the muscles of the 
face, causing squinting, &c. &c. or the pecu- 
liar "sardonic sniile,"or grin, which is caused 



by forcible retraction of the corners of the 
mouth, exposing the teeth. 

Sometimes an attack of general convulsion 
is prewarned by a local affection, the eye 
is unnaturally turned, or the thumbs, as 
often occurs in children, drawn across the 
palm of the hand; or hiccup, which is a 
convulsive affection of the diaphragm, pre- 
cedes the more widely diffused affection. 
In partial convulsion, the mind is probably 
unaffected ; but when the affection is widely 
distributed, or general, there is frequently 
no outward sign of consciousness, and when 
the convulsion ceases, and consciousness 
does return, there is no recollection of the 
past paroxysm. 

An attack of convulsion may come on 
suddenly, without any previous warning, 
but more generally it is preceded by symp- 
toms. If in a child, there has probably 
been disturbed and moaning sleep, starting, 
screaming, grating of the teeth, peevishness, 
heaviness about the eyes, or squinting, or 
rolling of the ball in sleep, and a disordered 
condition of the bowels. If in an adult, 
dreaming and unsettled sleep have occurred, 
headache, noises in the ears, disturbed and 
clouded vision, giddiness, nervous fears, 
loss of memory, and confusion of mind, 
have accompanied disorder of the digestive 
organs ; a tendency to vomit without obvious 
cause, or colicky pains in the bowels, hic- 
cup, and cramps in the hands or feet, have 
been the premonitors, and, just before the 
accession of the paroxysm, a creeping sen- 
sation or " aura" is often felt to extend 
gradually from an extremity up to the head. 
In one of the most terrible and protracted 
successions of convulsive attacks the author 
ever witnessed, each paroxysm could be dis- 
tinctly traced, commencing in one toe, gra- 
dually extending up the limb and trunk, 
until the whole frame was fearfully agitated. 
In such cases the convulsive movements of 
the limbs and the distortion of the features 
are truly terrible to witness ; but there is 
every reason to suppose that in many in- 
stances, and it is a great consolation to do so, 
the trial is to the spectators, and that the 
cerebral disorder which causes such violent 
commotion of the body extinguishes for the 
time any consciousness of suffering. Of 
course, when the mind is unaffected, as it is 
in lock-jaw or tetanus, or in hydrophobia 
and other cases, the pain of the convulsion 
is severely felt. The length of time a con- 
vulsion continues may vary from a few 
minutes to many hours, but generally the 
period is short, the paroxysms returning 
after intervals of cessation. The fit of con- 
vulsions may terminate in apoplectic stupor^ 



CON 



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in a state of extreme nervous exhaustion, in 
lethargy, or in prolonged sleep. For some 
time after, there is usually much languor, 
both physical and mental, and the faculties 
of the mind are confused and incapable of 
being exerted. There may remain perma- 
nent lesion of the nervous functions, such as 
paralysis, or disordered nervous action, 
such as St. Vitus' s dance : a squint often 
dates from an attack of convulsions in child- 
hood. In some cases bleeding from the nose 
or ears, or vomiting or diarrhoea appear to 
terminate the attack. 

Convulsions are the result of a great va- 
riety of causes. The brain itself may be the 
organ primarily affected ; there may be dis- 
ease of its structure, or pressure or irrita- 
tion exerted upon it, by disease or accident; 
there may be too great determination of 
blood to the head, or the reverse condition 
may exist, and the supply of stimulant blood 
to the brain may be inadequate. But con- 
vulsions quite as frequently arise from irri- 
tation of distant organs affecting the brain 
and spinal cord. In childhood, the irritation 
of teething is a most prolific source of con- 
vulsions — and perhaps not less so, irritation 
of the stomach and bowels ; causes which 
might, in the adult, produce transient head- 
ache, in the susceptible nervous system of 
the child may cause convulsion. In females, 
irritation connected with the generative 
system is a frequent source of convulsive 
action ; and, indeed, one of the most formida- 
ble phases of the disorder occurs in the pro- 
cess of childbirth. Strong mental emotion 
of any kind, such as joy, fear, &c. &c, are 
apt to cause convulsion. Suppression of 
accustomed discharges likewise is often 
followed by an attack of the malady. 
Worms in the intestinal canal cause it ; and 
the onset of acute disease, small-pox in par- 
ticular, but also febrile disease of any kind, 
is, in many instances, heralded by an attack. 
In fact, with those who are susceptible, 
there is scarcely an agent, from a carious 
tooth or the scent of a flower upward, which 
has not the power of exciting convulsive ac- 
tion — or something nearly approaching it — 
of the human frame. 

Some persons are much more liable to be 
affected than others, and children, as a 
general rule, especially so ; it is therefore 
very important that the premonitory symp- 
toms, either in them or in individuals of 
excitable temperament, should be carefully 
noted and attended to, and the exciting 
cause, if possible, discovered and removed. 
In children, the state of the gums and of 
the secretions from the bowels are espe- 
cially to be watched ; the first may require 



lancing, or the second clearing out by an 
active purgative, such as calomel and scam- 
mony. But when, from the occurrence of 
warning symptoms, and especially if the 
child, or any other member of the family, 
have previously suffered from convulsions, 
an attack is supposed to be impending, 
medical advice should be procured. A 
point of great importance to be determined 
is whether the disordered condition is con- 
nected with excess or deficiency of circula- 
tion in the vessels of the head and spine ; 
for if the former, it is evident that the low- 
ering treatment which it requires must be 
injurious should the latter condition prevail, 
for this must be corrected by tonic medi- 
cines, or even by the exhibition of stimulants, 
such as sal-volatile, or brandy in minute 
quantity. It must be clear to all how im- 
portant it is, either in the prophylactic or in 
the actual treatment of convulsions, whether 
in children or adults, that this point should 
be clearly ascertained. And as it is one 
which sometimes requires considerable me- 
dical acumen and experience satisfactorily 
to determine, it must be equally clear that 
it must render non-professional interference 
in such cases a matter of hazard, and not 
lightly to be undertaken. At the same time, 
the sudden and alarming nature of convul- 
sive attacks renders it necessary that some 
means of discrimination and some safe rules 
of treatment should be known to all who are 
likely to be appealed to in such cases, par- 
ticularly if resident in places far removed 
from immediate medical assistance ; and it is 
reiterated that the two opposite states must 
be kept in mind, the one arising from excess, 
the other from deficiency of circulation, and 
the treatment modified accordingly. 

If convulsion be threatened in a child of 
full habit, with firm flesh and good colour ; 
if teething is going on, the gums must 
be looked to, and lanced if requisite, the 
bowels may be freely purged with calomel 
and scammony, or with gray powder at 
night, followed by senna in the morning, 
the diet being at the same time reduced ; and 
should there be much heat about the head, 
and the symptoms remain unabated, leeches 
— one, two, or more, according to age — may 
be applied to the temples, and cold to the 
head generally. If, on the contrary, the 
child, even though fat, be pale, and the flesh 
loose, and if it is of feeble habit, any thing 
like lowering must be avoided; the gums 
ought, of course, to be attended to, and if 
the bowels are disordered, the secretions 
must be gradually corrected by a couple of 
grains of gray powder, given every night at 
bedtime, and, if requisite, a small dose of 



CON 



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castor-oil in the morning ; likewise, in either 
of the above cases, an antacid will probably 
be of service, such as three or four drops of 
solution of potash, or a teaspoonful of fluid 
magnesia, in the milk food, given twice a 
day. In judging of the energy or weakness 
of the cerebral circulation in infancy, as 
long as the opening of the head is unclosed, 
it affords a guide to judgment. When at 
this point, the scalp and sub-jacent parts ap- 
pear depressed, the condition is one in which 
any thing like lowering measures are inad- 
missible. Keeping the already given cautions 
in view, and remembering how often, both in child 
and adult, convulsion is threatened in consequence 
of irritation, not in the brain or spine, but at a 
distance from them, when it is suspected that 
an attack is impending, and when medical 
assistance cannot be at once procured, at- 
tention should be directed to any possible 
source of irritation, and should any such be 
found, its removal should, if possible, be 
effected. If no appreciable source of irrita- 
tion is discovered, to which symptoms of 
threatened convulsion can be referred, and 
if the brain itself be suspected to be in fault, 
the same cautions respecting excess or defi- 
ciency of vascular action must still be 
remembered. If plethora is undoubted, if 
the individual is of full habit, florid, and 
with a strong pulse, leeches and cold to the 
head, and free purging, with low diet, may 
be resorted to with every prospect of advan- 
tage. On the contrary, if the habit is feeble, 
the more negative system will be most safely 
pursued ; the bowels niu&t be regulated but 
not purged, the diet attended to as regards di- 
gestibility but not lowered, and every source 
of nervous exhaustion, either fatigue of body 
or mind, or of a sexual character, most scru- 
pulously avoided. If the extremities are 
cold, as they often are, their warmth must 
be preserved ; if the head is hot, the mode- 
rate use of cold will allay nervous excite- 
ment, as well as vascular action. Provision- 
al measures like the above will, if used with 
judgment, be most valuable even in unpro- 
fessional hands, but they are not to super- 
sede medical examination, which must be 
submitted to. 

In the treatment of an attach of convulsion 
the above directions must equally be borne 
in mind and acted upon. When a child is 
seized with convulsions, the most generally 
available remedy is the warm bath, and if 
used with judgment it is a good ontkThe 
temperature should be 98° ; if the child is 
strong and plethoric, it should not be im- 
mersed above the waist, and, while in the 
bath, cold should be applied to the head ; if 
the child is weak, it may be put in the water 



above the shoulders ; in either case the 
immersion is to be continued for twenty 
minutes. The gums are to be lanced if 
requisite, and leeches applied to the head 
under the cautions already given as to the 
abstraction of blood ; and under the same 
cautions purgatives are to be resorted to, 
either the more powerful ones of calomel and 
scammony, or calomel and jalap, or senna, 
or indeed the first efficient medicines of the 
class at hand, or the milder agency of castor- 
oil ; in addition, an aperient clyster may be 
administered with advantage. When the 
child is taken out of the bath, it should at 
once be wrapped up in warm blankets, and 
laid in its cradle, or in bed, and cold used 
to the head, or not, as thought well ; and 
if the fits still continue, mustard-plasters 
made with half oatmeal may be applied to 
the legs, but must be removed as soon as 
the skin is well reddened. 

When an adult is seized with convulsions, 
the treatment, conducted upon the same 
principles, must be very similar to that 
recommended for a child, with exception of 
the bath, which cannot be conveniently 
used ; in its stead, a warm bed, with hot 
applications to the feet, limbs, &c. must be 
substituted, and mustard-plasters may be 
used more freely. . If there is much heat or 
excited action about the head, it should be 
shaved, or the hair cut close off, and cold 
or iced applications freely employed. In 
following out these directions, the non-pro- 
fessional will be doing much, and indeed 
all they can legitimately do during the 
longer or shorter interval that must neces- 
sarily elapse before the case is seen by a 
medical man. Lastly, it must be borne in 
mind that convulsions are not unfrequent 
in extreme intoxication, and also in poison- 
ing from narcotics, such as opium : their 
occurrence from such causes would of course 
materially modify the treatment. In chil- 
dren particularly, they are unquestionably 
the frequent result of the administration of 
laudanum, and more frequently still of quack 
soothing and carminative medicines and 
elixirs. 

Refer to Apoplexy — Bath — Children — Clys- 
ter — Croup — Spasmodic — Head — Lockjaw — 
Spasm — Teeth — Worms, $e. 

COOKERY — For the sick and convales- 
cent. — The best methods of preparing suit- 
able nourishment for the sick is a matter of 
so much consequence, that its consideration 
here cannot be out of place. Its import- 
ance is, perhaps, scarce sufficiently appre- 
ciated by any class ; and among the poor, 
almost total ignorance prevails respecting 
it. Even when the needful materials are 



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abundantly provided, still things are pre- 
pared in such a barbarous and uninviting 
fashion, that the fastidious appetite of an 
invalid turns loathing from them ; and 
this simply from lack of knowledge or of 
attention in preparing. Constantly is the 
medical man told, "I could eat, but I can- 
not fancy such food as we have here" — and 
this, when material is amply provided, but 
nicety wanting. 

The reader is referred to the separate 
articles which treat of the various forms of 
food for further information ; but the follow- 
ing recipes are a few of those most directly 
useful. 

Sick-room Articles of Diet. — And here 
it may just be hinted that neatness in 
serving up, as well as care and perfect 
cleanliness in preparing, makes sick-room 
cookery more likely to be attractive to an 
easily offended appetite. 

ARRO-w-RooT.-'-Not quite a tablespoonful 
of arrow-root powder is to be mixed slowly 
and smoothly in a basin with a little cold 
water — and when done, a pint of boiling 
water added ; it should then be sweetened 
to taste, and put on the fire to boil for five 
minutes, stirring well the whole time. If 
wine is permitted, it should be put in 
after the arrow-root is poured into the 
bowl. The same quantity of arrow-root is 
a proper one, when it is prepared with milk 
instead of water. 

Oatmeal Gruel. — A dessertspoonful of 
meal must be mixed smoothly with two of 
cold water — a pint of boiling water poured 
on, and the whole boiled on the fire for ten 
minutes, well stirring for the time — sugar, 
or pepper and salt, being added, as may be 
agreeable to or proper for the sick person. 

Sago requires thorough washing in cold 
water to take away its earthy taste ; after 
doing so — (a tablespoonful will be a suita- 
ble quantity) — put it in a pint of milk, and 
boil it slowly till it is quite soft and has 
thickened the milk — ten minutes or a quarter 
of an hour is sufficient time — sweeten to the 
taste, and add wine, or flavour with lemon- 
peel, according to circumstances. Some in- 
valids prefer tapioca to sago. It is pre- 
pared in the same quantity as the other, but 
does not require the previous washing, and 
takes only half the time for softening on 
the fire. 

In all preparations for the sick, let the 
constant stirring while on the fire be at- 
tended to, whether directed or not. The 
least tendency to burning renders sick- 
cookery perfectly abominable. 

Ground-Rice Milk. — A tablespoonful of 
ground rice, a pint and a half of milk, and 



half an ounce of candied lemon-peel. Mix 
the rice very smoothly with the milk, then 
add the lemon-peel cut into very small 
pieces ; boil for half an hour; and strain as 
soon as off the fire. [Farina is to be pre- 
pared in the same manner, and flavoured 
to suit the taste.] 

This is an excellent nutritious beverage 
for the sick, or for early convalescence, 
when strict abstinence is not required. 

Simple Bread Panada. — Put a moderate 
quantity of grated or soft stale bread into 
enough boiling water to form a moderately 
thick pulp ; cover it up, and leave it to soak 
for an hour — then beat it up with two or 
three tablespoonfuls of milk, and fine sugar 
to sweeten — boil the whole for ten minutes. 
This preparation is occasionally acceptable 
to the invalid, when milk diet alone is re- 
jected. 

Carrageen Moss. — One ounce of it boil- 
ed in a pint and a half of water is suffi- 
cient to form a semi-transparent, moderate- 
ly consistent, nearly tasteless jelly, which, 
when sweetened and acidulated, or when 
mixed with milk, forms an excellent diet for 
invalids who require to have the strength 
supported. 

The Gelatine,' now so commonly used, is a 
very palatable preparation combined with 
either water or milk, and may be taken dis- 
solved in tea, coffee, or broth, without im- 
pairing the flavour of one or the other. 

Jelly from Gelatine. — To rather more 
than an ounce of gelatine add half a pint of 
cold water to soften it, then pour over it a 
pint of boiling water, and stir till the gela- 
tine is dissolved ; pare very thinly the rind 
of one lemon, and add, with the juice of 
three or four — if acids are permitted — one 
pound of loaf-sugar, the whites and shells 
of three or four eggs, thoroughly well 
whisked together, and stirred into the 
whole ; let it come to the boil upon the fire 
without more stirring, — if wine is ordered 
with it, it should be added after coming off the 
fire; pour it through a thick flannel jelly- 
bag, — what runs through at first will not 
be clear, and should be returned to the bag 
again ; let it stand still cold, and you will 
have a clear, sparkling jelly, which few in- 
valids will refuse. 

Gelatine with Milk. — An ounce of gela- 
tine is to be soaked in half a pint of cold 
milk ; when softened, a pint of boiling 
milk stirred well with it, till it is quite 
dissolved; it may be sweetened to taste, 
and put upon the fire to boil up altogether. 
It may be flavoured with lemon-peel, or cin- 
namon, or brandy, as is most liked, or most 
suitable. It will be quite solid when cold. 



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White Wine Whey. — Boil a pint of milk; 
add to it one or two glasses of sherry "wine, 
and sugar enough to sweeten ; let it boil till 
the curd has separated, then strain through 
muslin. If the wine does not possess 
sufficient acid to turn the milk, a little ren- 
net, or a teaspoonful of lemon-juice, or 
three or four grains of tartaric acid may be 
added. 

Barley-Water. — See Barley. 

Lemonade. — The juice of two lemons, 
the rind of one added to a quart of boiling 
water, sweetened moderately, and kept in a 
covered jar, or jug, is a useful drink for 
those suffering from cold or slight fever. 

Toast-Water. — This simple beverage is 
seldom well prepared. Let the water with 
which it is made have been boiled and be- 
come cold. Toast thoroughly of a fine deep 
brown, but not black color, half a slice of a 
stale loaf; put it into a jug, and pour a 
quart of the water over it ; let it stand two 
hours, and decant the water from the bread. 
A small piece of either orange or lemon-peel 
added with the bread is an improvement to 
toast-water. 

Linseed [Flaxseed] Tea. — One ounce of 
flaxseed, not bruised, two drachms of liquo- 
rice-root, bruised ; pour over one pint of 
boiling water ; place the jug (covered jugs 
with perforated spouts should always be 
used for drinks for sick people) near the 
fire for three or four hours, then strain off. 
When flaxseed-tea is ordered to be continu- 
ed, it should be made fresh every day. 

"Milk and Soda- Water. — Heat, nearly 
to boiling, a teacupful of milk ; dissolve in 
it a teaspoonful of fine sugar, put it into a 
large tumbler, and pour over it two-thirds 
of a bottle of soda-water. This is an excel- 
lent mode of taking milk when the stomach 
is charged with acid, and consequently feels 
oppressed by milk alone. 

"Rice and Gravy. — Let the rich gravy 
from a leg of roasted mutton or sirloin of 
beef stand till the fat forms a cake on the 
surface, remove it, and heat the gravy 
with as much well-boiled rice as will make 
it thick. A teacupful of this is very 
strengthening in the early convalescence of 
delicate children." — Dr. A. T. Thomson. 

["Biscuit Jelly. — White biscuit, four 
ounces ; water, four pints. Boil down one 
half, strain and evaporate to one pint. Add 
one pound of white sugar, four ounces of 
red wine, and a teaspoonful of cinnamon or 
peach-water. 

"Almond Jelly — Blanc Mange. — Sweet 

almonds bleached, one ounce ; white sugar, 

six drachms ; water, four ounces. Bub 

into an emulsion in a mortar ; strain, and 

N 



add isinglass or hartshorn jelly, eight 
ounces ; orange-flower water, one drachm ; 
essence of lemon, three drops. 

"Rice Jelly. — Rice, picked and washed, 
four ounces ; loaf-sugar, half a pound ; 
water sufficient to cover it. Boil till it be- 
comes a glutinous mass, then strain and 
and season to the taste. 

"Indian or Corn-meal Gruel. — Three 
tablespoonfuls of corn-meal sifted; water, 
one quart. Wash several times with fresh 
water, turning off the water as the meal 
settles ; then boil for twenty minutes, stir- 
ring all the time ; add a little salt ; then 
strain and sweeten, adding a little butter, 
wine, and nutmeg, if proper. 

"Oatmeal Gruel — Is made in the same 
manner. 

" Vegetable Soup. — One potato, one tur- 
nip, one onion, one carrot, (if liked,) and a 
little celery. Slice, and boil in one quart 
of water for an hour ; add salt to the taste, 
and cut up toast to soak in it. 

" Mutton Broth. — Lean of mutton, one 
pound ; water, one quart ; a little salt, pars- 
ley, and crust of bread. Boil slowly for 
two or three hours, skimming carefully. 
Vegetables, rice, or barley may be added. 

"Chicken Water. — Half a chicken, free 
from fat ; break the bones, add half a gal- 
lon of water, season with salt, and boil 
half an hour. 

" Suet Drink. — Sheep suet, two ounces ; 
milk, one pint ; starch, half an ounce. Boil 
slowly for half an hour. An excellent drink 
in dysentery." — American Medical Formula- 
ry, by Dr. J. J. Reese.'] 

COPAIBA, or Copaiva, or Balsam op 
Copaiva — Is a fluid resin obtained from 
trees native of Brazil. It is principally 
used in treatment of chest and venereal dis- 
eases. — See Balsam. 

COPPER.— This well-known metal is 
used in medicine, principally in the form of 
its sulphate, better known by the name of 
"blue vitriol," which occurs in crystals of 
a beautiful blue colour. It can never be 
employed as a domestic medicine internally, 
and scarcely, if at all, as an external appli- 
cation, with much benefit. In the latter 
form, indeed, mischief is often done, by the 
popular practice of sprinkling "powdered 
blue stone" upon sores and ulcers ; its 
injudicious and copious application giving 
much unnecessary pain, producing slough- 
ing or mortification of the surface to which 
it is used, and thus retarding, instead of 
hastening the cure. 

All the salts of copper are poisonous, but 
those which are most generally known and 
used as poisons are blue vitriol and verdi- 



COP 



146 



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gris. Another combination, the arsenite of 
copper — a compound of arsenic and copper 
— also known as Scheele's green,- a deadly- 
poison, has already been noticed under the 
head of arsenic. In addition to the above, 
poisoning by copper frequently occurs in 
consequence of the use of copper vessels in 
cooking, &c. 

Blue vitriol is sometimes taken to procure 
abortion ; its strong metallic taste, however, 
would prevent its being administered with- 
out the knowledge of the person taking it. 
It has been taken for the purpose of suicide, 
and the author has witnessed one case of 
the kind Which proved fatal in ten hours, to 
a woman above seventy years of age, who 
swallowed a large dose in order to commit 
self-destruction. The poison produces, in 
the first instance, violent vomiting, and in 
this way life may be saved by the emetic 
action of the salt itself ; purging succeeds, 
followed by extreme depression of the vital 
powers, cramps in the limbs and severe pain 
in the bowels ; occasionally jaundice has 
occurred. The matters ejected are tinged 
with the blue colour of the poison. In a 
case of poisoning by a salt of copper, the 
object must of course be to get the stomach 
freed from it as quickly as possible. Its 
own emetic action should be assisted by 
warm drinks, warm water, or milk, or 
mucilaginous drinks of some kind, such 
as linseed-tea, or barley-water ; sugar has 
been found useful in these cases as an anti- 
dote, and should be added in good quantity to 
the fluids which are administered. After the 
stomach has been well cleared by the vomit- 
ing, raw eggs should be given largely ; and 
if sickness does not recur, which it proba- 
bly will, it should be reinduced by putting 
a feather down the throat, or by the admi- 
nistration of a scruple of white vitriol in a 
little water. Of course, medical assistance 
should be obtained, but the above measures 
may be advantageously had recourse to in 
the interval. When poisoning by copper 
occurs in consequence of its presence in food 
which has been prepared improperly, or in 
badly cleaned copper vessels, the amount 
of the poison may not be sufficient to occa- 
sion death, but it produces severe symp- 
toms, similar to those above detailed. Cop- 
per vessels, unless protected by tinning, and 
even then, unless the protection is in a per- 
fect state, cannot be considered desirable 
cooking utensils; and when they are used, 
the strictest cleanliness is requisite for 
safety. Even if water is allowed to stand 
in a copper pan for any length of time, a 
poisonous salt is formed. But if the water 
contains an acid of any kind, such as vine- 



gar, if it holds common salt in solution, or 
if there be oily or fatty matter present, 
poisonous compounds are quickly formed. 
Consequently, food which contains any of 
these ingredients should never be prepared 
in copper vessels. The same objection, of 
course, holds good as regards preserving 
fruits, which all contain more or less acid, 
and are therefore liable to act upon copper. 
There is, however, less danger as long as 
the active operations of cooking are going 
on, than there is from allowing the articles 
above enumerated to stand for any length 
of time in a copper utensil freely exposed 
to the air. German silver, which contains 
a more or less considerable proportion of 
copper, is in some degree open to similar 
objections; and those who have used this 
material for any purposes, must have no- 
ticed the green stains which form upon its 
surface, and which are owing to decomposi- 
tion of the copper it contains. Many of the 
cheaper green pickles contain copper, which 
is added to them to make the colour appear 
finer. The adulteration may be detected 
by introducing a perfectly clean plate of 
iron — a table-knife — into the suspected arti- 
cle ; if copper is present, it will be depo- 
sited upon the surface of the former metal, 
in the form of a fine metallic film or coating. 
It has been the practice, on the continent, to 
add a small proportion of sulphate of copper 
to dough in the making of bread; the practice 
is not known to be followed in England. 
Copper has been detected in mussels which 
have caused symptoms of poisoning, but it 
is not considered to be the invariable cause 
of the injurious results which occasionally 
follow the use of this shell-fish as food. It 
should be remembered that the majority of 
the green colouring matters and pigments 
at present in general use are compounds of 
copper ; and, therefore, care should be ob- 
served in permitting children to have access 
to them. A child has been poisoned by a 
cake of green paint from a toy colour-box. 

Copper coins are sometimes swallowed by 
children, and may pass away by stool with- 
out any apparent bad consequences ; but 
this is not always the case, and severe epi- 
leptic fits have ensued in consequence of the 
accident. In the event of a child being 
known to have swallowed a piece of copper, 
salt, acids, and fatty matters should be ex- 
cluded from its food, which ought to consist 
of thick milky preparations, such as hasty 
pudding and the like, well sweetened with 
sugar; gentle doses of aperients being ad- 
ministered. The thickened food should be 
given as soon as possible after the accident. 

Refer to Arsenite of Copper. 



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CORDIALS — Are stimulants generally of 
an alcoholic nature ; the name is derived 
from the old idea that they "strengthened 
the heart." They certainly stimulate the 
circulation, and are useful in cases of de- 
pression from any cause, where such an 
effect is required. Brandy is, perhaps, as 
good and as generally attainable a cordial 
as any; the compound tincture of carda- 
mon and the aromatic spirit of ammonia 
constitute two of the best medicinal cordials. 

Refer to Excitants. 

CORIANDER SEEDS— Are produced by 
a plant, a native of Southern Europe ; it 
now grows wild in Britain. They are a 
pleasant and powerful carminative, the pro- 
perty depending upon the volatile oil Avhich 
they contain. In medicine, coriander is 
principally used to correct the griping pro- 
perties of senna. 

CORN. — A corn is a thickened state of the 
epidermis, or outer or scarf skin, caused by 
irritation, such as pressure or friction, act- 
ing upon the true or sensitive skin, which 
causes an increased growth of the flattened 
cells of which the epidermis is composed. 
The corn, produced in the first place by 
external pressure or friction, soon becomes 
in itself an additional source of irritation, 
and, by its hardness, increases proportion- 
ally the inflamed and sensitive condition of 
the true skin underneath. If the causes are 
removed, the disease gets well, as any one 
who has suffered from corns can testify, after 
having been confined hj illness for any time. 
Tight shoes are undoubtedly the most 
general originators of corns ; but badly 
made, ill-fitting ones also give rise to the 
affection, not by pressure, but by friction. 
Soft corns generally form between the toes, 
and are very troublesome and painful : they 
are kept soft by the continued perspiration 
of the part. 

The most efficient cure for corns is, of 
course, to get quit of the cause — the offend- 
ing boot or shoe — but as some persons are 
so liable to the affection, or have their feet 
so formed, that if they wear boots or shoes 
at all they must suffer from corns, the best 
palliative is keeping the hardened mass well 
pared down in the centre. Vinegar, or 
strong acetic acid, applied to a corn every 
evening will sometimes effect a cure, a little 
olive-oil being smeared over every morning. 
Various corn-plasters are used ; the most 
effective and rational are those which are 
made thick, and have a hole cut in the 
centre for the corn, which is thus preserved 
from pressure. [A piece of buckskin spread 
with adhesive plaster, cut to the size of a 
sixpence, and with a hole in its centre large 



enough to permit the corn to come through, 
serves the same purpose.] Soft corns should 
be cut with scissors, a piece of linen should 
be worn between the toes, and the strictest 
cleanliness observed. [Soaking the feet 
in strong oak-bark tea will do much toward 
hardening the skin and checking excessive 
perspiration.] A peculiar kind of corn oc- 
casionally forms under the corner of the 
nail of the great toe, and causes much pain 
and irritation ; if discovered by slightly ele- 
vating the nail, the thickened mass may be 
turned out. 

Refer to Skin. 

CORN.— See Grain. 

CORNEA. — The transparent, glass-like 
portion of the eye. — See Eye. 

CORROSION.— The term, when applied 
to the living body, means the gradual de- 
struction of any of its tissues by chemical 
action. 

CORROSIVE SUBLIMATE.— See Mer- 
cury. 

COSMETICS — Are external applications 
used to improve the appearance of the skin, 
as regards whiteness, &c. Their employ- 
ment is always to be condemned ; moreover, 
they frequently contain deleterious matters, 
such as corrosive sublimate of mercury, 
salts of lead, &c. &c. Lndirectly they are 
injurious, by leading the mind from the only 
true cosmetics, obedience to the laws for the 
maintenance of physical health, which the 
Almighty has linked with our existence — 
Cleanliness, temperance, abundant fresh air 
and exercise, and early hours, and the cheer- 
fulness which results from the healthful oc- 
cupation of the mind in legitimate pursuits, 
are cosmetics which no art can imitate or 
supply. 

COSTIVENESS, or Constipation — Is 
undue retention of the fcecal contents of the 
bowels, and their evacuation in a harder and 
drier condition than natural. The state is one 
in a great degree dependent upon habit and 
constitution ; for that which would be con- 
sidered constipation in one person, would 
not be so in another, and vice versa. As a 
general rule, however, the bowels ought to 
relieve themselves thoroughly once in the 
twenty-four hours; when such is not the 
case, the condition may be said to be one of 
costiveness. 

With some individuals, a single evacuation 
of the bowels once every three or four days, 
and even less often, seems to be sufficient, 
and perfectly compatible with their enjoy- 
ment of perfect health ; and when such is the 
case, it is of course superfluous to endeavour 
to correct it, and it is better to let well 
alone. If, however, in conjunction with 



COS 



148 



COS 



this condition of the bowels, the person suf- 
fers from headache, from languor, from dis- 
tension of the abdomen, if the breath is 
disagreeable, and the tongue furred, the 
state is not compatible with health, and 
should be corrected. 

The causes of costiveness are very nume- 
rous. The nature of the food, as might be ex- 
pected, exerts considerable influence ; bread 
badly made, and especially if alum be mixed 
with it, cheese, milk with some persons, fari- 
naceous articles, such as arrow-root or 
ground rice, and food of too concentrated a 
character, all tend to constipate. Deficient 
exercise, particularly if combined with much 
exertion of mind ; any drain upon the sys- 
tem, as in suckling, abundant perspirations, 
loss of nervous power, and old age, have the 
same effects. Pregnancy, and tumours in 
the abdomen, constipate by mechanical ob- 
struction, and in the same way contraction 
of any portion of the alimentary canal. The 
colon or large bowel is very frequently the 
seat of the constipation; it loses tone, 
allows itself to be distended, sometimes to an 
enormous extent, or contracts to a very nar- 
row calibre in some portion of its course. 
Lastly, a very common inducing cause of 
costiveness, particularly in females, is inat- 
tention to the intimation of nature to relieve 
the bowels. 

As, except in the case of a few persons of 
constitutional peculiarity, confined bowels 
cannot be compatible with health, comfort, 
or activity of either mind or body, the state 
must be rectified, and that in a proper man- 
ner, not as it is usually attempted. Perhaps 
there is no ailment to which the human body 
is subject which is more frequently mis- 
managed than constipation. Every effort 
should be made to correct the disorder with- 
out the aid of medicine. In the food, all 
those articles which have been enumerated, 
or which are known to constipate, must be 
avoided. The bread used should be made 
of coarse flour [or bran] ; if vegetables and 
fruits agree in other respects, they may be 
freely consumed, and cocoa substituted for 
tea or coffee : food is not to be taken in a 
state of too great concentration, but so that 
by the bulk of its refuse it may afford sub- 
stance to stimulate the action of the bowels. 
In addition, there are various articles of 
diet which exert an aperient effect, and 
which may be used -or not, according to the 
taste of the person : such as Scotch oatmeal 
in the form of porridge, honey, prunes, &c. 
Exercise, whether on foot or horseback, 
is another valuable aid in the removal of 
the costive state ; it not only quickens all 
the functions, but it assists defecation 



by the mechanical motion it communicates 
to the intestines. A similar effect may in 
some cases be produced by friction or 
kneading the abdomen with the hand ; the 
practice is scarcely so much resorted to as 
it might be. Another very important point 
is regularity in the time of evacuating the 
bowels ; not waiting for the urgent sensa- 
tion, but retiring for the purpose at one set 
period of the day, when time can be given. 
[Soon after breakfast is the most natural 
time, as digestion is perfected during the 
night.] Persons who are liable to costive- 
ness should give themselves at least a quar- 
ter of an hour, or even longer, for the daily 
evacuation of the bowels. Lastly, as con- 
stipation is so frequent an attendant upon 
the sedentary life of the student, and upon 
the anxious-minded man of business, a holi- 
day both from books or desk, and change of 
air and scene, is both a good and pleasant 
remedy. 

When neither diet nor regimen will effect 
the cure, other means must be had recourse 
to. If there is simple costiveness, without 
disorder of the digestive functions, the best 
remedy will be the regular use of some 
simple clyster : if, on the other hand, furred 
tongue, with acidity of stomach, flatulence, 
pain between the shoulders, headache, &c. 
betoken deranged digestion, medicine will 
be required, at all events in the first in- 
stance : the liver is probably at fault, and 
five or six grains of blue pill, or of com- 
pound colocynth and calomel pill, followed 
in the morning by the black draught, or by 
castor-oil, will be requisite to commence the 
treatment. 

When the stomach, liver, and upper bow- 
els have been well cleared by the above 
medicines, it is requisite to keep the bowels 
open ; otherwise a few days will see all the 
symptoms returned — and, in fact, such is 
too often the case. Persons are content 
with taking a dose of strong opening medi- 
cine every few days, or once a week, as 
the case may be, and rest content with 
thus, as it is called, having a good clearing 
out — albeit they are under the necessity of 
increasing the strength of the doses. The 
practice is one incompatible with sound 
health, and is most injurious to the stomach 
and bowels themselves : many cases of ob- 
struction, and even inflammation of the 
bowels are produced by it. The principle 
to be proceeded upon in the treatment of 
costiveness is, that it is more easy to keep 
the bowels in action than to excite them 
to it when they have become thoroughly 
torpid, and therefore the individual should 
not rest content without the daily evacua- 



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COT 



tion. As has been said above, if simple 
constipation, depending upon inaction of 
the lower bowel, exists, the use of the 
clyster will in all probability be sufficient ; 
but medicine may be required, perhaps 
daily, for some time, or it may be used 
alternately with the clyster. Some medi- 
cines are better adapted than others to the 
treatment of habitual costiveness, and of 
these castor-oil, aloes alone or in its com- 
binations, senna, and ipecacuanha are the 
principal ; their great advantage is not los- 
ing their effect by continued use. When 
castor-oil can be taken regularly, in most 
cases it answers extremely well ; and if 
taken regularly, the dose requires rather 
diminution than increase. It is a medicine, 
moreover, which never seems to injure the 
tone or the mucous coat of the bowels. In 
the constipation of pregnancy, castor-oil is 
so well known as the best and safest aperi- 
ent that it scarcely requires mention. Aloes 
is peculiarly well adapted to relieve certain 
forms of costiveness, particularly that of 
the sedentary, and may be taken in the form 
of pill, in combination with soap, in the 
compound rhubarb pill, or compound colo- 
cynth pill : any of these are most excellent 
combinations. If there is debility of sto- 
mach, the addition of a quarter or half a 
grain of quinine to each pill increases the 
efficiency of the medicine and gives tone to 
the stomach. The quinine must not be con- 
tinued for more than a fortnight at a time. 
The dose of aloes when regularly taken 
does not require to be augmented. When 
quicker action is required, the compound 
decoction of aloes may be taken with ad- 
vantage instead of pills. The principal 
contra-indication to the use of aloes is the 
occuirence of piles, which, if inflamed, or 
if the dose be too strong, are apt to be ag- 
gravated by the medicine ; in this case cas- 
tor-oil, or infusion of senna, or. the clyster, 
should be substituted for a time at least. In 
some cases, on the other hand, when the 
piles are not inflamed, aloes taken regularly 
in small doses, seems to exert a beneficial 
and curative action upon them ; probably 
in consequence of keeping the intestinal 
veins from becoming overloaded with blood. 
Senna, either in infusion or electuary, is a 
medicine well adapted for the relief of cos- 
tiveness ; it is perfectly safe, and does not 
seem soon to lose its effect. Ipecacuanha, 
not alone, but in quarter or half grain doses, 
especially when added to the aloetic pills, 
exerts a most beneficial effect in cases of 
habitually confined bowels. A weak solu- 
tion of Epsom salts, a drachm to the half pint 
of water, with or without the addition of five 
n2 



or ten drops of dilute sulphuric acid, when 
taken on first rising in the morning, will 
prove effectual with some, and forms a 
change from the use of the other aperients. 
[A quarter of a pound of salts in a pint of 
water, and a wineglassful taken at bed- 
time, is also a useful and easy method of 
taking it.] Again it is repeated, keep the 
bowels free, by food, by exercise, by habit, 
if possible, by clysters or medicine if ne- 
cessary, but do not let them become costive. 

In some individuals in whom the walls of 
the abdomen are very flaccid, and do not 
afford sufficient tonic support to the con- 
tained bowels, costiveness frequently exists, 
and is much remedied by the use of an 
elastic or other belt, worn to support the 
entire belly. 

Refer to Alimentary Canal — Aloes — Clys- 
ter — Digestion — Laxatives, §c. 

COTTON— Is a soft downy fibre obtained 
from the seed capsules of the cotton-plant, 
a species of gossypium. In its manufac- 
tured state, as calico, it is useful for many 
purposes, such as bandages, &c. in medical 
practice. The use of cotton cloth [muslin] 
in the treatment of sores is generally consi- 
dered to be more likely to irritate than linen, 
but the difference, if there is much, is great- 
ly exaggerated. The cause has been said to 
be in the different form of the constituent 
fibre ; that of the cotton, as seen under the 
microscope, being flat — that of the lint 
round. Much of the manufactured lint 
consists of cotton alone or mixed with flax. 
It has been thought that the flat sharp (?) 
edges of the cotton fibre were the irritating 
agents. The use of the sheet cotton, in the 
form as used for wadding dresses, is a most 
invaluable application in burns. It is also 
sometimes used to dress blisters. 

Refer to Lint — Burns, $c. 

COTYLEDON UMBILICUS, or Wall 
Pennywort — Is a native of Britain, and is 
found growing on old walls, chiefly in the 
south of England. The whole plant is suc- 
culent, and its leaves, which are round, 
spring directly from the soil, or nearly so ; 
from their centre there is sent up a round 
stem about nine inches high, which bears a 
number of yellowish-green, drooping flow- 
ers. The plant is remarkable from its juice 
having lately come prominently into notice 
as a remedy for epilepsy. It was introduced 
by Br. Salter, of Poole ; and the author can 
from his own professional experience testify 
to its marked good effects in this most in- 
tractable and distressing malady. Of course, 
in those neighbourhoods in which the plant 
grows, the fresh expressed juice may be 
used ; but most efficient extracts are madq 



cou 



150 



COU 



from it by various of the London chemists. 
The dose of the fresh juice is one ounce 
twice a day. 

COUCHING — Is an operation performed 
upon the eye, by -which the lens, when it 
has become opaque from disease, is shifted 
or depressed to another part of the interior 
of the eye-ball, and thus removed from the 
axis of vision, which it obstructs. 

Eefer to Eye. 

COUGH — Consists in the violent expul- 
sion of air from the lungs through the air- 
passages. In most cases it must be re- 
garded rather as a symptom of disease than 
as a disease itself. Cough may arise from 
a great variety of causes. From direct ir- 
ritation of the air-tubes themselves, by the 
inhalation of cold and damp air, or of irri- 
tating vapours, by the mechanical irritation 
of foreign substance accidentally introduced 
into them, by the pressure of tumours, or 
by irritation of the throat and fauces, par- 
ticularly when there is relaxation of the 
uvula, and also in consequence of disease, 
inflammatory or otherwise, of the lungs 
themselves. Further, cough may be sympa- 
thetic with disorder in the stomach, or liver, 
or with irritation in the bowels, occasioned 
by worms or other irritant agents, or it may 
be the result of nervous derangement, such 
as hysteria, or be spasmodic, like hoop- 
ing-cough. So numerous are the ailments 
and diseases of which cough is a symptom, 
that it frequently requires considerable dis- 
crimination to determine the real cause of 
the irritation. Many of the acting causes 
are undoubtedly trivial, but many are deep- 
ly seated and fatal diseases ; and therefore, 
whenever an individual becomes the subject 
of cough which cannot be readily account- 
ed for by cold or some other direct cause, a 
medical examination ought to be submitted 
to. And even if the cough has been in the 
first instance the result of cold, should it 
continue "hanging about" a person, without 
obvious reason, medical advice ought to be 
taken ; mischief may be brewing, and be 
the cause of the irritation, or the cough ex- 
cited by some trivial and easily remedied 
cause, may itself be causing disease in the 
lungs of a predisposed person. 

Cough is spoken of both medically and 
popularly as dry and moist. A dry cough 
may be the result of direct temporary irri- 
tation of the air-passages, but more gene- 
rally it is symptomatic, either of incipient 
disease connected with the chest, or of sym- 
pathetic nervous irritation, probably con- 
nected with the abdominal viscera. Moist 
cough is generally connected with direct 
affections of the chest, such as common 



catarrh, and with inflammatory affections, 
or with asthma or consumption. 

It has already been said that a cough 
should never be allowed to continue for any 
length of time without the cause being ascer- 
tained by medical examination; till this is 
done, it can scarcely be expected that the 
proper remedy can be applied. In the first 
instance, however, simple remedies may be 
tried. If the cough be clearly traceable to 
cold or catarrh, it may be treated according 
to the directions given under these heads ; 
if it be very dry, demulcent medicines, such 
as the mucilage and tolu-mixture, or barley- 
water, or linseed-tea, may be taken freely, 
with from five to ten drops of ipecacuanha 
wine two or three times a day, to which 
may be added fifteen or twenty drops of 
tincture of henbane to allay irritation. 
Opium and its preparations are not gene- 
rally desirable in dry cough — unless, indeed, 
it be spasmodic — as. the drug itself exerts a 
drying effect upon the mucous membrane 
of the lungs. The inhalation of the steam 
from boiling water is sometimes highly be- 
neficial. In dry, and also in moist cough, 
counter-irritation, by blisters, on the ante- 
rior part of the chest, or between the 
shoulders, is often of much service. The 
surface of the chest should be well pro- 
tected by flannel next the skin, by a dressed 
hare-skin, or by a warm plaster, either in 
front or behind. In moist coughs, the 
amount of fluids and of demulcents must 
be somewhat more restricted than in the 
above. The preparations of opium may be 
given in small quantity, either alone or in 
cough-mixtures, but none answers better 
than paregoric, taken in one or two tea- 
spoonful doses, in water ; this allays the 
irritation and teasing frequency of the 
cough ; and to each dose, if expectoration is 
difficult, five or ten drops of ipecacuanha 
wine, and the same of tincture of squill 
may be added. The author has found the 
following pill most extensively useful in 
coughs depending upon irritation in the 
bronchi or air-passages: — Take of powdered 
opium five grains, of powdered squill sixteen 
grains, of powdered ipecacuanha twelve 
grains, of powdered camphor eighteen grains, 
of powdered gum-ammoniac twenty-four 
grains, of powdered rhubarb twelve grains : 
make into a mass with syrup, and divide into 
thirty pills : of these, one or two may be 
taken for a dose, 

The foregoing remarks apply only to 
chronic or continued cough ; of course the 
treatment of the affection as it arises in 
connection with other disease, either acute, 
such as inflammation of the lungs, or chro- 



cou 



151 



COU 



nic, falls under the general management of 
these disorders. When feverish symptoms 
occur along -with cough, all stimulation, 
either in diet or by stimulant expectorants, 
is to be avoided ; indeed, as a general rule, 
when cough exists, the diet should be as 
little stimulating as circumstances "will per- 
mit, and the usual allowance of animal food 
curtailed ; but in old people, and those who 
have lived freely, the lowering system must 
not be carried too far ; it may be requisite 
even, at times, to stimulate, and to support 
strength by strong meat-soups. 

Again, it is repeated, a cough ought not 
to be allowed to continue. If not relieved 
by some of the simple remedies mentioned 
above, medical advice should be sought — 
particularly in the case of the aged — and if 
there is much secretion of phlegm or mu- 
cus, the least continued impediment to the 
expectoration of which, in an old person, 
may rapidly induce dangerous or fatal em- 
barrassment of the lungs, often most unex- 
pectedly. 

The possibility of a relaxed or elongated 
uvula being the cause of cough must not be 
forgotten. An examination of the throat will 
detect it, and the state may be relived by the 
use of some astringent gargle, by a small 
fragment of catechu allowed to dissolve in 
the mouth, or by touching the uvula once or 
twice a day with a camel' s-hair brush dipped 
in "tincture of steel." 

Refer to Catarrh — Cold — Counter-irritation 
— Expectorants — Lungs, §c. 

COUNTER-IRRITATION— Is irritation or 
excited action in one portion of the body, 
■which counteracts or withdraws analogous 
action going on in another portion. It may 
be naturally or artificially established, and 
it may be called into action within the 
body, as well as without ; but the term is 
now generally applied solely to counter- 
irritant action artificially excited upon the 
skin. There are many various modes of ex- 
citing counter-irritation : some may be and 
are used popularly with perfect safety ; 
others are only admissible in medical hands. 

Counter-irritants may simply produce red- 
dening of the skin, or they may blister, or 
they may cause discharge of purulent mat- 
ter, or even mortification of the surface. 
Heat, according to the temperature at which 
it is used, may give rise to any or all of 
these effects : mustard will redden smartly, 
and may blister ; ammonia will do the same, 
according to strength ; camphor in solution, 
either in spirit or oil, will redden. 

Of the blistering counter-irritants the 
Spanish fly is the best, and almost univer- 
sally employed. Boiling water, or its steam, 



or metal heated in boiling wate* have all 
been used for the purpose, and might be, on 
emergency. Counter-irritation by tartar 
emetic, or tartarized antimony, takes the 
form of pustules or pimples. The salt is 
applied either in the form of ointment, or 
as a saturated solution, used as hot as can 
be borne, and rubbed upon the skin by 
means of a piece of flannel. The pustules 
formed by the latter mode are said to heal 
speedily, and to leave no scar, which some- 
times happens after the ointment. When 
a common blister is irritated, " kept open," 
secretion of purulent matter takes place ; 
but the system is a bad one, and is pro- 
ductive of much unnecessary pain and irri- 
tation. 

Issues and setons cause discharge of mat- 
ter. Counter-irritation by means of galvanic 
agency has recently attracted notice. 

Iron heated to a red or white-heat, moxas, 
and other applications which destroy the 
texture to which they are applied, fall under 
the head of cauterants, and can never be 
used as domestic remedies. There is, how- 
ever, one application of the hot iron, intro- 
duced by Dr. Corrigan, of Dublin, which 
might safely be used by the non-professional, 
and, as the instrument can be made by any 
blacksmith, might prove a valuable resource 
in remote districts, for the relief of nervous 
and rheumatic pains, such as lumbago, 
sciatica, &c. &c, in which it is often of 
essential service. 

The instrument (fig. xli.) consists of an 
iron portion (1) about four inches and a 
half long, which ends in a disc (2) half an 
Fig. xli. 



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152 



COW 



inch in diameter, and a quarter of an inch 
thick, and a "wooden handle, (3.) When it 
is used, it is grasped so that the point of 
the forefinger may rest upon the bend at 4. 
The disc is then to be introduced into the 
flame of a spirit-lamp, or a piece of burning 
paper, and held till the metal (at 4) be- 
comes uncomfortably hot ; the handle is 
then to be grasped, and the disc applied 
lightly, and momentarily, and at short in- 
tervals to the skin over the affected part. 
Each touch of the disc produces a shining 
mark on the skin, and very shortly the whole 
surface becomes reddened and slightly in- 
flamed. 

As regards the use of counter-irritants 
generally, it is often serviceable to excite 
the skin by friction or heat before using 
them. When fever is present and inflamma- 
tion goiny on, non-professional persons will 
do quite as much, if not more good, and be 
much less likely to do harm, by using the 
mild counter-irritation of moist heat than 
by applying blisters, mustard, &c, particu- 
larly close upon the seat of the disease. If 
a blister is put on in these cases, it should 
be a large one. For further information 
respecting the counter-irritants individu- 
ally, the reader is referred to the various 
articles — Antimony — Blister — Mustard, §c. 

COUNTENANCE.— The expression and 
aspect of the human face is much and 
peculiarly affected by the various diseases 
•which affect the body ; and the first view of 
a countenance often conveys to a physician, 
who has studied the subject, immediate, 
valuable, and certain prescience as to the 
nature of the disease for which his patient 
is about to ask advice. The indications are 
partly due to the changes of complexion 
■which are associated with different forms of 
disease ; but expression is equally signifi- 
cant. The physiognomical evidences have 
been classed by a writer, Mr. Corfe, who, 
enjoying abundant scope for such observa- 
tions, has made them an object of special 
attention. 

The following is a summary of Mr. Corfe's 
arrangement: — 

Countenance in — 
A. — Brain Affections. 

1. Lethargic, in disease causing insen- 

sibility. 
Examp. : Apoplexy. 

2. Livid, in disease causing deficient 

change in the blood. 
Examp. : Suffocation and Coma. 

3. Distressed, in disease causing men- 

tal disturbance. 
Examp. : Paralysis and Fever. 



B. — Chest Affections. 

1. Dusky, in disease interfering with 

blood changes. 
Examp. : Bronchitis. 

2. Anxious, in disease impeding respi- 

ration. 
Examp. : Croup. 
C. — Abdominal Affections. 

1. Pinched, in painful seizures. 
Examp. : Colic and Cholera. 
D. — Nutrition Affected. — Emaciation 
General. 

1. Wan, in diseases of debility. 

Examp. : Consumption and Cancer. 

2. Hue peculiar, in diseases affecting 

the blood. 
Examp. : Heart disease and Jaun- 
dice. 
E. — Enlargement of Organs, Glands, &c. 
1. Disturbed, in diseases causing con- 
tinued uneasiness. 
Examp. : Sore-throat, Rheuma- 
tism, &c. 
F.— Vascular Disturbance. 

1. Flushed, in febrile disease. 

Examp. : Inflammatory fever. 

2. Pale and languid. 

Examp. : Hemorrage, &c. 

Refer to Complexion, fyc. 

COUP DE SOLEIL, or Sun-stroke.— See 
Heat, effects of. 

COW-POX— Is the disease affecting the 
cow, which, transferred to the human sub- 
ject, confers in the majority of cases immu- 
nity from attacks of small-pox ; and in those 
in which it does not give complete protec- 
tion, renders the attack of that usually 
virulent disease comparatively mild. 

Cow-pox shows itself upon the teats of 
the cow in the form of bluish or livid- 
looking vesicles, surrounded by a ring of 
inflammation, while at the same time the 
animals are feverish and the milk dimi- 
nished. At first the vesicles contain clear 
fluid, but ultimately become pustular, or 
filled with matter. The cow is liable to 
other forms of pustular disease affecting the 
teats, but they do not present the same 
characters nor follow the same course as 
the genuine cow-pox: which is, moreover, a 
constitutional disease, sometimes extremely 
severe, and even fatal to the animals. 

The name of Dr. Jenner, who discovered 
this inestimable boon and introduced the 
practice of vaccination — as the inocula- 
tion of cow-pox matter is termed — must 
be known to all. His attention was first 
directed to the subject from the known 
circumstance, that when the cow-pox had 
prevailed among the cows of a particular 



C w 



153 



COW 



district or farm, many of those connected 
with the management of the animals, like- 
wise became affected with the disease, and 
therefrom a certain number were protected 
against small-pox. The value of this cir- 
cumstance seemed at first to be materially 
impaired by the fact that the protection 
was neither universal nor certain, until the 
investigations of Dr. Jenner made it clear 
that the protection or non-protection de- 
pended upon the stage which the disease had 
attained in the animal at the time it was 
contracted by the human attendant ; that is 
to say, if the vaccine disease advanced into 
the stage of maturation, or that in which 
the contents of the vesicle, which forms its 
outward manifestation, had become con- 
verted from a limpid-looking fluid into 
matter, although sores were produced upon 
the hands of the milkers, that certain pro- 
tection was not afforded which ensued when 
the sores were produced by the fluid from 
the vesicle in an earlier stage. 

Following up his investigations, Dr. Jen- 
ner clearly demonstrated, that tvhen the human 
subject w as properly inoculated ivith virus taken 
from the cow-pox vesicle, at the proper stage of 
its progress, and when in consequence of that 
inoculation the disease was regularly produced 
and went through its proper stages, both locally 
and constitutionally, the individual thus affected 
was thenceforth all but certainly protected from 
the contagion of small-pox. These circum- 
stances call for particular attention at the 
present time, when the value of vaccination 
and its protective power is becoming much 
disputed. It is unquestionable, that within 
the last few years, small-pox has prevailed 
much more extensively, and been more fatal, 
than was the case some time previously ; 
also, that many persons who had been vac- 
cinated have taken the disease, and that a 
certain proportion of that number have died 
from it. As regards the complete protec- 
tion of every individual who is vaccinated, 
against the contagion of small-pox, it could 
never be expected — for the simple reason, 
that one attack of small-pox is not in every 
case a security that the disease may not be 
contracted a second time ; for, although, in 
the eruptive fevers generally, as well as in 
small-pox, the general rule is one attack in 
a lifetime, it by no means invariably holds 
good ; and it is unreasonable to look for 
more from cow-pox than we find in the 
analogous cases already alluded to. Admit- 
ting, then, that certain exceptional instances 
may fairly be expected in which the most 
perfectly developed cow-pox will not pro- 
tect against small-pox even in its most fatal 
form, it becomes a question how far its pro- 



; tection really extends, and whether, from 
i some cause or other, its influence has not 
| become diminished since the early days of 
its introduction. Many are inclined to this 
opinion, on account of the recent epidemics 
of small-pox which have prevailed in various 
districts ; but it will require much stronger 
evidence of the fact than has ever yet been 
produced to justify, as some would have it, 
the abandonment of vaccination and the 
recurrence to inoculation for small-pox. 
One thing is certain, that Dr. Jenner, 
strongly alive to the circumstance that 
milkers inoculated with the genuine cow- 
pox were not protected by it if the disease 
had passed a certain stage, both practised 
and insisted upon the practice as a condi- 
tion necessary for success, that the same 
law should be had regard to in the trans- 
ference of the matter from one human sub- 
ject to another. It must be asked, has this 
precaution been observed in the cases of 
those who have proved to be insufficiently 
protected. It may or may not have been 
the case ; but there is some reason to expect, 
that among the thousands and millions who 
have undergone vaccination, a certain pro- 
portion have thus been lulled by the sem- 
blance of protection which was no protection 
at all. Again, it is an ascertained fact, that 
the presence of other disorders materially 
interferes with the regular progress and 
perfect development of cow-pox ; and thus 
there is introduced another element of 
fallacy and of failure. And, lastly, are there 
not those who have been vaccinated, but in 
whom the disease, owing to constitutional 
peculiarity, or insufficient performance of 
the vaccinating process, has either been 
irregularly developed or not at all, but who 
nevertheless rank among the vaccinated? 
With all these sources of failure, it cannot 
be matter of surprise, that a proceeding to 
which is confided the protection of millions 
against so active an enemy as small-pox, 
should in a certain proportion of instances 
fail. Still less so when it is reflected, that 
amid the various hands to which its per- 
formance is intrusted, some will prove 
careless ; nay, that it is not unfrequently 
performed by those who are ignorant of the 
distinctive characters of the true cow-pox 
disease. This is not said in condemnation 
of the performance of vaccination by non- 
professional persons, under peculiar circum- 
stances ; for in many cases it has proved and 
must prove of the most essential benefit ; but 
still they cannot be expected to distinguish 
accurately an irregular development from 
one which is the reverse. 

The most interesting recent fact connected 



cow 



154 



COW 



with the history of vaccination, and one 
which throws light upon its constitutional 
influence, has been elicited by the experi- 
ments of Mr. Ceely, of Aylesbury, which 
prove the identity of the two diseases, cow- 
pox and small-pox, and that their apparent 
difference depends upon their mocliiication 
by the animal constitution. In other words, 
that by taking the matter from a patient 
labouring under small-pox, and therewith 
inoculating a cow, the genuine cow-pox was 
produced ; and thus, that by its passage 
through the constitution of the cow, the 
former virulent disease is deprived of its 
virulent and fatal character, and converted 
into a mild and'perfectly safe disorder, and, 
equally important, deprived of its contagious 
property, otherwise than as it can be communi- 
cated from one person to another by direct 
introduction of its tangible virus into the 
blood. Connected with this fact is the 
occurrence of the grease on the heels of 
horses, which was at one time considered 
identical with cow-pox, but must now be 
considered as the same virus, but modified 
by the equine constitution. 

The next point is one intimately connected 
with the prejudices of the public, and espe- 
cially of the poor — the possibility of other 
diseases, or a tendency to them, being in- 
troduced along with the cow-pox virus, 
taken from persons who either had the 
dreaded disease, or a tendency thereto. The 
idea is not without apparent foundation, but 
the state of the case is one which most 
parents are unwilling to admit. Any medi- 
cal man who has had much to do with vac- 
cination, and who has watched its effects, 
must have known cases in which children, 
previously apparently healthy, have, after 
passing through cow-pox, become liable to 
cutaneous eruptions, discharges from the 
ears or eyes, and even abscess ; some of these 
are of course adventitious circumstances, 
but they occur too often and too closely fol- 
lowing vaccination, to be entirely so ; more- 
over, they are precisely analogous to what 
is witnessed every day of the effect of 
eruptive febrile diseases, such as measles 
and scarlatina, upon children of weakly 
and scrofulous constitution. That the virus 
itself introduces other than its own specific 
disease is not to be believed, but that the 
peculiar disturbance it occasions in the 
constitution, stirs up, as it were, the latent 
tendencies to disease above named, cannot 
be doubted. It is proper that the public 
should be rightly informed upon this point, 
for it is one on which much misconception 
prevails, and it is the chief ground of pre- 
judice and even of resistance to vaccination, 



especially among the poor. The medical 
man is constantly met with objections, 
on the score of the liability to the intro- 
duction of other diseases along with the 
cow-pox, and when a reluctant consent is 
yielded, it is always guarded with strict 
injunctions as to the selection of the matter 
from a " healthy child, "each person consider- 
ing their own offspring as unexceptionable. 
It certainly is not a pleasant admission for 
parents, either to themselves or to others, 
that their children have bad or scrofulous 
constitutions ; but the fact still stands, that 
vaccination, as well as the other eruptive 
fevers, may in them give the first impetus 
to latent disease. A parent may decide not 
to subject a child to the chance, but in 
doing so, it is exposed to the much greater 
hazard of an attack of small-pox, in the 
first place as a disease, and in the second 
as an excitement of other diseases, still 
more powerful than vaccination. Further, 
however, as a proper concession to the 
opinions of the public, a medical man ought 
to take the vaccine virus from perfectly 
healthy children only ; and it may be said, 
if we find such a powerful modification of 
the constitutional effects of the disease by 
its passage through the body of the cow, 
there may be some influence, to us unappre- 
ciable, exerted in the passage through the 
varied constitutions of mankind. At all 
events, the simple supposition is sufficient 
to dictate care in the selection of those from 
whom the vaccination lymph is taken. 

The best period of life for the performance 
of vaccination, is infancy, between the third 
and fifth months, before the constitution be- 
comes disturbed by the process of teething ; 
it may, however, be performed at any time, 
from immediately after birth, should cir- 
cumstances, such as exposure to the conta- 
gion of small-pox, render it advisable, and 
of course at any period of after life. A 
child ought to be free from illness or disor- 
der at the time of vaccination ; any tend- 
ency to fever, to diarrhoea, &c. &c or any 
eruption, should be removed before the pro- 
cess is undergone. It is always preferable 
to vaccinate from the fresh arm if possible. 
When this cannot be done, vaccine virus or 
lymph is used, which has been preserved for 
the purpose, either dried on ivory points, or 
between two small squares of glass, or li- 
quid, in small glass tubes. In these cases 
it ought to be as fresh as possible, otherwise 
it is liable to fail ; but if well preserved 
from the air by means of oiled silk or me- 
tallic leaf wrapping, and kept in as cool a 
place as possible, it Will keep its efficiency 
far longer, and is thus sent or taken to 



cow 



155 



COW 



warm climates. The hermetically sealed 
tubes are said to be peculiarly well adapted 
for the above purposes, and sugar has also 
been used as a medium for preserving the 
lymph for a lengthened period. The scabs, 
also, dried and kept from the air, are capable 
of pdlducing the disease after keeping ; 
they require to be [powdered and] rubbed 
down with a little water when used. 

The part of the body on which vaccina- 
tion \s usually performed is the arm, about 
halfway between the shoulder and elbow ; 
a point not of very great importance in 
males, but to be attended to in females, 
who may wear low dresses or short sleeves, 
and who will not thank the doctor for a scar 
upon a visible part. Some vaccinate upon 
both arms ; others consider three, or even 
two well-developed vesicles upon one arm 
sufficient. In choosing the arm in a child, 
it should be done with reference to the arm 
on which the nurse or mother habitually 
nurses it ; attention to this simple point 
may save the child some uneasiness, or even 
from failure of the entire process, by the 
vesicles being rubbed or broken. 

All that is requisite for the process of 
vaccination is the contact of the virus with 
the surface of the true skin, which of course 
is done by piercing through the upper or 
scarf skin ; this may be effected without 
pain sufficient to make an infant cry, by a 
series of scratches crossing one another, 
continued till the slightest exudation of 
coloured serum takes place. A small quan- 
tity of the vaccine is 'now to be placed 
upon the abraded spot, and the thing is done. 

If the lymph has been dried, it is advisable 
to rub it into the exuded serum with the 
point of the instrument used. The points 
of insertion should be placed about three 
quarters of an inch asunder. Of course 
any thing which will abrade the skin in the 
manner described above, and apply the 
virus, may be used as a vaccinating instru- 
ment ; a large needle will do, if nothing 
better is at hand, but a lancet, not over sharp, 
is perfectly convenient for the purpose ; or 
the vaccinator of Dr. Graham Weir (fig. xlii.) 
which is furnished with a series of metallic 
points (1) at one end of the instrument, for 
the abrasion of the cuticle, and a small knife 
(2) at the other, for the collection and appli- 
cation of the virus. When ivory [or glass] 
"points" (fig. xliii.) are used to vaccinate 
from, the charged extremity (1) may either 
be well rubbed on the scratched surface of 
the skin, or the virus may be scraped off 
and applied with the lancet, or, a deeper in- 
cision being made with the lancet, in place 
of the scratches, the extremity of the point 



Fig. xlii. 



Fig. xliii. 



is to be pressed into it for twelve or fifteen 
seconds. 

The course of the vaccine disease is gene- 
rally a regular one. About the third day 
after the insertion of the lymph, the spots 
appear slightly elevated and inflamed, like 
small pimples ; on the fifth, each has a per- 
ceptible vesicle upon it, which continues 
enlarging, until, about the eighth day, it 
assumes its perfectly developed character- 
istic form, (fig. xliv.,) that of a circular 
Fig. xliv. 




vesicle with depression in the centre. At 
this period it contains a transparent "lymph" 
and it is surrounded by a perceptible blush, 
or " areola," the vesicle itself looking pearly 
or yellowish. By the tenth day, the lymph 
has become changed into matter, and the 
vesicle looks more opaque and darker ; the 
areola of inflammation has much extended, 



cow 



156 



OR A 



the affected skin feels hot and hard, and 
is sometimes covered with minute blisters. 
After the eleventh day, the areola begins 
to fade, the vesicle darkens still more in 
colour, becomes dryer and shrivelled, and 
finally assumes the form of a dark choco- 
late-brown scab, which separates somewhere 
about the twenty-first day, leaving the skin 
healed, but permanently marked with the 
impression of the vesicle, and with a num- 
ber of little pits. Occasionally the process 
does not go on quite so regularly ; four, 
five, or six days may elapse before the 
points of insertion inflame ; and it may be 
the tenth or eleventh before the vesicle is 
fully formed. On the other hand, it may 
advance so quickly as to be well formed by 
the seventh day. These differences are 
chiefly due to constitution. In a weakly 
child the process is apt to be delayed, and 
vice versa. The constitutional symptoms 
also vary, but generally are palpable about 
the eighth day ; the child is fretful and 
feverish, and continues so, more or less, for 
three or four days. Without the evidence 
of constitutional disturbance, the protection 
cannot be calculated on as complete. 

The management during the progress of 
the vaccine disease is very simple, the prin- 
cipal being the protection of the vesicles 
from injury, either by rubbing or by the 
dress. A piece of soft linen should be 
placed upon them on the fifth day. If the 
inflammation of the arm is severe, as some- 
times happens, a cold poultice of bread and 
water should be applied. A little Goulard 
water will allay the after-irritation, if 
troublesome. A dose of some simple aperi- 
ent, castor-oil or senna, should be given on 
the tenth or eleventh day, and repeated 
once or twice afterward. Care should be 
taken that the scabs are not forcibly de- 
tached, otherwise a sore, sometimes difficult 
to heal, may be the consequence. Some- 
times this will happen in spite of all pre- 
caution, in children of a scrofulous habit, 
and a troublesome ulcer form. It may be 
dressed with cold cream, or simple water- 
dressing, or may require a weak astringent 
lotion, such as two grains of the sulphate of 
zinc to the ounce of water. 

Occasionally, an eruption of vaccine vesi- 
cles comes out all over the body; it is not a 
circumstance of importance, and makes no 
difference in the treatment. 

When matter is taken from the cow-pox 
vesicle for the purpose of propagating the 
affection, it is requisite to puncture the 
vesicle all round ; for, in consequence of its 
being divided into separate cells by par- 
titions radiating from the centre — such as 



we see in the section of an orange — if one 
cell only is opened, the amount of lymph 
which exudes is comparatively small. The 
ivory points may simply be dipped in the 
exuded lymph and dried ; or the square of 
glass, if glass is used, gently applied to the 
vesicle. The "points," when dry, fkould 
be enveloped in some material which will 
exclude the air, such as goldbeater's leaf, 
or they may be kept in a bottle. When 
glass is used, the two squares should be 
put together before the lymph is quite dry, 
and if likely to be kept long before using, 
they also should be wrapped up from the 
air ; if to be used at once, paper is suffi- 
cient. 

The question of revaccination is much 
mooted. If the process has been properly 
passed through in early life, there can be no 
possible necessity for its repetition before 
puberty; but after that period, during which 
the constitution undergoes considerable 
change, it is an expedient precautionary 
measure which ought to be resorted to. 
The process of a second vaccination is very 
different from that of a first, being irregular 
in everyway, sometimes causing the slightest 
degree of irritation, at other times giving 
rise to rapid, almost erysipelatous inflam- 
mation of the arm. When it takes effect, it 
usually occasions slight feverish symptoms, 
loss of appetite, and headache, for a day or 
two. A dose or two of aperient medicine 
should be taken when these symptoms are 
passing away. The virus of a second vacci- 
nation is quite inefficient, and should never 
be taken. 

[In many of the large towns of the United 
States, physicians are appointed to vacci- 
nate the people without charge. Their re- 
sidences may usually be learned at the city 
halls.] 

Refer to Skin — Small-pox. 

CRAB — The well-known shell-fish, is an 
article of diet unsuited to those of weak 
digestion. In some constitutions it causes 
griping when eaten, and in others a cuta- 
neous eruption. 

CRAB'S-EYES— Formerly used in medi- 
cine as antacid remedies, particularly in 
cases of gravel, are concretions which form 
in the stomach of the craw-fish. 

CRAMP — Is a spasmodic, involuntary, 
and painful contraction of the muscular 
fibres. The term is generally applied to 
the affection of the voluntary muscles, in 
contradistinction to spasm, applied to that 
of the involuntary. Any muscles may be- 
come affected with cramp, but those of the 
legs and arms, of the former especially, are 
most liable to do so, doubtless from the 



CRA 



157 



CRE 



greater liability of the nerves supplying the 
lower extremities, to irritation and pres- 
sure, two great exciting causes of the dis- 
order. The cramp may be confined to one 
or two muscles, such as those of the calves 
of the legs, or may be more general, as 
happens in cholera. The affected fibres are 
drawn in hard knotty contractions, and 
maintain this condition for a longer or 
shorter time. The most frequent causes of 
cramp are the presence of indigestible food 
in the stomach, or of acid in the bowels, or 
the pressure exerted on the nerves by over- 
loaded bowels. The weight and pressure of 
the child, acts in a similar manner in preg- 
nancy and labour, and occasions painful and 
troublesome cramp. The disorder is also 
often associated with the presence of worms. 
When cramp affects the arms and fingers, 
it may be connected with disease of the 
heart and great blood-vessels of the chest. 
The power of the application of sudden and 
prolonged cold in producing cramp is often 
sadly exemplified in the case of bathers. 
The best immediate remedy for cramp is 
friction with the hand, or better still, with 
the soap and opium liniment. When the 
legs are affected, it is always expedient to 
take medicine, rhubarb and magnesia, with 
a teaspoonful of sal-volatile, or fifteen grains 
of carbonate of soda, with sal-volatile or a 
little ginger ; and afterward to clear out 
the bowels with some active aperient, such 
as castor-oil, especially if there is any exist- 
ing constipation, or a possibility of their 
being loaded. Any other disorder of the 
digestive organs ought, of course, to be at- 
tended to. Some persons find relief from the 
immediate attack of cramp, by tying a band 
of some kind tightly round the limb, be- 
tween the affected part and the body, while 
others are in the habit of standing upon 
some cold substance. The first process is 
perfectly safe, and may be tried ; the second 
certainly is often effectual, but it is not devoid 
of danger. Active friction is quite the best 
temporary remedy. Cramp affecting the 
arms is always to be regarded with suspi- 
cion ; if it recurs, a medical opinion should 
be taken. 

Refer to Convulsion — Spasm, §c. 

CRANIUM.— The skull containing the 
brain. 

CRADLE— The old form of child's bed, 
is now nearly superseded by the more con- 
venient bassinet. Either, if well arranged, 
should have a tolerably firm mattrass, a, firm 
pillow, a piece of protective waterproof cloth 
over the mattrass, and soft blankets, but no 
curtains, which are quite incompatible with 
the health of the child. Rockers beneath, 




if they allow only very gentle motion, are 
admissible, but not otherwise. 

Refer to Children. 

CREAM— Is that bland, oily portion of 
the milk which separates and floats on the 
top ; its composition is very nearly that of 
fat. It is a constituent of the milk of all 
animals. As the amount of cream, contained 
in cows' milk especially, varies consider- 
ably, the proportion may be ascertained by 
allowing the milk to repose in tall cylindri- 
cal glasses. Zinc pans have been recom- 
mended for use in dairies, as exerting some 
chemical action upon the milk, and causing 
the more abundant separation of cream. 
If there is chemical action, there must be 
danger of impregnation from the metal, and 
though it may be slight, it is better avoided. 

Cream is nourishing, but not suited for 
weak stomachs, except in small quantity, 
mixed with other articles of diet, such as 
arrow-root mucilage, when it may some- 
times be advantageously substituted for a 
larger proportion of milk. 

Refer to Milk. 

CREAM OF TARTAR, or Bitartrate 
of Potash. — See Potash. 

CREATINE, or Kreatine— Is a crystal- 
lizable substance, existing in the flesh of 
animals. 

CREASOTE— Obtains its name from its 
powerful antiseptic properties. When pure, 
it is a colourless fluid, of a strong pene- 
trating odour, which is known to most 
persons from its being extensively used as 
a palliative in toothache. It is obtained 
from tar, and, for that reason, is sometimes 
called "spirit of tar." For allaying the 
pain of toothache its power is superior to 
that of any other remedy. A single drop 
of creasote, rubbed up with a little sugar or 
gum, in an ounce of water, will often allay 
obstinate vomiting. 

It can be made into pill very nicely with 
crumb of bread ; but the pills should not be 
kept for more than three or four days. It 
may also be given with spirit of juniper, or 
with acetic acid, (vinegar,) which dissolves 
it. It disgusts some patients, but others 
like the smoky flavour, and in such cases it 
is a specific against sea-sickness, and rarely 
fails in the vomiting of pregnancy. It is 
an admirable ingredient for pomades for 
chilblains, threatening, incipient, or ulcer- 
ated, five or six drops being rubbed up 
with the ounce of lard. Dr. Cormack, in 
his treatise on creasote — Edinburgh, 1836 — 
brought forward many arguments and facts 
to prove that the Egyptian mummies owed 
their preservation, as well as their medical 
virtues to creasote ; and upon the occasion 



CRE 



158 



CRO 



of the unrolling of an Egyptian mummy in 
1850, the same author addressed a very in- 
teresting communication to the Athenseum, 
of June 15th, 1850, in which he seems to 
establish beyond doubt that the essential 
part of the mummifying process was the 
application of heat to bodies filled with 
bitumen. He shows, upon the authority of 
Royer, &c. &c. that large quantities of bitu- 
minous substances were always introduced 
into the body, and that the strong heat was 
then always applied. 

CRESSES — In the various forms of land 
and water-cresses, are wholesome salads, 
but, like other vegetables which are eaten 
uncooked, are not likely to agree with those 
of weak digestion. Water-cresses, so famed 
popularly, for their effect "in purifying the 
blood," probably owe their beneficial influ- 
ence to the presence of a small portion of 
iodine. 

CRETINS — Are individuals in whom de- 
ficient development of the brain, and of the 
body generally, is associated with mental 
imbecility. " Cretins are met with in various 
quarters of the world, and even in this 
country, but their peculiar location is in 
the dark, deep valleys of Switzerland. The 
condition is often associated with the exist- 
ence of bronchocele, and the two diseases 
have been considered as connected, but it is 
probably not more than coincidence of ex- 
citing cause. 

The most characteristic features of cre- 
tinism are, the stunted stature, which seldom 
exceeds four and a half feet, the deformed 
head, large belly, and distorted limbs, the 
countenance being an index of the imbecile 
or idiotic condition of the mind. There are, 
of course, various grades of cretinism. The 
malady is instructive in showing how strong 
an influence is exerted upon the develop- 
ment of the human frame, by circumstances 
such as surround these unfortunate beings 
in their childhood ; deficiency of light, and 
deficient change of the damp malarious at- 
mosphere of the deep valley. It is also to 
be feared that it exemplifies the power 
exerted by the habits of the parents upon 
their offspring ; and that drunkenness and 
debauchery of the former often entail cre- 
tinism upon the latter. There is no chance 
of amelioration, either physical or mental, 
unless the cretin is removed from his native 
home to the free air of the mountains above. 
The endeavour to improve the condition of 
these unfortunates is now being made in an 
establishment situated on one of the Swiss 
mountains, under the care of a philanthropic 
physician — Dr. Guggenbuhl — who is de- 
voting his life to the object. The results 



obtained, both mental and physical, are said 
to be encouraging. 

CRISIS— -In disease, means a sudden 
change, tending either to recovery or death. 
Much more importance used formerly to be 
attached to the critical periods of diseases 
than there is at present, although, in some, 
undoubted periodical changes do take place, 
but not with sufficient certainty or regu- 
larity to admit of much calculation. A 
crisis has generally been considered to be 
denoted by some well-marked circumstance, 
such as profuse perspiration, discharge of 
blood, cutaneous eruptions, boils, abscesses, 
or the like, or by the appearance of copious 
deposites or sediment in the urine ; and there 
can be no question that decided and per- 
sistent improvement in the character of a 
disease does often follow immediately upon 
the occurrence of these " critical" ejections. 

Refer to Fever, #c. 

CRO TON-OIL— Is obtained by pressure 
from the seeds of a shrub, the Crolon tig' 
Hum, a native of Hindostan, Ceylon, &c. 
The oil, when good, should be of a pale 
amber colour, about as thick as castor-oil. 
It is very acrid, and so powerfully cathartic 
as to be a very unsafe remedy for domestic 
use internally ; and, indeed, should never 
be resorted to, except in the one case of 
apoplectic seizure, when medical assistance 
is at a distance. In such a case, a single 
drop of croton-oil — if it is procurable — 
mingled with a little sugar, might be placed 
on the tongue. 

As a counter-irritant, croton-oil is ex- 
tremely useful. It may be made into a 
liniment, with equal parts of the strong 
solution of ammonia and water, or it may 
be used alone. It brings out a thick crop 
of pustules, when rubbed on the skin in 
small quantity. It sometimes, however, 
affects not only the part to which it is ap- 
plied, but causes a general cutaneous erup- 
tion, with swelling of the eyelids. It 
occasionally exerts the latter effect upon 
persons who happen to be near while the oil 
is used. It is not improbable that what are 
said to be concentrated preparations of 
castor-oil contain croton-oil. 

CROUP — Is an inflammatory affection of 
the larynx and upper portions of the air 
passages. It is peculiar to children — males 
are more liable to it than females — and when 
one in a family suffers from the disease, the 
rest almost certainly have a tendency to it. 
The malady seldom occurs during the first 
year of life, but is most frequent in the 
second ; at puberty the tendency to it ceases, 
although cases of genuine croup have oc- 
curred after that period. The rapidity with 



CRO 



159 



CRO 



which croup at times progresses to a fatal 
termination, and the distressing character 
of the malady, always render it a dreaded dis- 
ease. Fortunately, it is one which, if taken 
in time, is greatly under the control of well- 
directed treatment. Its dangerous nature 
must ever make proper medical advice a 
necessity, but the importance of early active 
remedial measures renders it at the same 
time highly desirable that treatment should 
be resorted to without the slightest delay. 
Moreover, the well-marked characters of 
the disease render it easily distinguishable 
by the unprofessional — doubly so by those 
who have once witnessed it, or heard its 
peculiar cough. The great danger in croiip 
arises not only from the possibility of the 
narrow chink in the larynx through which the 
air passes becoming closed by swelling; but 
also from the remarkable product of a pe- 
culiar inflammation which is formed upon, 
or thrown out by, the lining membrane 
of the trachea and larynx. This formation, 
" false membrane" as it is named, resembles 
thin leather of an ash colour. It tak_es the 
form of the tube which it lines, and indeed is 
sometimes coughed up in perfectly tubular 
portions. More generally, however, when 
this false membrane forms, death is the 
result, from its clogging up the narrow 
chink of the larynx, and preventing the 
ingress of air to the lungs. Croup may 
begin very suddenly. A child goes to 
bed to all appearance perfectly well, and in 
the course of two or three hours comes a 
cough, which strikes even the most unob- 
servant as peculiar, which falling upon the 
ear of the anxious parent, who has ever 
heard it before, tells at once of danger. 
The child seems as if it coughed through 
a brazen tube. Perhaps at first the little 
invalid is not awakened, and if now visited, 
is found flushed and fevered, moaning 
slightly, perhaps, and restless, the breath- 
ing slightly quickened ; the cough comes 
again, the child awakes or is awakened ; if 
it speaks, the voice is hoarse ; if it cries, 
hoarser still. Should the disease be neglect- 
ed at ihis time, or go on uncontrolled, the 
cough, still retaining its peculiar character, 
becomes more frequent; the breathing quick- 
ened, is also accompanied by the character- 
istic dry wheezing occasioned by narrowing 
of the passage through which the air is 
drawn ; the head is thrown back in the 
efforts to breathe, respiration is insuffi- 
ciently performed, and the blood being 
insufficiently changed, begins to evince its 
deteriorated character in the blue colour 
of the lips, the dusky coldness of the skin, 
and the affection of the brain which gives 



rise to partial insensibility or delirium. 
The pulse, previously quick, becomes still 
quicker, but at the same time feebler, and 
at last the child dies in a state of almost 
unconscious suffocation. There may, how- 
ever, in the progress of the disease, be 
intervals of comparative ease, alternating 
with paroxysms of spasmodic obstruction 
to the breathing, threatening, and some- 
times causing immediate suffocation. The 
average duration of a fatal attack of croup 
is from three to four days, but it may, and 
does, terminate much more speedily. When 
under proper treatment the disease is 
checked, the first best sign is the cough 
beginning to "loosen," the breathing at 
the same time becoming tranquil, and the 
skin moist ; the pulse changes from its hard 
quick beat to one of a softer and a slower 
character. Croup does not, however, in- 
variably begin suddenly ; frequently the 
child has been suffering, apparently, from 
common cold in the head, and the attack of 
croup seems to be a consequence of the in- 
flammatory affection of the membrane of 
the nose and throat extending into the 
trachea, and taking on the peculiar charac- 
ter of the more fatal disease. At other 
times there has been slight drowsiness for 
some days previously, but not sufficiently 
well marked to attract attention, although 
at the same time, from hoarseness not being 
common among children, its occurrence 
should always rouse suspicion, especially 
if the child itself, or any of the family, have 
suffered from croup. Sometimes a child 
will have a croupy cough for some nights 
in succession before the attack of the real 
formed disease ; and parents are apt to be 
lulled into security by the fact, that in 
children susceptible of croup, any cough 
partakes more or less of the shrill croupy 
intonation. Another, and highly dangerous 
form of croup, is that in which the inflam- 
mation commences on the throat, the ton- 
sils and soft palate, and uvula, which 
quickly become covered with an ash-co- 
loured membrane. At first the child is 
supposed to be merely suffering from sore 
throat, for there may be little or no cough, 
or embarrassment of breathing, but the in- 
flammation extends downward into the air 
passages, and the croupy symptoms become 
developed ; by the time this stage is reached 
the case is all but hopeless. Fortunately 
this dreaded disease, the most distressing, 
perhaps, by which a parent can lose a 
child, is, in every form but the last, amen- 
able to proper remedies if adopted at once. 
So strikingly, indeed, is this the case, that it 
is very common to find parents taking the 



CEO 



160 



CKO 



matter in their own hands after they have 
seen a child treated for the disease once or 
twice, keeping, as they ought to do, a supply 
of the proper medicines constantly at hand, 
and by their prompt application, nipping 
the incipient attack in the bud ; the medical 
attendant is either not sent for, or if he is, 
it is only to find that the proper treatment 
has been followed and the disease checked. 
The remedy, in incipient croup, is tartar 
emetic given in tolerably full doses, either 
in the form of solution in water, or rubbed 
up with sugar, but never as antimonial 
wine. The form of a powder, one or two 
grains of sugar with the appropriate dose of 
the remedy, is the best form for keeping, as 
the solution decomposes and becomes inert, 
but the latter is perhaps the most quickly 
efficient form of administration. In a house 
which contains a child liable to croup, six 
or eight of the powders ought to be ready 
at all times, and also bran-bags. To a child 
of two years of age, the eighth of a grain is 
to be given at once, to one of four years the 
sixth ; and this dose to be repeated every 
ten minutes or quarter of an hour, till full 
free vomiting is produced. [A much safer 
and often more certain emetic is a drachm 
of powdered alum.] At the same time a 
warm bath may be got ready, into which the 
child is to be immersed for a quarter of an 
hour as soon as possible, or what will in the 
author's opinion answer equally well, large 
poultices of hot moist bran should be placed 
over the upper part of the chest and fore- 
part of the throat, while the child is kept in 
a sufficiently warm situation. In the habita- 
tions of the poor, especially, the latter mode 
of treatment is certainly preferable to the 
bath, which cannot always be procured with- 
out delay, nor managed without danger of 
after-chill. An hour after the vomiting, the 
dose of tartar emetic [or alum] is to be re- 
peated, and vomiting again excited, and its 
subsequent repetition at the end of one, two, 
three, or more hours, must depend upon the 
continuance and urgency of the symptoms ; 
the bran poultices being continued. The 
child may be allowed to drink freely of 
toast or barley water, or thin gruel, but not 
tea — which decomposes the tartar emetic — 
unless the infusion is extremely weak. If 
a case of incipient croup be thus treated, it 
will, in all probability, and may be subdued 
without medical assistance — though it is 
certainly safer to have it ; but if the fever 
is extremely high, and if the breathing has 
any approach to a crowing sound, medical 
attendance must be procured if possible, and 
with the shortest possible delay. If it can- 
not be procured, and if the attack does not 



seem to yield after the second or third dose 
of tartar emetic, leeches must be used — one, 
as a general rule, for each year of the child's 
life — not on the throat itself, but over the 
upper part of the breast-bone, in which situ- 
ation a blister must also be placed, if it be 
tried, as it may be, later in the disease. If, 
after tartar emetic has been used for four or 
five hours, the disease progresses, the fre- 
quency with which the remedy is given must 
now be diminished, and sickening doses 
given at longer intervals, otherwise there 
may be danger of depressing too much ; but 
calomel must be commenced with, and to a 
child of two years of age, a grain is to be 
administered every four hours. The strength, 
if it seems to fail, should be supported with 
weak animal broth — that made from veal or 
fowl is the most suitable — given in small 
quantity and at short intervals. Later in 
the disease, when weakness increases, the 
strength of the broth must be increased, the 
tartar emetic entirely stopped, and solution 
of acetate of ammonia given instead, a tea- 
spoonful every two or three hours to a child 
of three years old. Or if symptoms of sink- 
ing, cold or blue surface, and weak pulse, 
seem to demand it, five to ten drops of sal- 
volatile, or the same quantity of brandy, 
must be given in a little water, or the car- 
bonate of ammonia resorted to ; eight grains 
should be dissolved in an ounce and a half 
of water, and of this, two teaspoonfuls given 
during one hour. A little white-wine whey 
may also be given. Such must be the 
general outline of treatment to be pursued 
in a case of confirmed croup, should it fall 
to be treated without the presence of a medi- 
cal man. But again it is reiterated, the first 
twelve, nay the first eight hours, are the all- 
important period, which, if lost, can scarcely 
be recovered ; for, though children do recover 
when the disease has advanced into its second 
stage, and even sometimes from such despe- 
rate circumstances as to make it a duty 
never to despair of saving life, the chances 
are but small compared with those which 
the first few hours hold out, that period, 
which in some situations must elapse before 
medical assistance can be procured, and 
which thus places the life of the child in the 
hands of a parent or guardian. If it is 
croup, even if it is suspected to be, let there 
be no temporizing, but let the treatment 
now laid down be promptly, actively, un- 
sparingly carried out. If the antimonials act 
strongly on the bowels, they should be 
checked with one or two drops of laudanum. 
Bleeding from the arm is practised . by 
medical men in croup, but cannot be a safe 
proceeding for the unprofessional. In the 



CRO 



161 



CRO 



last stage, opening the windpipe holds out 
the last, and that but a faint hope of saving 
life. Of course a surgeon is required for 
its performance, if the parent consents to it. 

In that fatal form of croup which com- 
mences in the fauces, an unprofessional 
person can do but little with hope of suc- 
sess ; if discovered in time, medical aid 
should be procured. The local application 
of the solution of caustic to the whole sur- 
face within sight, and to the interior of the 
larynx, may be successful. If croupy 
symptoms have come on, one or two emetics 
of ipecacuanha may give relief; but the case 
is so desperate that it is a question whether, 
in the absence of a medical man, it is not 
better left entirely alone. If, however, the 
life of one child cannot be saved, the possi- 
bility of this form of the disease extending 
to the others of a family by contagion, 
should be known, and guarded against by 
timely and effectual separation. But should 
another child become affected, the disease 
being thus discovered at once, a solution of 
lunar caustic (nitrate of silver) should be 
made, in the proportion of twenty grains to 
the tablespoonful of rain-water, and the in- 
flamed throat thoroughly brushed over with 
it, with a hair pencil, and the process re- 
peated in eight or ten hours. If fever is 
present, small doses of tartar emetic, the 
twelfth of a grain, should be given every 
three or four hours to a child of six years 
of age, and two grains of calomel every 
eight hours, and an aperient given if 
required. These measures are to be fol- 
lowed out until medical assistance is pro- 
cured. 

The causes of croup are almost invariably 
connected with cold and moisture, and par- 
ticularly during east winds ; hence, on the 
east side of Britain the disease is con- 
sidered to be more prevalent than on the 
other ; but it may also be occasioned by 
the removal of wrappings from the throat, 
and exposure to a cool air when a child is 
heated. Children liable to croup are still 
more so after attacks of acute or debilitating 
disease. 

The prevention of croup is, of course, of 
the highest importance, and, therefore, the 
causes of it, just enumerated, must be 
avoided in every way. Slight colds should 
never be neglected in children or families 
predisposed, but should be treated by con- 
finement to the house, or to bed if requisite, 
by milk diet, diluent drinks, and by the 
tolu and mucilage cough mixture, with the 
addition of ipecacuanha wine ; paregoric 
should also be given to allay troublesome 
cough, and, in fact, those measures recom- 
o2 n 



mended in Cold carried out. The sus- 
ceptibility may also be lessened by not 
clothing the throat too warmly, and by the 
regular practice of bathing the throat and 
chest well with cold water every morning, 
rubbing afterward with a rough towel till 
thorough reaction ensues. This practice 
is, of course, better commenced in warm 
weather, and not too soon after an attack 
of the disease. Flannel should always be 
worn next the skin, and care taken particu- 
larly that bed-chambers, and rooms chil- 
dren habitually live in, are not too warm, and 
never occupied while the floors are wet 
after washing. A residence at a distance 
from water is to be preferred. 

Refer to Antimony — Children — Larynx — 
Trachea, §c. 

CROUP — Spasmodic, or Child-crowing 
— Is a species of convulsive or spasmodic 
affection of the muscles of the larynx, 
which, by narrowing and closing the chink 
in that organ, through which the air passes, 
occasions the sound of the breathing to re- 
semble that of the true inflammatory dis- 
ease. This spurious croup is often an 
alarming, and sometimes a fatal disease ; it 
generally occurs before the end of the third 
year of life, and in consequence of irrita- 
tions acting more or less at a distance from 
the affected larynx, which receives the im- 
pressions through its nerves. Enlargement 
of the glands of the neck, affections such 
as eruptions of the scalp, the irritation of 
teething more especially, or the presence of 
irritating matter in the bowels, may any of 
them give rise to the affection. It comes on 
suddenly, the child is seized in a moment 
with " catching at the breath," struggles, 
the face changes colour, and the veins are 
full. If the spasm be not relaxed, after a 
few ineffectual efforts at breathing, the child 
must die ; but if the spasm gives way, the 
air is drawn into the chest with a crowing, 
croupy sound. It is of much importance 
that this spasmodic disease should be dis- 
tinguished from xeal inflammatory croup, 
on account of the very different treatment 
required ; it may be known by the absence 
of fever, the stopping of the breath being 
much more instantaneous than that which 
occurs in the real disease. In an affection 
presenting symptoms so sudden and so 
alarming, immediate remedies must be used ; 
a little cold water should be dashed on the 
face at once, and, as recommended by Dr. 
Watson, a sponge dipped in hot water ap- 
plied to the forepart of the throat — medi- 
cal assistance being, of course, procured 
quickly. In this disease, a child, even when 
apparently dead, might be saved by open- 



CRU 



162 



ing the windpipe. After one of these at- 
tacks have occurred, the strictest examina- 
tion as to the probable cause should be in- 
stituted by a medical man. The gums 
lanced if requisite, the bowels cleared with 
a purgative, and the glands of the neck 
specially observed, and, if enlarged, the 
cause ascertained and removed. 

Refer to Convulsion — Glands, §c. 

CRUSTA-LACTEA.— An eruptive disease 
affecting the head and face. — See Skin, dis- 
eases of. 

CRY OF CHILDREN.— The principal 
distinctive difference in the cry of children 
is, whether it be that of expiration from, or 
inspiration into the lungs. The cry of a 
strong child, suffering pain, is more of the 
expiratory ; that of a weak, exhausted child, 
of the inspiratory or sobbing character. 

CRYSTAL LENS.— See Eye. 

CUBEBS, or Cubeb Pepper — Is the fruit 
of a climbing plant, a native of the islands 
of the Indian Ocean. It is used in affec- 
tions of the urinary organs. The dose from 
a half to a whole teaspoonful. 

CUCUMBER.— A pleasant article of diet 
for the strong, but a very unwholesome one 
for invalids. 

CUMIN — is the fruit of an umbelliferous 
plant, a native of Greece and Egypt. The 
seeds contain an aromatic volatile oil. Cu- 
min plaster is stimulant to the skin, and 
useful in cases in which very active excitant 
action is uncalled for. 

CUPPING — Is a process of blood-letting, 
by which blood is drawn from wounds made 
for the purpose, by the agency of suction, 
exerted by a cup or other vessel exhausted 
of air, or nearly so. It is a very old surgi- 
cal expedient, and in former times it was, 
and, indeed, among uncivilized nations at 
the present time, it is still effected by the 
primitive agency of a sharp flint or knife, 
and a cow's horn with the tip removed, suc- 
tion being made by the mouth of the opera- 
tor. In modern surgery, cupping, when well 
performed, is at once one of the most ele- 
gant and most useful of our methods of 
treatment. For the purpose of wounding 
the skin, a metallic box, containing a set 
of lancets, varying in number, is provided. 
In this box, (fig. xlv.,) which is called the 
scarificator, the lancets are so fixed as to 
be discharged, when set or cocked, by a 
trigger (1) and spring, which causes them 
to pass rapidly through the skin in a semi- 
circular sweep — so rapidly indeed, that the 
usual sensation of cutting is not felt. The 
most convenient number of lancets is twelve, 
and the depth of the wound made by them 
can be increased or diminished by turning 



CUP 



llx. sir. 




the screw, (2 ;) this must be done while 
they are fixed at half-cock, and protruding 
from the instrument. The only other es- 
sentials for cupping are a vessel from which 
the air can be exhausted, and kept so when 
it is applied to the skin, and flame of some 
kind, or some others means, for exhausting 
the air. There are, however, sundry other 
little requisites convenient for the operation, 
to be mentionod hereafter. 

Cupping is applicable in most instances 
where local abstraction of blood is called 
for, and may often be substituted for leeches, 
and even for general bleeding; it is a 
safe operation when used in proper situa- 
tions, and most may be taught its perform- 
ance by a few practical lessons. It is, more- 
over, a most useful accomplishment for per- 
sons who are far removed from medical as- 
sistance. It is hoped that the following de- 
tails may be sufficiently clear to enable even 
those who have never seen cupping perform- 
ed, to effect it in case of need ; but by all 
means let every one who contemplates -the 
possibility of such a requirement get prac- 
tical instruction, which there can be no 
difficulty in doing. 

Cupping-glasses of various kinds are and 
have been used, but the most general is the 
bell-shaped form, (fig.xlvi.,) of various sizes; 

Fig. xlvi. 




some of these are made with brass fittings 
at the top, for the attachment of an ex- 
hausting syringe. But the most useful form 
of all, and that most easily applicable by 
an unpractised or an unprofessional hand, is 
the leech cupping-glass, (fig. xlvii.,) which is 
the invention of Dr. Fox, of Derby. When 
this is used, the next instrument, the lamp 
or torch, (fig. xlviii.,) is not required as it is 
for the application of the bell-shaped glass ; 




163 



CUP 



this torch is simply a lamp made for burn- 
ing spirits of wine, by means of a wick 
which will afford a large flame. 



xlviii. 




Cupping maybe performed in most situa- 
tions on which it is possible to fix a glass, 
by a proficient; but the range of the un- 
professional operator must be much more 
limited, partly on the score of safety, but 
also for the reason, that in some situations 
they are not likely to draw blood sufficient 
to effect any good object. As a general 
definition, an unprofessional person may cup 
anywhere upon the back of the trunk of the 
body, from and including the nape of the 
neck, to the bottom of the spine, and also 
on the forepart of the chest. In selecting 
a place within the above limit it should 
always be ascertained that there is room for 
the rim of the glass to be in contact with 
the skin throughout its entire circle. It 
being pre-supposed that the abstraction of 
blood is called for, and it being also pre- 
supposed that the intending operator is pro- 
vided with the necessary instruments, he 
should also have some warm water, a good- 
sized piece of sponge, or, in lieu of it, a 
piece of flannel, a light, and some plaster. 

The person to be operated upon being 
conveniently placed, and the skin bared, it 
should be moistened with warm water, or 
the circulation of the part excited by means 
of hot water fomentation applied for some 
time ; an exhausted glass is then to be ap- 
plied for a few minutes ; removed, the scari- 



ficator placed upon the portion of skin 
which had been drawn up by the glass, and 
the lancets, which have been put on full 
cock, discharged. The scarificator being 
removed, the exhausted glass is again to be 
applied over the wounds made by the lan- 
cets, (fig.xlix.) The blood ought immediately 

Tig. xlix. 




to commence flowing. If the bell-shaped 
glass is used, when applied, one edge should 
be made to rest upon the skin, (fig. 1.,) the 



Fie. 1. 




flame of the spirit torch passed rapidly 
under it and withdrawn, and the glass at 
the same instant pressed entirely down 
upon the skin. This is the point of the opera- 
tion most difficult to perform well and effi- 
ciently by the unpractised, for if the ex- 
haustion is incomplete, suction, and conse- 
quently the abstraction of blood, are so 
likewise ; and in endeavouring to make the 
movements quickly, there is a liability of 
burning the skin. Fortunately, an indivi- 
dual can practise the manoeuvre upon the skin 
of his own thigh at any time. Much of this 
is avoided by the use of the leech cupping- 
glass, from which the air is exhausted by 
simply putting into it a small fragment of 
paper, half an inch square, dipped in spirits 
of wine, or spirit of some sort. A short 
piece of wire (fig. xlvii. 1) with a small "por- 
tion of tow tied to the end of it and dipped in 
the spirit, is used to ignite the paper in the 
glass, the latter being applied -to the skin 
the moment this is done, and the wire 
withdrawn ; the confined air extinguishes the 
lighted paper in the cupping-glass at once. 
In addition to simplicity in application, 
the leech-glass has also the advantage of 
taking at once a considerably larger quan- 
tity of blood than the other form, and thus 



CUP 



164 



CUE, 



of requiring to be less frequently reapplied; 
moreover, the blood, as it flows, gravitates 
to the bottom of the glass, and does not clot 
over the wounds, as it does with the bell- 
shaped instrument. These remarks do not 
refer to the quick, elegant, and efficient 
manipulation of a professed cupper, but as 
the operation must be in the hands of the 
unskilled. When an applied cupping-glass 
is to be removed, it must be done by press- 
ing down a portion of the skin at its edge 
with the point of the finger, so as to admit 
the air, which enters with a hiss. If, after 
a cupping-glass has been on some time, the 
blood does not flow freely, but clots upon 
the wounds, and it is desirable that more 
blood be drawn, the glass should be taken 
off, and — when the wounds have been 
cleansed with warm water — reapplied. When 
the operation is concluded, it is only neces- 
sary to cleanse the wounds, which will not 
continue to bleed in the situations indicated 
for cupping in this article, and to put a 
little adhesive plaster upon them, [or a 
greased rag will suffice.] 

Such is the operation, under the pre- 
supposition that the operator is provided 
with the requisite instruments; but in the 
absence of these, very good substitutes may 
often be made. To make the incisions, 
which should be about the eighth of an inch 
in depth, any sharp instrument will suffice ; 
for the cup, a tumbler, or wineglass, or any 
similar vessel with a uniform rim will do ; 
and to exhaust the air, whatever will blaze 
freely. In cases of poisoned wounds, the 
application of a cupping-glass, where it can 
be done, either with or without enlargement 
of the original wound, is a good precaution, 
and will retard the absorption of the poison, 
during the interval of procuring medical 
assistance. 

Dry cupping is a most useful remedy, 
perhaps too little used ; it is the application 
of the cupping-glass for from ten to twenty 
minutes, without any previous scarification. 
The blood is thus withdrawn from parts in 
the vicinity of that operated on, and relief 
afforded without weakening by actual ab- 
straction of blood. In local congestions of 
blood, in local pain, &c. it is often of much 
service. The principle of dry cupping has 
been brought forward as a remedial measure 
on a large scale by M. Junot, who, by means 
of vessels capable of being exhausted after 
the manner of a cupping-glass, and which 
are made sufficiently large to include a whole 
limb, thus draws temporarily a great mass 
of blood — from three to four pounds — out 
of the current of the general circulation, 
and produces the effect of a large bleeding, 



without its weakening results. The method 
is said to be successful, but it has not been 
much employed in this country. 

Cupping is certainly a most useful accom- 
plishment for the emigrant. It is a safe 
method, and, when once practised, an easy 
one of blood-letting ; but, by all means, let 
it be practically learned if possible, and 
then the above, though meant for all, will 
be more certainly useful in bringing back 
to the memory the minutiae which so aptly 
escape it. The chief inconveniences of the 
leech cupping-glass are its greater bulk and 
liability to fracture than, the bell-shaped 
form. 

CURD.— See Cheese. 

CURRANTS— The well-known fruit, either 
black, red, or white, are extremely whole- 
some, disagree with few, and are particu- 
larly well adapted, either fresh or cooked, 
to form part of the cooling diet requisite for 
health in very hot weather. Moreover, the 
mechanical action of their seeds has a most 
beneficial effect in exciting the bowels. 
Some bilious persons say they find benefit 
from eating a few ripe red currants a short 
time before breakfast, and that the practice 
tends to keep off the increased liability to 
bilious attacks during the hot weather, when 
currants are in season. 

The black currant possesses more astrin- 
gency than the other varieties, and when 
preserved, is much domestically used in 
sore throats, &c. ; it also acts upon the 
bowels. Boiling water poured upon a por- 
tion of currant preserve, and the infusion 
allowed to cool, forms one of the pleasantest 
and most useful of our fever beverages. 
Black currant leaves are used in infusion 
as a domestic diuretic. What usually goes 
by the name of the dried black currant is 
no currant at all, but a species of small 
grape. It is brought almost solely from the 
islands of the Levant. It is a favourite do- 
mestic aperient — particularly in the lying-in 
chamber — mixed with gruel. It probably 
acts mechanically. 

CURRY — Is food of any kind prepared 
with the well-known condiment curry-pow- 
der, which is composed of turmeric, cayenne, 
and black peppers, mustard, ginger, and 
other spices. 

The preparation is not adapted for inva- 
lids, and should only be used sparingly by 
those in health, especially if they have any 
tendency to irritation of the stomach and 
bowels, or to head affections. It is pro- 
bably better adapted, as regards wholesome- 
ness, to give requisite stimulating power to 
the rice and other foods of hot climates, 
than as an addition to an animal diet. 



165 



BAR 



CUT.— See Wounds. 

CUT-THROAT.— In this horrible casual- 
ty two dangers chiefly threaten life imme- 
diately : the one, death from immediate 
bleeding, if any of the large vessels of the 
neck have been divided ; or, if this has not 
been the case, death from blood finding its 
way into the windpipe. In the first, few 
unprofessional persons could possess on 
the instant either sufficient knowledge or 
presence of mind to render much efficient 
assistance — certainly not in the case of the 
large arteries ; but bleeding from a small 
branch might be arrested by the means 
suggested in article Artery. Should a su- 
perficial vein be wounded, and pouring out 
dark blood, gentle pressure in its course, 
between the wound and the head, might be 
of service. To prevent the danger of suffo- 
cation, when the windpipe is opened, and 
when the bleeding does not immediately 
threaten life, the position of the person is 
the principal thing to be attended to ; this 
should be either on the side or on the face, in 
whichever situation fluids may most easily 
run off without entering the tube. This 
being done, and some light gauze material 
thrown loosely over the wound, nothing 
more should be attempted before the arrival 
of that medical assistance which must as 
speedily as possible be procured. Above all 
things, no attempt should be made to close 
the wound. 

Refer to Artery — Hemorrhage — Wounds. 

CUTANEOUS.— Belonging to the skin. 

CUTICLE. — The epidermis or scarf skin. 
• — See Skin. 

CYNANCHE.— A term applied to affec- 
tions about the throat, which tend to pro- 
duce suffocation. 

CYST. — A membraneous-like bag, within 
the body, containing morbid matter. The 
matter varies much in consistence and 
appearance. Cysts frequently form just 
beneath the skin, and some persons are 
peculiarly liable to them. In aged people 
cysts often form, and are conspicuous upon 
the head. Cysts in superficial situations 
are generally quickly and easily removable 
by the surgeon. The upper eyelid is often 
the site of a small cyst. 

BALBY'S CARMINATIVE— Is a quack 
compound of carbonate of magnesia with va- 
rious essential oils. It also contains opium, 
and this fact alone ought to be sufficient to 
exclude it from use. Magnesia, carmina- 
tive distilled waters, and opium likewise, 
are all unquestionably, when properly em- 
ployed, useful even for infants ; but in the 
majority of cases, the latter drug is quite 
uncalled for, and when it is necessary, its 



administration requires the utmost care and 
circumspection of the medical man. It can- 
not, therefore, be a matter of indifference 
whether a medicine sold and kept for gene- 
ral use contains so powerful an ingredient 
as opium, or whether, when a simple mix- 
ture of magnesia, or chalk and dill water 
will answer every purpose, a medicine — 
that is, opium — is given, which cannot fail 
to act injuriously, unless positively indi- 
cated by the peculiar circumstances of the 
case. A dose of "Balby" will undoubtedly 
"still" a child, perhaps more quickly than 
a simpler or more cautiously combined pre- 
paration ; but its very power of action in 
this respect indicates its power likewise of 
inflicting evil consequences. If a carmina- 
tive simply is required, a simple carminative 
should be given in some such mode as that 
recommended in the article Children. If 
opium is called for, let it be given — under 
medical sanction — as opium, in known and 
graduated doses ; but it is criminal folly to 
use it in the indefinite hap-hazard way in 
which such productions as the one in ques- 
tion are used. " According to Br. Paris, 
there are five drops of the tincture of 
opium to two ounces of this mixture ; but 
in another formula it is stated that this 
tincture forms one eighteenth part of the 
liquid. Like most of these quack prepara- 
tions, it probably varies in strength. An 
infant is reported to have been destroyed 
by forty drops of this preparation — a quan- 
tity equivalent to little more than two drops 
of the tincture of opium." — Taylor's Juris- 
prudence. 

The possibility of any preparation intended 
for children containing a variable propor- 
tion of opium, ought to be sufficient to deter 
those who have the care of the young from 
hazarding either the lives of the latter, or 
their own peace of mind, by its administra- 
tion. Moreover, it is impossible, habitually, 
to give opium, even in small doses, to chil- 
dren without injury, even if fatal conse- 
quences do not result. 

Refer to Opium — Quack Medicines, §~c. 

BARNEL GRASS— Is a species of rye- 
grass, the seed of which has a beard or awn, 
like barley, and which, unlike the grasses 
generally, is poisonous. It is more common 
on the continent than in England, and the 
seeds are occasionally so abundantly mingled 
with those of barley, or other grain, as to 
cause symptoms of poisoning in those con- 
suming articles of food made from the meal 
— a point of some consequence, now that so 
much continental grain and meal is con- 
sumed in this country. When chewed, meal 
containing darnel grass causes a burning 



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DAN 



sensation in the throat, and giddiness, head- 
ache, and lethargy follow. An emetic would 
probably be the best remedy. 

DAMP. — 'Moisture is one of the most 
prolific and most generally acknowledged 
sources of disease ; in whatever way applied 
to the body, whether in the atmosphere, or 
clothing, or bed, it is alike apt to be pro- 
ductive of bad consequences, often of the 
most serious character. "When combined 
with decaying vegetable matter, and more 
especially when favoured by heat, fever and 
ague are the results of undue moisture ; 
when cold and damp unite their depressing 
influences, colds of every kind, inflamma- 
tory attacks, scrofula and consumption, 
rheumatism and neuralgia ensue. 

Dampness, or injurious excess of mois- 
ture, may depend upon the natural forma- 
tion of the country, or character of the soil, 
or upon a superabundant growth of timber, 
which obstructs the drying effect of the 
sun's rays and of a free circulation of air. 
The effects of these conditions are evidenced 
by the agues of the marsh districts, the cre- 
tinism of the low, dark, damp valleys of 
the Alps, the fevers of the tropical forests 
and African rivers, or in a lesser degree 
by the relaxing effect of a damp and some- 
what mild climate, like that of Devonshire. 
The advance of the improvements of civil- 
ization does much, if it cannot do all, to 
rectify these sources of disease. The cut- 
ting of watercourses, the clearing of timber, 
are for the most part attended with increas- 
ed salubrity of the district. The latter, of 
course, requires circumspection ; for much 
harm may be and has been done by the in- 
judicious removal of protecting belts of 
trees ; neither must it be forgot, as mention- 
ed in article Ague, that the intervention of 
a wood may prevent the extension of the 
malaria of a marsh. But the shelter of trees 
is a different thing from closely encircling a 
house with them ; they will retain moisture 
around, more or less according to the nature 
of the soil and the denseness of their growth, 
and in a way which is not compatible with 
health. 

Dampness and moisture in excess cannot 
of course be prevented, when owing to the 
vicinity of large bodies of water ; but in such 
a case the chief evils to be dreaded are the 
cold winds which " come off the water" 
laden with vapour, and which, as happens 
in many situations, are liable to produce 
croup in children and catarrhal affections 
in the predisposed. If these influences 
cannot be guarded against, of course re- 
moval is the only remedy. 

Damp houses must be unwholesome; if 



occupied too soon after building; disease, 
especially of a rheumatic character, is the 
frequent consequence. Most generally, in- 
sufficient drainage, particularly in the coun- 
try, is the cause of dampness, and it is, 
moreover, after a house has been built, one 
difficult to rectify, but it should be done as 
far as possible ; even houses which appa- 
rently stand high are damp* from this cause, 
especially if the ground slopes to, as well 
as from them. If no other remedy is avail- 
able, nothing is so effectual as covering the 
damp floor with sheet lead, which effec- 
tually excludes the moisture, if it does not 
do away with the cause. 

Damp clothes and beds are so generally 
recognised as causes of disease, that the 
fact scarcely requires to be insisted on or 
indeed the additional one, that when the 
former are unavoidable, the danger is much 
if not wholly done away with by continued 
active motion, which keeps up the animal 
temperature ; and it is probable that this 
preventive not being available in the case 
of the latter, renders a damp bed almost 
synonymous with disease and death. 

Damp in most instances acts, undoubt- 
edly, by abstracting, either by evaporation 
or otherwise, the natural temperature of the 
body ; but as dry cold does this likewise 
without producing the same certain injuri- 
ous consequences, it is probable that mois- 
ture also calls into action changes connect- 
ed with the electrical conditions of the 
body, of the precise nature of which we 
are not at present cognizant. One thing is 
certain, that moisture is always more apt 
to act injuriously upon the system when the 
nervous power is either depressed or not 
in its full state of activity, as it is during 
sleep, or for the first hour or more in the 
morning, after rising, and before food of 
some kind has been taken ; hence it is 
always found that fogs and moisture are 
much more likely to injure during the first 
morning period, and that the best protec- 
tion is some warm food or drink, [not alco- 
holic,] which may support or gently stimu- 
late the system. 

Refer to Ague — Neuralgia — Rheumatism — 
Scrofula. 

DAMSON — The well-known fruit, is 
wholesome when ripe ; but for invalids 
should be cooked. It is slightly aperient. 

DANDELION, on Leontodon Taraxa- 
cum. — The plant, native to this country, is 
too universally known to require descrip- 
tion. Its leaves, when blanched, are used 
as a salad in some parts of the continent, 
and the root is sometimes roasted and mixed 
with coffee. As a medical agent, taraxacum 



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is too much neglected. It is found by 
every hedge side, and is one of the most cer- 
tain and active diuretics we possess, whether 
native or foreign. Perhaps no better proof 
of its utility can be cited than that the author 
always finds patients who have once taken 
the medicine, recurring to it again and again 
of their own accord. No doubt something 
is due — and it is a consideration of some 
weight to the fact — that it is procura- 
ble without expense. It rarely fails to in- 
crease very considerably the flow of urine. 
Various preparations, extracts, &c. of dan- 
delion are recommended and are employed, 
and are undoubtedly efficient, but the fresh 
infusion of the recent root is the best mode 
of administration. For this, roots of not 
less than the thickness of the little finger 
should, if possible, be used, and after being 
washed from the soil, sliced transversely in 
pieces a quarter of an inch thick. Of these, 
a good double handful, or from two ounces 
and a half to three ounces, are to be put into 
a jug, a pint of boiling water poured upon 
them, and the whole allowed to "draw" for 
an hour or two beside the fire, but not boiled. 
The infusion will have a greenish-brown 
colour, and two or three cupfuls should be 
taken during the day, until the desired 
effect is produced. The taste is not very 
unpleasant, is slightly bitter, and to some 
mawkish, but may be improved by the ad- 
dition of a little orange-peel. In addition to 
its action in increasing the flow of urine, 
dandelion improves the tone of the diges- 
tive organs, and most certainly exerts a 
stimulant action upon the liver. Indeed, it 
is in disorder of the digestive organs accom- 
panied with deficient action of the kidneys, 
the urine being scanty, high coloured, and 
depositing a pink sediment, that dandelion 
exhibits its most beneficial influence. It may 
be advantageously combined with broom, 
as a diuretic, and of course with other medi- 
cines, such as the tincture of columbo, with 
potassa, &c. 

Refer to Broom — Liver — Kidneys. 

DANCING— Properly so-called, is the ac- 
tive exertion of the body in sprightly, 
graceful movement, accompanied with ex- 
hilaration of mind, and, when thus indulged 
in by the young, is a most beneficial and 
healthful recreation. It is no argument 
against dancing in itself, that it is too often 
connected with many things that are injuri- 
ous, such as heated rooms, late hours, and 
the like — these belong to other considera- 
tions ; but as an exercise, congenial both to 
the minds and the physical requirements of 
the young, it is, as every exercise of the body 
in which the mind enters with pleasure and 



interest, a most efficient promoter of health, 
and it is much to be regretted that its abuse 
and associations, in some instances, both 
with physical and moral evil, should cause 
its abandonment in any place where there 
are young people. 

DANDRIFF — Is the formation and sepa- 
ration of numerous thin white scales, or 
scurf, from the skin, and is most usual upon 
the scalp ; but in persons of delicate skin, 
occurs also upon the face. In infancy it is 
very common upon the head, and among the 
poor there is a prejudice against its re- 
moval, "for fear of cold," so that it is 
allowed to accumulate along with the dirt, 
and presents a most filthy appearance. 
Generally, the skin underneath, the seat 
of dandriff, is not much changed, but some- 
times it becomes reddened and slightly 
irritable. 

In adults, the disease, if it can be called 
so, is troublesome, from the quantity of 
scales, or scurf, which mingle with the hair 
and shake from it upon the clothes. 

In any case, care should be taken to avoid 
irritating the skin; the hair-brushes should 
be soft, and the small-tooth comb — at all 
times a doubtful substitute for thorough 
washing — must never be used. 

In the case of infants, washing regularly 
with soap and water, and the use of some 
simple pomatum, or of an ointment com- 
posed of ten grains of red oxyde of mer- 
cury to the ounce of lard, will remove the 
inconvenience ; and either in their case, or 
in that of adults, an alkaline wash will be 
found useful. Mr. Erasmus Wilson re- 
commends two drachms of solution of caus- 
tic potash to eight ounces of soft or rose- 
water. [A drachm of borax in four ounces 
of water, with a few drops of oil of berga- 
mot, is also a cleansing wash for the head 
afflicted with dandriff.] 

DANGER.— See Death. 

DATE.— The fruit of the date-palm con- 
stitutes a considerable portion of the food 
of the people of Egypt and Northern Afri- 
ca, Arabia, and Persia. The nutritive ma- 
terial is chiefly sugar. As imported into 
this country, dates are not a digestible arti- 
cle of diet. 

DATURA STRAMONIUM.— See Thorn 
Apple. 

DEADLY NIGHTSHADE.— See Bella- 
donna. 

DEAFNESS— Or deficiency in the sense 
of hearing, may be either partial or com- 
plete, and it may be accompanied with 
dumbness. The causes of deafness may 
be temporary or permanent, and the affec- 
tion may be due to disorder of the brain 



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and nervous system, to disease and dis- 
organization of the essential portions of 
the organ of the hearing itself, or to causes 
which interfere with the transmission of 
sound. 

The temporary causes of deafness may be 
such as have their origin in temporary dis- 
order of the brain, resulting from external 
violence, or from disorder either local or 
general, more particularly some forms of 
fever, of which deafness is a frequent con- 
comitant. Some drugs, quinine particu- 
larly, given in too large doses, also give rise 
to the affection. 

Temporary deafness is frequently occa- 
sioned by common cold, which seems to 
cause tumefaction of the membranes lining 
the passage of the external ear; or when 
the throat is affected, obstruction of the 
Eustachian tube, which extends between the 
internal ear and the throat, either by swell- 
ing or accumulated mucus. These causes 
often continue in action, and keep up the 
deafness, long after the cold has disappeared. 
[Infants whose heads are left without caps 
in cold weather are very liable to suffer 
in this manner; and many cases of "run- 
ning from the ears" are also due to the same 
cause.] 

Permanent deafness may result from dis- 
ease of the brain, such as paralysis, or from 
violence, such as severe blows or falls upon 
the head. The author has one patient, a 
gentleman afflicted with permanent partial 
deafness, the result of a dangerous fall 
when hunting, the effect upon the brain 
being evidenced by the fact that his pulse, 
which formerly ranged at 72, has never 
since exceeded, in health, which is perfect, 
40 in the minute. Disease of the ear itself, 
or its effects, can scarcely fail to cause deaf- 
ness. The internal portions of the ear are 
liable to a variety of. disorders or diseases 
which it would be useless and out of place 
to notice in this work. Many of these take 
their origin during attacks of acute disease 
— particularly measles or scarlet fever — in 
scrofulous individuals. Discharges occur 
from the ears, and the minute bones con- 
tained in the cavity are sometimes discharged. 
To allow of this, of course, the membrane of 
the tympanum or drum of the ear must 
be wholly or partially destroyed. This im- 
portant membrane -of the ear being dis- 
eased, is often the occasion of deafness. As 
mentioned above, the obstructions, either 
in the outer ear passage, or in the Eus- 
tachian tube, first arising from common 
cold, may become permanent ; in the case 
of the latter, when the swelling subsides, 
thick mucus may block it up ; in that of the 



former, hardened wax, or cerumen. Thi3 
last mentioned cause of deafness is very fre- 
quent, is easily discoverable, and no less 
easily removed, affording most striking relief 
to an almost total defect of hearing. It is 
perhaps the only affection of the organ 
causing deafness which is likely to be well 
or safely treated domestically. — See article 
Cerumen. 

The subject of deafness, and of diseases of 
the ear generally, has been greatly neglected 
by medical men, and consequently has fallen 
into the hands of quack aurists. Within the 
last few years, however, it has been taken 
up by more than one distinguished member 
of the profession, and promises fair to take 
the place its importance demands, and to 
have its causes and treatment investigated 
and established on a true, scientific, and 
rational basis. 

A person affected with temporary deaf- 
ness, if it is traceable to an assignable 
cause, such as cold, should wait the effect 
of time for its alleviation. A blister ap- 
plied behind the affected ear, or, better still, 
an eruption brought out just below the ear, 
by tartar emetic or croton-oil, may pro- 
bably give some relief. If wax be suspected 
or ascertained to have accumulated, it should 
be removed, as directed under article Ceru- 
men, but never by ear-picks or such like 
dangerous weapons. When no assignable 
cause for the deafness, whether permanent 
or temporary, can be discovered, a medical 
man should be consulted — if he has given 
special educated attention to aural surgery, 
so much the better — but unqualified quacks 
with nostrums and never-failing cures must 
be shunned. No one, surely, can be so cre- 
dulous as to believe that any application, or 
variety of applications, put into the outer 
ear — and strong stimulants are often used 
in this way — can be remedial for a symptom 
owing to causes so varied. Some varieties 
of deafness are alleviated by appliances to 
the external ear-passage, and some remark- 
able cases have been published of great im- 
provement in hearing resulting from small 
pellets of cotton wool, or other substances, 
moistened and introduced so far into the ear 
as to be in contact with the tympanum mem- 
brane, which had been perforated by disease. 
For moistening these, and indeed for moist- 
ening the passage of the external ear, when 
too dry, — an occasional cause of deafness, — 
or for moistening hardened wax previous to 
syringing, the fluid named glycerine is better 
adapted than the oil generally in use. Va- 
rious other modes of treating deafness, with 
reference to its various causes, have been 
and are employed. Its dependence upon 



DEA 



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DEA 



obstruction of the Eustachian tubes has ori- 
ginated the practice of passing an instru- 
ment, or Eustachian catheter, np these pas- 
sages, for the purpose of clearing them. 
The operation is one which requires both 
practice and tact for its safe and efficient 
performance. Some years ago the same 
thing -was attempted by forcing air into these 
tubes by an instrument made for the pur- 
pose ; but a fatal accident seems to have 
interfered with the continuance of the prac- 
tice. Lately, the pressure exerted upon the 
membranes of ears by the diving-bell has 
been brought forward as a cure for deafness. 
These and other practices and propositions 
may be good, or the reverse ; but one thing 
is certain, either these or any other reme- 
dies, except the one or two simple ones 
mentioned above, should never be resorted 
to without proper medical sanction and 
management. When deafness is confirmed, 
and cure cannot be obtained, relief must be 
sought in the various artificial methods — 
ear-cornets, and the like — for collecting and 
conveying to the ear as large a body of 
sound as possible. The remarkable power 
of gutta-percha in the conveyance of sound 
has afforded many facilities for adding com- 
fort to the deaf, and improving their means 
of hearing ; and many instruments for the 
purpose are manufactured by the Gutta- 
percha Company. It seems probable, how- 
ever, from the investigations of Dr. Allen 
Thomson, that while attention is given to 
concentrate and convey sound in cases of 
deafness through the usual ear-passages, its 
communication through the bones or hard 
parts of the head is too much overlooked. Dr. 
Thomson's investigations were founded upon 
the fact, "that sounds transmitted by contact 
of the sounding body directly to the head or 
other hard parts, appear louder when the 
external meatus — or ear-passage — is closed." 
The same authority further remarks, " I am 
inclined to think that much more might 
be done than has yet been attempted, in a 
certain proportion of such cases, by assist- 
ing the hearing through the hard parts of 
the head, or by other means. Indeed, it 
seems surprising, considering how long it 
has been known that in some deaf persons 
the hearing of sounds is improved by pro- 
moting their transmission through the bones 
of the head, that an apparatus calculated 
to facilitate this mode of communication of 
the sonorous vibrations has not been em- 
ployed instead of the ear-trumpet, which 
can be of comparatively little service to 
them." Further, "In those hearing best 
through the hard parts of the head, it has 
long been known that the air passages, or 
P 



accessary parts of the organ, principally 
are affected. In those partially deaf per- 
sons, on the other hand, who hear best by 
the meatus, it appears very probable that 
in general an affection of the internal ear, 
or loss of sensibility of the auditory nerve, 
is the cause of deafness. In these last 
the ear-trumpet is of essential service, by 
concentrating all the weaker vibrations in 
the passage which is to carry them to the 
nerve, whose sensations are deadened. In 
the former the meatus should be closed, and 
every means ought to be used, as by sound- 
ing-boards, to collect, and solid elastic rods 
to conduct the vibrations to the hard parts 
of the head." 

With respect to the deaf and dumb, or 
" deaf-mutes," as they are now' called, 
whatever the cause, whether congenital 
deficiency, or complete deafness brought on 
by disease or accident before the power of 
speech had been thoroughly acquired, the 
education should be conducted in an es- 
tablishment for the purpose. It cannot 
be done at home, but much may be done 
by the philanthropic and earnest endea- 
vours which have devised, and are now 
daily devising, new methods for imparting 
to these unfortunate individuals the bless- 
ings of knowledge. It has probably been 
an error in the education of the deaf-mutes 
hitherto, that they have been brought up 
in establishments by themselves — a plan, 
it would seem, less likely to fit them for 
mingling usefully with the world in general 
in after-life, than commingling them with 
children who have the power of speech. 
In Donaldson's hospital for the education 
of poor children, recently opened in the 
neighbourhood of Edinburgh, an endeavour 
is now being made to correct this error, and 
a considerable number of deaf and dumb 
children are being brought up with the 
others, being of course taught in a different 
manner. It seems unquestionable that this 
commingling must have a beneficial influ- 
ence, not only on the unfortunates them- 
selves, but also upon the others, teaching 
them to regard their deaf-mute playmates 
with familiar kindness, instead of the dis- 
tant dislike or ridicule, which are too apt to 
be attached to, or openly displayed toward, 
the persons and manners of those who pre- 
sent any unusual defects, either of mind or 
body, by children more happily constituted. 

Dr. Allen Thomson further remarks — 
"Dumbness is known usually to proceed 
from deafness, either existing from birth, 
or arising early in life. The exceptions to 
this are very rare, and occur only from de- 
fective formations of the organs of voice and 



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speech, or from disease of the brain. In 
the case of dumbness arising from total 
congenital deafness, sounds can never be 
associated with ideas, and consequently 
feelings, emotions, actions, and the names 
of objects or description of their qualities 
and states, must find a language in natural 
gesture, or in conventional written and 
manual signs. In the second case, that, 
viz., of total deafness coming on later in 
life, even if speech shall already have been 
acquired, it may be gradually lost, in con- 
sequence of the want of habit to associate 
sounds with speech. This occurs, however, 
only in early life, when the habit of speech 
has not been fully impressed on the memory. 
I am informed by Mr. Kinniburgh* that it 
rarely happens that dumbness is entailed 
by deafness so late as the tenth or eleventh 
year, and that the extent to which this may 
occur will depend very much on the cir- 
cumstances in which the individual is placed. 
In those who become only partially deaf, 
but to such an extent as to incur the risk of 
becoming also mutes, it seems probable that 
much of the power of retaining voice and 
speech, or of regaining it, may depend on a 
very small difference in the amount of hear- 
ing ; and I am inclined to think that much 
more might be done than has yet been at- 
tempted, in a certain proportion of such 
cases, by assisting the hearing through the 
hard parts of the head, or by other means." 

Refer to Ear — Glycerine, §c. 

DEATH.— The departure of the animat- 
ing spirit from the material body, the 
separation of the living soul from the 
frame so "fearfully and wonderfully made," 
which is no longer fitted to be its habita- 
tion or medium of communication with earth 
and earthly things, is a subject which few 
can approach without awe and fear — none 
without interest, though it may be of a 
solemn kind, as the one event from which 
no child of Adam is exempt. The possibi- 
lity or the probability of illness having a 
fatal termination, devolves a great respon- 
sibility, and much anxiety upon the mind of 
a medical man, as regards the patient more 
particularly. There is the preparation of 
the mind for the great change to be con- 
sidered ; the settlement of worldly affairs 
on which may depend the future welfare of 
others to be thought of; but there is also 
the effect of the announcement, nay, of the 
slightest hint of danger, upon some indi- 
viduals, to be duly pondered, lest the mental 
shock may put the finishing stroke to what 



* The late superintendent of the Deaf and Dumb 
Asylum in Edinburgh. 



disease has begun, and extinguish the last 
faint chance of recovery. None but those 
who have had to bear it know the weight of 
anxious thought that such considerations 
press upon a conscientious mind. It is a 
position for which no stated rule can be 
framed, and in which the judgment must 
be guided by the many contingencies and 
considerations which surround every case of 
the kind. It may be requisite on the first 
symptoms of danger occurring in some dis- 
eases, particularly in those likely to affect 
the powers of the mind, to make the an- 
nouncement early ; in others it may be de- 
layed for some time after the physician has 
decided in his own mind that the case can 
have none but a fatal issue, till, indeed, the 
idea, without being actually imparted, has 
gradually dawned upon, or been gently 
awakened in the mind of the patient, and 
has by degrees ripened into conviction. 

The question of encouraging hope of re- 
covery depends upon considerations similar 
to those which influence the announcement 
of necessary death. Many of these rest upon 
religious grounds, which it would be out of 
place to touch upon here ; but in a medical 
point of view, the tonic influence of this 
powerful emotion of the human heart must 
never be forgotten. With some, the hopes 
of a blissful future may be so strong that 
they overpower all wishes connected with 
this world : but these are, it must be said, 
exceptional cases ; the love of life is strong, 
the majority hope to get well. This hope is 
as it were an anchor and cable, linking them 
with the life and activity of earth : destroy 
it, and they sink at once ; the emotion is a 
sustaining tonic which no remedy can sup- 
ply. It is for this reason that the office of 
announcing the possibility or probability of 
death should not be devolved upon the medi- 
cal attendant, except in certain cases. 
Coming from him, it takes too much the 
form of a final sentence. There are, it is 
true, various ways of breaking the subject; 
but softened down as it may be, it comes 
with a depressing force which it has not 
when friends or ministers breathe the pos- 
sibility of such an occurrence. To the 
poor, and even to those who might know 
better, an important caution is required. 
Too frequently it happens that while a 
medical man is examining his patient, or 
still within hearing, questions relative to 
the patient's state are put, whether " there 
is any danger ?" whether the person will 
"get better?" and other interrogatories, 
which he can scarcely either answer or re- 
fuse to reply to, without conveying to the 
patient information he may not wish to 



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communicate. Every medical man must 
have felt himself at times thus unfairly 
embarrassed. 

The symptoms of approaching death must 
of course be liable to great variation, de- 
pending upon the cause of the fatal event, 
and the peculiar constitution and tempera- 
ment of the patient. 

Sudden death is usually considered to be 
that which occurs without immediate pre- 
vious warning ; for there are few cases in 
which some indications have not been de- 
veloped of the disorder of the organ, or 
structure, which at last gives way and snaps 
the thread, unless, of course, life has been 
quickly destroyed by some external acci- 
dental agency. 

Dr. Alison says, " All causes of sudden 
or violent death operate either by directly 
depressing or suspending the vital actions 
of the organs of circulation, or by obstruct- 
ing the arterialization of the blood, and 
thence arresting the circulation at the 
lungs." The action of the organs of circu- 
lation, that is, of the heart and blood-ves- 
sels, may be fatally depressed by a sudden 
shock communicated to the brain and 
nervous system, and death quickly pro- 
duced, as in the case of severe blows, ex- 
tensive burns, and the like : or the depres- 
sion may be caused by abstraction of the 
blood itself by hemorrhage. In such cases, 
death is the result of faintness. The arte- 
rialization of the blood may be fatally in- 
terfered with, and speedy death ensue, from 
injuries to the nervous'system, which inter- 
fere with the process of respiration, or by 
causes which impede directly the access of 
air to the lungs, causing asphyxia or suffo- 
cation, death being the result of the influ- 
ence of the unchanged, or it might be 
called poisonous, blood upon the brain. 
Nearly all cases of death are, indeed, refer- 
able to the above direct causes ; but many 
cases of sudden death are most obviously so. 
Neither is death always owing to one or 
other of these causes distinctly acting by 
itself, for they may be variously commingled. 
The premonitions of approaching dissolu- 
tion are often strongly marked. Independ- 
ent of these authenticated cases, in which 
the mind has been powerfully impressed 
with the conviction of impending death, in- 
dependent of, or not directly connected with 
physical causes, there are others which come 
under the notice of the physician ; such are 
strange and sudden impulses of the mind, 
longing after familiar friends or scenes 
suddenly acquiring unusual force, to be in- 
dulged in before the eyes are sealed to the 
things of this world. As the closing scene 



draws near, most appear conscious of the 
coming change ; but some hope on to the 
last, and cherish the idea of a return to 
earthly joys and sorrows and business, till 
the latest breath is drawn. 

"When death is slow in its approaches, the 
physical signs, though varying, preserve a 
measure of uniformity, which in most cases 
too plainly points out the coming event. 
They are thus well described in a recently 
published work.* "When the evidences of 
dissolution, however, begin to manifest them- 
selves, a general failure of the temperature, 
with a cold dew on the skin, may generally 
be considered as indicative that the scene is 
about to close. In many cases it is easy to 
recognise the fatal turn which diseases take 
by the alteration which the symptoms un- 
dergo. Where internal inflammations are 
about to issue in death, there is mostly a 
striking change in the expression of the 
face, and sometimes a curious shrinking of 
the body." 

" The nose and lips are very character- 
istic in the dying. The lips become pale, 
the nostrils dilated and dark-looking, and 
the hairs about the lips seem more than 
usually apparent ; the teeth look like pieces 
of ordinary bone, and the eyes seem to 
shadow through the eyelids, or are partially 
turned under the lids ; the nails look dark, 
and the ends of the fingers sodden. Finally, 
convulsive twitchings often show themselves 
in the face, with singular elevations of the 
eyebrows, and staring of the eyes. A gap- 
ing attempt to breathe terminates the strug- 
gle. W f hen coma is present, a mucous rattle 
is of fatal import ; and I contrario, when the 
lungs are affected, the supervention of coma 
is equally to be dreaded. 

"When fluids taken by the patient flow- 
back from his mouth, or fall heavily down 
his throat, as if poured into an ordinary 
tube, death is soon to be expected. 

" In young children a curious playing with 
the bed-clothes often attends fatal affections 
of the brain. I remember a little child, 
who had her handkerchief in her hand, 
which she spread out repeatedly with appa- 
rent care, and in a fantastic manner that 
would have been amusing, but for its fatal 
import. The picking of bed-clothes, and 
catching of the hands as if at imaginary 
objects, are well known as terrible indica- 
tions. 

" Chomel remarks, as of serious presage, 
the automatic manner in which a patient 
will unceasingly draw his hand to his side, 

* "Medical Aspects of Death," by J. Bower Har- 



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in spite of the efforts of the physician to 
ascertain his pulse. 

"The signs of death are not, however, 
always very marked ; for when death arises 
in advanced and feeble age, the vital powers 
are so easily depressed, and the heart's 
action brought to a stand in so impercep- 
tible a manner, that it is common to speak 
of it as a quiet sleep." 

These signs of approaching dissolution are 
terrible and distressing to witness in those 
we have loved ; and though, undoubtedly, 
existence is sometimes terminated in a pa- 
roxysmal agony of pain, there is reason to 
believe that in slowly approaching death, 
such as has been described, the sensations 
are much blunted in consequence of the 
insufficient change of the blood. 

The symptoms which indicate that death 
has actually taken place are, in the majority 
of instances, perhaps too unequivocal to be 
mistaken; but sometimes it is not so, and 
there is a difficulty in determining whether 
life actually has departed, even hours after 
any appreciable sign of conscious existence 
has been given. The signs of death may be 
divided into those which precede putrefac- 
tion, and the occurrence of that unequivocal 
evidence itself. Some, indeed, have con- 
tended that it alone should be received as 
evidence of death ; but there are obviously 
many circumstances under which it is im- 
possible to await its occurrence, nor is it 
necessary to do so. 

The absence of apparent respiration is a 
generally received symptom of death, and 
a looking-glass, or light feather or down, 
placed before the lips, are used as tests. 
Mr. Harrison, whose work has been already 
quoted, says both are fallacious, and in- 
stances the circumstance represented by 
Shakspeare, of Prince Henry having been 
deceived when he carried off the crown from 
his father's pillow. 

" By his gates of breath 
There lies a downy feather which stirs not; 
Did he suspire, that light and weightless down 
Perchance must move." 

The light down may be stirred by any 
passing current, or the mirror may be dim- 
med by some exhalation from the body, and 
either prove deceptive. 

Mr. Harrison further observes, "If the 
observance of the- respiration be taken as 
the indication of life, and its absence as a 
proof of death, the exposure of the naked 
chest and abdomen would enable the spec- 
tator to form a much more accurate appre- 
ciation of it, especially if it be made care- 
fully and for a sufficient length of time." 

Stiffening or rigidity is another generally 



received sign of death, but it may not occur 
at all, or very transiently. A false rigidity 
may be present immediately after dissolu- 
tion, in consequence of death from some 
nervous affection. It was formerly thought 
that persons killed by lightning did not 
become rigid, but the examination of re- 
cent cases has proved this to be erroneous. 
"The rigidity of death appears to come on 
with various degrees of rapidity, an,d its 
duration is also various. It usually com- 
mences in about seven hours, but it may 
be deferred considerably longer, even from 
twenty to thirty hours. When the body is 
greatly weakened by disease, the rigidity 
comes on much sooner, but is much more 
evanescent. It has been known to arise in 
fifteen or twenty minutes. Its duration 
varies from twenty-four to thirty-six hours, 
but may continue many days. In some 
nervous diseases affecting the living body, 
rigidity occurs, but scarcely in a way to 
deceive. When the limbs have become 
rigid, and the rigidity has been succeeded 
by flexibility, the fact of death having oc- 
curred can never be doubted." Professor 
Louis, from observations made upon more 
than five hundred subjects after death, 
found that the articulations began to be- 
come stiff even before the loss of animal 
heat. Fodere, another authority, has veri- 
fied the justness of this observation several 
times in hospitals, and concludes that the 
flexibility of the limbs is one of the prin- 
cipal signs by which we may judge that a 
person is not dead, although there is no 
other sign of lffe. 

The cooling of the body after death 
depends much upon contingencies ; the co- 
vering, the surrounding temperature, the 
presence of much fat, &c. all exert a modi- 
fying effect. In cases where much blood 
has been lost the body is observed to become 
cold rapidly. 

The occurrence of discolorations on va- 
rious parts of the body, particularly the 
most dependent portions, are frequent se- 
quents to death, and the darkening of 
that portion of the white of the eye which 
is exposed to light, has also been pointed 
out as a symptom to be depended upon, 
and along with it, dilatation of the pupil. 
The above symptoms, singly, might not per- 
haps convince of the occurrence of death ; 
but more or less combined, they cannot be 
doubted. Putrefaction commencing of course 
does away with all doubt. 

It may seem to some that it is unneces- 
sary to dwell so minutely upon the evi- 
dences of the last great change ; but it is 
a subject on which many entertain great 



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anxiety, and from the fact that a considerable 
number of ascertained cases have occurred, 
in which mistakes have been made with 
respect to death, it is desirable that accu- 
rate information upon the subject should 
be generally diffused. It ought to be re- 
membered that the corpse of a person who 
has died of a contagious disorder, particu- 
larly the eruptive fevers, may propagate 
the disease. The influence of season in 
causing death is well marked. "According 
to Quetelet's tables of mortality in Belgium, 
the greatest number of deaths among indi- 
viduals above twenty-five takes place in 
February, and the smallest number in July. 
Other researches, as regards Berlin, show 
that the greatest number of children die in 
summer and the fewest in winter, while with 
adults the case is exactly reversed. It has 
also been observed that more deaths on the 
average occur between six a. m. and noon, 
than at any corresponding period in the 
twenty-four hours. 

Lastly, one word as to the treatment of 
the dying. Let quiet, attention to every sign, 
the moistening of the lips, the gently shifted 
position, be the attentions ; but who can tell 
how painful the disturbance of the forced 
stimulant or medicine, the noisy lamenta- 
tion, or the pulling about or pulling away 
of pillows which nurses are apt to practise, 
may be to the last moments ? 

In persons found dead, or apparently so, 
the first thing is of course to ascertain the 
real state of the case. If death is doubtful, 
judging by the signs 'stated in the early 
part of this article, the first object must 
be to ascertain, if possible, the cause of the 
condition which so nearly approaches to it: 
this must be the first step, but it must be 
taken with all possible speed, in order that 
proper measures for resuscitation may be 
adopted. The causes may either be natural 
or violent. Of the former, apoplexy, sudden 
fainting, or suffocation from internal affec- 
tions, may be in operation ; of the latter, 
suffocation from unnatural causes, poison, 
wounds, burns, cold, starvation, lightning, 
include the most probable influences. Some 
of these, such as burns, wounds, the action 
of lightning, cold, and many of the usual 
modes of suffocation, such as hanging, 
drowning, &c. are too evident, either in 
themselves or from concomitant circum- 
stances, to be overlooked ; but others, par- 
ticularly those cases of apparent death 
resulting from natural causes, from some 
forms of suffocation, and from poisons, 
are almost beyond the power of the un- 
professional to investigate. For the mode 
of distinguishing, and for the subsequent 
p2 



treatment, the reader is referred to the 
articles devoted to these subjects. It is 
repeated, when a person is found apparently 
dead, do not let the fact be assumed without 
investigation, [do not wait for the coroner ;] 
the spark of life may yet linger in its earthly 
tenement, may yet be not past recall, beyond 
which the loss of even a short time, or the 
total abandonment of care, may quickly place 
it. If there is the faintest hope that life is 
i not quite gone, while the causes of the mis- 
j hap are investigated, means, such as are 
| recommended under the peculiar circuni- 
I stances, should be at once adopted, and 
| vigorously — no half measures will turn the 
I scale between life and death. These things 
I are peculiarly important, for often it can 
only be a fortunate chance that places a 
medical man on the spot where cases such 
as the above have occurred. Of course, 
where it is possible, medical assistance 
ought to be as quickly procured as may be, 
but time may or must necessarily elapse, 
and while it slips by, life slips away, which 
might be preserved by the knowledge pos- 
sessed by some intelligent bystander, which 
might lead him to think that there was 
still hope — often too readily given up by 
the crowd — and lead him to direct the adop- 
tion of rational and really efficient measures, 
instead of the useless, or worse than useless, 
treatment followed, where there is no infor- 
mation to guide or head to direct. 

When persons are found who are undoubt- 
edly dead, there yet remains something to 
be done, for the cause may be natural or 
unnatural, and in the latter case the ends 
of justice may either be forwarded or re- 
tarded by those who first discover the body. 
The exact position should be noted. The 
stiffening or not of the limbs. The presence 
or absence of warmth about the chest or 
abdomen particularly. The state of the 
clothes. Whether there are signs of vomited 
or other matters discharged from the body. 
Wounds noticed, and the state of the blood 
upon them, whether fresh, coagulated but 
yet soft, or hardened. And, indeed, what- 
ever the circumstances connected with the 
finding of the body can suggest to the intel- 
ligent mind, should be ivritten down. On the 
arrival of the judicial and medical authori- 
ties, there are other matters of course to be 
investigated, which only they can undertake ; 
but as most of those above mentioned are 
evanescent, the persons first on the spot can 
best, or only, testify to them, and facts, which 
may appear trivial to note at the moment, 
may, in criminal cases, be the turning point 
on which conviction hinges. — Refer to Apo- 
plexy — To causes of unexpected death generally. 



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DEBILITY, or Weakness— Is a falling off 
from the usual power of the individual to 
perform those exertions, -whether of duty 
or pleasure, in -which he has habitually en- 
gaged, and which, judging from the consti- 
tution, mode of life, &c. he might naturally 
be expected to perform. 

Illness and debility may also be said to 
be synonymous, for it is difficult to imagine 
the former unaccompanied or not followed 
by weakness, except in the few exception- 
al instances in which apparent debility, 
caused by the presence of morbid matter in 
the blood, is relieved by the disorder which 
carries off the cause of the depression. 
Such is seen to be the case in mild attacks 
of bilious diarrhoea, which do not go far 
enough to affect the general strength, and 
which are immediately followed by relief to 
the feelings of languor and weakness which 
preceded them; indeed, unwonted discharges 
of any kind, whether in the urine, or from 
the skin, or even of blood in small quantity, 
if they do not go too far, are often followed 
by feelings of strength rather than of de- 
bility. In these cases, however, the debility 
was apparent, not real ; that of oppression, 
rather than of depression. To these and 
similar sources, then, may be referred 
all those causes of apparent debility, or in 
other words, of languor or torpor, which 
arise from impurity of the blood, conse- 
quent upon the retention of noxious matters 
in that fluid, which are from some cause un- 
removed, as they ought to be, by the agency 
either of lungs, liver, kidneys, bowels, or 
skin, or which have been absorbed into the 
vital fluid from without. 

It may be said that these are not cases of 
debility at all, and perhaps by medical men, 
understanding and strictly investigating 
their causes, they would not be considered 
so; nevertheless they give rise to an appear- 
ance of weakness, of which the unprofes- 
sional only can judge ; and under these cir- 
cumstances, it is requisite plainly to point 
out the distinction, which is of no light im- 
portance, in the modes of treatment and 
management usually resorted to. A per- 
son from some cause or other gets his blood 
loaded with morbid matter ; either he has 
indulged in too full living, animal diet, and 
alcoholic drinks especially, or he has ne- 
glected to take exercise, or to keep the skin 
in active operation ; or the lungs, liver, 
kidneys, or bowels are oppressed or inac- 
tive ; he has, in fact more or less poisonous 
matter circulating throughout his frame, — 
he feels low, both in body and mind, languid 
and listless, thinks himself weak, and takes, 
perhaps, a little extra animal food, a little 



more wine or malt liquor, to correct the 
(supposed) debility. The consequence must 
be a fit of illness of some kind, " a bilious 
attack;" a fit of gout or gravel, of piles or 
of some cutaneous eruption, which the sys- 
tem makes a safety valve ; or it may be that 
apoplexy or some other congestive disease 
is induced. It is surely superfluous to say 
more respecting the serious tendency of 
such an error as that which mistakes false 
debility for real, and induces the individual, 
instead of seeking strength by the reduc- 
tion and alteration of his diet, and by the 
regulation of the excreting functions of the 
body, either by general or medicinal means, 
to rush to the other extreme, and, in the 
endeavour to get rid of the disorder, to add 
to the cause of it. Of course real debility 
may co-exist with apparent, the result of 
impure blood ; such happens in acute or 
exhausting affections of the liver, lungs, 
&c. &c. and the case assumes a complicated 
and highly dangerous character. 

As apparent debility is referred to im- 
purity of blood, so the cause of real debility 
must be looked for, in many cases, in its 
deterioration or deficiency. The vital fluid, 
which is the medium for supporting our 
animal temperature, and for supplying plas- 
tic elements to the ever-wearing textures of 
the body, may be deficient in all or any of 
the elements required for these purposes, or 
it may itself have been drained away by 
hemorrhage. The first office of the blood, 
the maintenance of animal heat, is so essen- 
tial, that it seems arranged by the Author 
and supporter of our life, that to carry on 
this, the soft constituents of the body may 
be sacrificed almost to the extreme limit ; 
but this very circumstance must be a cause 
of debility during illness, when, to obtain 
fuel as it were, muscular substance is con- 
sumed away, while muscular motion is un- 
exercised. Again, whatever plastic elements 
the blood may be deficient in, the organs 
to which those elements should be supplied 
become debilitated. This is most striking- 
ly exemplified in the case of the bones in 
childhood, where food is deficient, which 
become soft — rickety — for want of the due 
supply of earthy matter; still more gene- 
rally is it exemplified, in those cases so 
often quoted, of animals fed, or rather 
starved, upon certain kinds of food, such as 
arrow-root, white sugar, bread made of 
fine flour, &c. &c, which, however whole- 
some as articles of diet in themselves, do 
not contain plastic elements for the build- 
ing up or sustaining the bodily tissues in 
strength and healthy active operation ; to 
deficiency, therefore, of the blood, as regards 



DEB 



175 



DEB 



those elements required in the unceasing 
operations of the living frame, must we look 
for the most generally operating and palpa- 
ble cause of debility. But this cause is 
itself only an effect of other causes. If the 
blood is to nourish well, it must be well 
nourished itself. The supplies it is ever 
yielding to the system must be rendered to 
it from without ; the food must not only be 
in quantity and quality sufficient to pre- 
serve the balance of nutrient materials in 
the blood, but it must be properly digested, 
properly fitted for its commixture with the 
vital fluid ; if either food or digestion be defi- 
cient, more or less debility must result. 

Many causes, of course, may operate to 
diminish or totally prevent the supplies 
of food taken. Febrile disease of any kind, 
accident, disorders of the digestive organs, 
and numberless others do this; and so certain 
as they do — except, to be sure, where a 
little wholesome starvation is required — so 
certain does debility follow ; for although 
food may neither be taken nor digested, the 
bodily requirements, heat, movement, and 
even the power of thought, must be kept 
going, and if the materials are not furnish- 
ed from without, they will be taken from 
within — the body preys upon itself, or lives, 
as it were, upon its capital — and it is need- 
less to say that debility must result. The 
body, in such a case, might well be com- 
pared to a steamship at sea, run short of 
coal, the inner wood-work of which, even 
at the risk of weakening the hull, is neces- 
sarily broken up to supply the engine and 
enable the vessel to reach the harbour of 
safety. So the body, suffering under acute 
disease, and unsupplied with food, must 
make use of that which constitutes its in- 
ternal structure, although it may be fear- 
fully weakened, or perhaps destroyed, by 
the process. The supply of proper nutri- 
ment, and its presence in the blood, are so 
intimately connected, that they may be re- 
garded as one and the great source of real 
strength. Without good blood, neither 
muscle, nerve, nor any other constituent of 
the body can be in its best state of healthy 
efficiency. Of course, deficiency of the 
circulating fluid caused either by loss from 
hemorrhage, or any other drain which ab- 
stracts all or part of its constituents, must 
act as a cause of debility equally with those 
previously mentioned. 

Again, the blood may be adequate to ful- 
fil all that is required of it, but some organ 
fails ; it seems to lose its power of appro- 
priating to itself elements fitted for its 
nutrition, although brought to it in the 
circulation, even in sufficient proportion to 



maintain moderate healthy action ; cr the 
individual organ may be overtasked and 
debilitated, its tissues used up more rapidly 
than they can be repaired, or its nervous 
power exhausted. Here we have another 
source of strength or weakness, real or 
apparent, the nervous power, the agent 
through which movement is communicated. 
The action of the nervous system, as regards 
strength or debility, must be looked at in 
connection with its healthy or its morbid 
operation ; in other words, its strength con- 
sists in the amount of exertion it is capable 
of stimulating and maintaining, either gene- 
rally or partially, without subsequent ex- 
haustion. This limitation is requisite, for 
were it not drawn, it would make the ex- 
citement of the nervous system the measure 
of strength — it would make the transitory 
exertions of enormous power exhibited at 
times by patients in the last stages of real 
debility, from fever, or the almost resistless 
struggles of the delicate hysterical girl, 
tests of real strength, instead of paroxysms 
of morbid excitement, which terminate in 
the most exhausting, or it may be, fatal de- 
bility and collapse. 

In the healthy constitution, and sufficient 
nutriment of the organic constitution of the 
body, and of the nervous system, lies the 
true element of strength, or the real seat of 
weakness. To use a simile, the machine 
must be strong in all its parts, and its 
moving power adequate to its require- 
ments, to constitute real, well-balanced 
strength. 

When the central organ of the nervous 
system, the brain itself, becomes debili- 
tated, the condition may be manifested by 
partial or general affections of the body, or 
by disorders of the mind. The brain may 
be debilitated or exhausted by the excessive 
stimulation of alcohol, opium, and other 
agents which act upon it peculiarly, also by 
sensual excesses, over-nursing, and the like ; 
but perhaps the most frequent source of a 
weakened brain in this country is undue 
exertion of it as the agent of the mind ; 
it is tasked till it gives way — is used up. 
This is not a figurative expression — it is the 
actual truth that the substance of the 
brain is actually consumed by the process 
of intense thought, the amount of consump- 
tion, probably, being in proportion to the 
exertion the mind is put to. In persons of 
irritable and nervous temperament it is not 
uncommon to find deposites of phosphatio 
salts in the urine after the mind has been 
strained ; and we can only look to the nerv- 
ous system and brain as the most probable 
source of the additional excretion of phos- 



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176 



DEB 



phorus. The subject is undoubtedly an 
obscure one at present, but it is deserving 
of notice, from bringing directly and sen- 
sibly to the mind, and in a physical point of 
view, the possible and probable manner in 
•which this wonderful agent of man's intel- 
lect may be and is exhausted. 

Having then seen that debility may 
either be apparent or real, and that in the 
latter case it may depend upon deficient 
nutriment or deficient healthy supply of 
nervous power, it remains to consider the 
causes which most generally tend to bring 
about these conditions. 

Debility has been divided into original 
and acquired. The former is witnessed in 
the children of parents whose constitutions 
have been weakened by any cause, such as 
dissipation, advanced life, &c. &c. and also 
in the children of scrofulous families. The 
latter, or acquired debility, may of course 
be caused by whatever lowers the standard 
of health. As already mentioned, insuf- 
ficient nourishment is one great source of 
debility ; likewise the absence of the usual 
stimuli of solar heat and light, deficiency of 
fresh air and exercise, and of stimulation to 
the mind by a proper amount of healthy 
active exertion. Again, there is the de- 
bility produced by the direct action of 
injurious agents, a continued damp climate, 
either warm or cold, poisons gradually 
absorbed in necessary employment, or acci- 
dentally but continually taken into the sys- 
tem, and such like ; and also by depressing 
passions of the mind, such as anxiety, fear, 
&c. &c. 

Lastly, there is debility, the result of 
direct abstracting and exhausting influ- 
ences. Any habitual loss of blood, or drain 
or discharge of any kind, over-nursing, or 
sexual excesses. One especial cause of debi- 
lity requires notice : it is that occasioned in 
young children or people who sleep with 
the aged ; for the fact is an undoubted one, 
that the practice has an extremely debili- 
tating effect upon the former. It is one 
which should never be followed or permitted. 
The withdrawal of accustomed excitements 
often occasions debility of an alarming 
and even fatal character. The debilitated 
drunkard or the opium-eater cannot without 
danger be deprived of his usual stimulant ; 
and even the man who has lived in the 
most perfect moderation cannot always, 
without danger of inducing great debility, 
leave off an accustomed stimulus. It is 
not said that in many instances this may 
not be done with impunity, or even benefit, 
but there are cases in which it is hazard- 
ous. The effect is not manifested, perhaps, 



for a considerable time — it may be weeks or 
months — but it is manifested some time ; and 
the author has met with some cases of 
extreme depression and general weakness, 
traceable to no other cause than an unad- 
vised and rigid adherence to the strict rule 
of teetotalism. It matters not what the 
long-accustomed stimulant may have been, 
whether of alcohol, of fresh air, or of mental 
exertion, it cannot be withdrawn without 
danger of inducing weakness. 

In the treatment of debility, whether 
simple, or complicated with disease, it mast 
be obvious to all that it must be adopted 
with due reference to the cause. This 
must, if in continuance, be removed or 
rectified as quickly as it may be. If the 
mischief, as occurs in original debility, or 
in that produced by causes which have 
ceased to operate, cannot be prevented, of 
course nothing remains but to build up or 
restore strength by nourishment, tonic medi- 
cines, change of air and scene, especially to 
the seaside when that is practicable. In 
every case, however, of marked debilit} r , the 
medical man should be consulted ; he only 
is likely to detect with certainty the cause 
or causes, and to direct the adoption of 
appropriate remedies. 

It may seem that too much space has been 
devoted to this subject, but it is one which 
is so erroneously regarded by the public 
in general, particularly by the lower classes, 
that it is a matter of importance that more 
correct views should be imparted, and that 
there should be a more enlightened under- 
standing of the subject, of the principles by 
which debility is to be judged and treated. 
The case of apparent debility was disposed 
of in the first portion of this article. 

In the weakness which accompanies fever 
and acute inflammatory attacks, nothing is at 
times more difficult than to convince people 
not only of the utter uselessness, but of the 
injuriousness, of administering any food but 
that of the mildest and most unstimulating 
character, such as the appetite alone desires, 
if it desires it at all ; and notwithstanding 
nature herself points instinctively to the 
proper course, they will persist in the idea 
that if the person "would eat, he would be 
better." Undoubtedly if he would and 
could eat and digest the food taken, he 
would be better, for he must be better be- 
forehand to do so. But the popular idea is, 
that if food can be got into the stomach, 
it must give strength ; and foolish friends 
foster the same impression in the mind of 
the invalid, till he forces himself to take 
food ; and many a promising case is thrown 
back in this way, although the medical 



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attendant is never informed of it, and can only 
guess at the cause. Fortunately, nature 
often resents the error, and vomiting relieves 
the stomach of its injurious load; if not, 
fever, headache, &c. and relapse are the too 
frequent consequences. 

It is repeated, in the treatment of debility, 
•whatever may be the cause> if still in ope- 
ration, that must be rectified ; but the -weak- 
ness itself is only to be repaired by a suffi- 
ciently ample supply and circulation of 
healthy blood. The latter must be pro- 
cured by every means which tend to enrich 
and purify the vital fluid. Good food 
well digested, air, exercise, and the use 
of all accessories to health, assisted when 
suitable by such regular and regulated ex- 
ercise of the debilitated parts themselves 
as will increase the circulation of blood 
through them, without exhausting either 
their constituent tissues or nervous power ; 
but it is useless, and worse than useless, to 
load a stomach which cannot digest it, with 
food and drink, in the vain hope of giving 
strength, as people too often do, or wish to 
do, in cases of febrile or other disease. To 
resume the simile of the steamer, although 
the seasoned wood-work within may be 
broken up to feed the engine and to carry 
the vessel safely into port, it would be no 
slight hinderance, and no small aggravation 
of her danger, were she to be loaded with 
water-logged or green wood, which would 
not burn when it was wanted. So it is with 
the body in fever : the, already prepared and 
digested components stored up in its tis- 
sues, though not perhaps accumulated for 
the special purpose, will yet answer well to 
keep its works in movement; but crude 
food is like the green, wet wood, useless for 
good, and fitted only to overload and retard. 
"When increase of nourishment is called for 
in cases of debility, care must always be 
taken to adapt it to the condition of the 
digestive organs ; these are generally weak- 
ened, and while the food given contains much 
nutriment, it should be as easily soluble in 
the stomach as possible. For information 
on this head, however, the reader is referred 
to the articles on Digestion, Food, &c. 

Refer to Animal Heat — Bilious Cholera — 
Blood — Fever — Nerves, $c. 

DECAY — Or the gradual giving way of 
the physical powers in old age, may almost 
be considered as a part of the preceding 
article. After the sixtieth year in men, and 
somewhat earlier in women, as a general 
rule, the period of old age or of decay com- 
mences. The descent has begun impercep- 
tibly perhaps at first, but it is progressive. 
There may be no positive disease, but the 



circulatory powers fail, the arteries lose 
their elasticity and tone ; and in this, per- 
haps, lies one great cause of the decay of the 
body generally — the deficient circulation of 
blood; the brain, the muscles, the whole body 
becomes smaller, and shrinks, and if there 
is no disease, the powers of material life are 
gradually extinguished, a few degrees' fall in 
the thermometer may be all that is required 
to put out the flickering flame. For the 
management of this stage of life the reader 
ir referred to the article on Old Age. 

DECIDUA, or Deciduous Membranes — 
Are those which line the uterus during 
pregnancy, and which are cast off shortly 
after the birth of the child. 

DECLINE.— See Consumption. 

DECOCTION— Literally, means a prepa- 
ration .which has been boiled ; but in medi- 
cine, by the term is understood that which 
has been boiled for a certain length of time 
for the purpose of extracting matters from 
crude materials, which cannot otherwise be 
obtained. Moreover, when improperly em- 
ployed as a process, it drives off volatile 
matters which ought to be retained. The 
most useful decoctions used in medicine 
are — 

Compound decoction of aloes. 

Decoction of cinchona-bark. 

Decoction of oak-bark. 

Decoction of sarsaparilla. 

Decoction of senega-root. 

Decoction of elm-bark. 

Decoction of poppy. 
The preparations of gruel, barley, flaxseed, 
&c. &c. are also clas-sed with the decoctions. 

There are many other medicinal decoc- 
tions, but they either do not require men- 
tion in this work, or the preparation, as in 
the case of dandelion, broom, &c. is better 
made as an infusion. For information re- 
specting those mentioned, the reader is re- 
ferred to the respective articles. 

DECOMPOSITION— Is the separation of 
the component principles or elements of 
compound bodies from each other, the pro- 
cess being either naturally or artificially 
excited. — See Antiseptics — Fermentation — Pu- 
trefaction. 

DEFORMITY— Means "any and every 
deviation from the recognised symmetrical 
proportions of the human frame; but the 
word is more definitively applied to those 
irregularities of form which consist in a 
partial deviation from the natural position 
of the body, unaccompanied by malforma- 
tion of the general original structure. It 
is probable that to a conviction on the part 
of the profession that club-feet are actual 
malformations, we are to ascribe the unac- 



12 



DEF 



178 



DEE 



countable fact of this species of distortion 
having almost to the present day been left 
without rational or truly scientific attempts 
made to remedy it." Deformities are either 
congenital — that is, dating from birth — or 
acquired. With respect to the causes of 
congenital deformities, "some are at present 
inclined to attribute them to a mental im- 
pression, generally a sudden one, received 
by the mother during pregnancy — but it 
oftentimes happens that the mother can as- 
sign no cause ; in other cases the deformity 
appears hereditary." "In non-congenital 
cases, teething, worms, and irritation of the 
spinal chord are frequent causes. Certain 
occupations, such as much standing, or car- 
rying heavy loads ; position also may be 
regarded as a cause, especially in lateral 
curvature of the spine ; but occasionally we 
are at a loss to discover any cause, the 
deformity coming on insensibly, while the 
patient is apparently in perfect health." 
These cases, if attended to at their com- 
mencement, might certainly be relieved and 
prevented ; but it often unfortunately hap- 
pens that there is little interference with 
the general health. The deformity, as in the 
foot for instance, coming on insidiously, no 
attention is paid to the circumstance; a 
weakness, as it is termed, of the ankle is felt, 
and the foot deviates occasionally from its 
natural position ; and thus, if the case be 
neglected, the foundation is laid for a per- 
manent deformity, or at all events a perma- 
nent weakness of one or both limbs, which 
may involve their being disabled for life. 

The most simple form of distortion is the 
horse-foot, which consists of complete ele- 
vation of the heel, so that the patient in 
walking rests entirely on the toes, (fig. li.) 

Fig. li. 




Mr. Tamplin, the experienced surgeon to 
the Royal Orthopaedic Hospital, from whose 
work the substance of this article is taken, 
says that he has never met with this kind of 



deformity as a congenital one, but it is a con- 
sequence of disorder of the system, and more 
especially of nervous irritation, such as that 
caused by teething, worms, &c. It may 
also be occasioned by wounds or local irri- 
tations, such as ulcers, affecting the calf of 
the leg, or " it may arise spontaneously, the 
patient experiencing no pain or inconve- 
nience beyond the inability to bend the foot 
or ankle-joint in the act of walking, and 
retaining at the same time power over all 
the muscles." When weakness of the liga- 
ments of the ankle-joint is conjoined with 
the above deformity, in the course of time 
the foot is liable to become so much dis- 
torted that the person at length comes to 
rest on its outer edge in walking. 

Another deformity of the foot, that in 
which it is simply bent inward, may date 
from birth, and frequently does ; but it may 
also be induced by various causes of irrita- 
tion affecting the nervous system. The 
flat or splay foot, although it may be a con- 
genital formation, is also liable to be caused, 
where previous debility exists, by the carry- 
ing of heavy loads, and other things which 
necessitate much pressure upon the arch of 
the foot. " The first thing which attracts 
the attention of the patient to this deformity 
in its incipient state, is a sense of weakness, 
more especially on the outer side of the 
ankle-joint;" they then observe the flat 
appearance of the sole of the foot, and the 
tendency of the inner ankle to approach the 
ground in walking. As the deformity in- 
creases, the pain in the joint and the sense 
of weakness increase to such an extent that 
the patient becomes totally unable to follow 
his ordinary occupation. 

It would be a superfluous waste of time 
and space here to enter further into a con- 
sideration of the various deviations from 
the natural formation to which the limbs 
are liable : suffice it that whether the infant 
is born with these deformities, or whether 
it becomes the subject of them as life ad- 
vances, they cannot too soon be submitted to 
medical management. Modern surgery has 
demonstrated that they are remediable so far 
that all striking deformity can be removed, 
and that an otherwise almost useless member 
can be adapted to perform its natural offices, 
if not with grace, at least with comfort. 
The great improvement in the treatment of 
these defects consists in division of the 
tendons which occasion the distortion. This 
practice Mr. Tamplin strongly recommends 
as the preferable one, whether " for in- 
fants at the earliest age, or late in life," 
for the following reasons: — "First, from 
the facility with which it is accomplished ; 



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179 



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secondly, because it incurs comparatively 
no risk, and scarcely any inconvenience; 
thirdly, because you at once overcome the 
principal resistance, and render the after- 
treatment painless to the patient, and com- 
paratively easy to the attendant. Independ- 
ently of this the child is not subjected 
to such constant confinement of the limb as 
is absolutely necessary when you do not 
have recourse to an operation ; you can 
allow exercise to be taken for a certain time 
during the day — and that, even in infants, 
must have a most beneficial effect." 

The above remarks of perhaps the most 
experienced surgeon in this kingdom in the 
treatment of distortions, have been brought 
forward in the hope that parents and 
others having the care of children may not, 
knowing the general causes of non-congeni- 
tal deformity, neglect the first warning 
symptoms of its insidious approach ; and in 
the case of children born with distortions, 
may place them at the earliest possible pe- 
riod under efficient surgical management, 
and not be deterred by the fear of an ope- 
ration, which, in proper hands, is perfectly 
safe, comparatively painless, and unattended 
with loss of blood. 

Deformity occurs from the softened con- 
dition of the bones, in the disease of child- 
hood named rickets, and also from soften- 
ing of the bones in adults, but these cases 
are the effect of distinct and well-marked 
diseases. — See Rickets — Softening of Bones, ^c. 

Deformities and contractions of the shoul- 
der and elbow-joint are very generally the 
result of injury or disease. The wrist-joint 
and the joints of the fingers are also liable 
to distortion from the same cause. In some 
cases the contraction is seated in the skin ; 
in others the joints are deformed and per- 
haps displaced by rheumatic disease. De- 
formity of the fingers may also be congeni- 
tal. Such cases should be put at once 
under the management of the surgeon. 

Refer to Neck — Rickets — Spine, $c. 

DELIRIUM — Is a temporary disordered 
condition of the mental faculties, occurring 
during illness, either of a febrile or of an 
exhausting character. It is generally a 
symptom of serious import, but not always. 
Many children, and some adults, become 
partially delirious, or "wandering," from 
very slight causes — even a simple feverish 
cold being sufficient to produce the effect. 
In such cases, of course, judgment must be 
formed with some reservation. In fever, 
and febrile diseases generally, delirium may 
be no more than slight confusion of ideas 
on waking from sleep, or it may amount to 
furious and dangerous excitement, or merge 



in low muttering, or terminate in confirmed 
coma or stupor. 

Delirium may be the effect of disordered 
or inflammatory action affecting the brain 
itself, or it may be sympathetic with active 
disease in other parts of the body, such as 
the heart ; it may be caused by long-con- 
tinued and exhausting pain, and by a state 
of inanition of the nervous system. In the 
treatment and alleviation of the symptom, 
it is of the highest importance that it should 
be ascertained to which of the above con- 
ditions it is owing ; and from this circum- 
stance, any attempt to remedy it by the un- 
professional (who must be liable to error 
on this head) cannot but be attended with 
some risk. It may, however, at times, be 
requisite even to run this risk for the 
chance of doing good, and then the follow- 
ing directions may serve as some guide. 

When delirium occurs in a person of full 
habit of body, accompanied with inflamma- 
tory fever, with quick strong pulse, blood- 
shot eye, and flushed countenance, abstrac- 
tion of blood in the first instance, either 
from the arm, by leeches, or by cupping, 
cannot fail to be of service. Along with 
bleeding, free purging with calomel, com- 
bined with compound colocynth pill, with 
jalap or scammony, or followed by senna 
and Epsom salts, should be resorted to ; the 
head should be shaved and kept cool with 
the coldest applications to be procured, the 
feet should be kept warm, the room dark- 
ened, and every source of excitement re- 
moved. If there is violent effort and unruly 
conduct, the limbs must be restrained firmly, 
but gently, whenever attempts to exercise 
them in an improper manner are made. In 
this case a broad belt passed loosely over 
the bed, and fastened at each side, so as to 
confine only when any attempt at rising is 
made, is of considerable assistance. In 
this form of delirium, it is of the most es- 
sential import that watch should be kept 
without one moment's interval, night and 
day. There must be no risk run of sleepy 
attendants, and there must be sufficient 
physical power to restrain the almost super- 
human, though transient, efforts made by 
delirious patients. Some of the most pain- 
fully distressing accidents of illness have 
occurred in consequence of neglect of these 
precautions. One unguarded moment, one 
five minutes' sleep, have neutralized days 
and nights of anxious care and watching. 
In the brief interval of remitted surveillance, 
the patient has escaped from bed, from 
room, even from house, by the usual modes 
of egress, or has dashed madly through the 
first window in his way, or laid hold of the 



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180 



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first means of self-destruction. The force 
of the excitement, it is true, is generally 
soon over, but it lasts long enough for se- 
rious or fatal mischief. No apparent quiet 
for some time is to be trusted ; unceasing 
care must be exercised till intelligence 
returns. 

The low form of delirium is differently- 
characterized. The mental disturbance is 
equally complete, but wants the violence of 
the inflammatory form. Generally the per- 
son lies in a dreamy state of incoherent 
thought ; but even in this form, occasional 
fits of excitement, and attempts to get out 
of bed, and the like, occur, and must be 
guarded against. It is this form of delirium 
which generally becomes developed in the 
progress of typhus and typhoid fever. The 
head is hot, but it is not the fierce heat of 
the inflammatory attack, the vessels do not 
throb in the same manner, and the eyes are 
not bloodshot, the pulse is feebler and more 
easily extinguished, the tongue and the 
hands are tremulous, the former when pro- 
truded, and the latter are perhaps affected 
with convulsive startings. When these 
symptoms are at all marked, there can be 
but little doubt as to the nature of the 
case. To take away blood now, is to kill. 
The head should be shaved and kept cool, 
the bowels moderately but sufficiently open- 
ed, and the warmth of the feet attended to, 
perfect quiet being observed around the 
patient. In such a condition, particularly 
if there is tendency to nervous or convulsive 
twitching of the fingers or of the tendons at the 
wrist, opium may certainly be given with 
benefit — the best form is Battley's sedative 
solution ; the dose for an adult, fifteen drops 
in the evening, five drops additional being 
given every two hours till sleep is procured, 
or till thirty drops have been administered 
in all; or the mwiate of morphia may be 
given, in half or quarter grain doses, in the 
same manner ; or in the absence of these, 
any other preparation of opium in corre- 
sponding quantity. Sleep is the only remedy 
for the irritation and irritable exhaustion 
of the nervous system which is attended 
with this form of delirium, and opium alone 
is to be trusted to for procuring the soft 
restorer. Strong meat-soups and wine may 
also be requisite, but the consideration 
of these matters rather belongs to the sub- 
ject of fever. 

A form of delirium, accompanied with 
much nervous irritation, is apt to be de- 
veloped in the course of scarlet fever, to- 
ward the third day of the eruption, or 
when it is beginning to fade. In the pro- 
gress of rheumatic fever, this same delirium 



of exhaustion may occur, and, like the 
others already mentioned, requires the treat- 
ment by opium. 

Sympathetic delirium takes either of the 
above forms, according to circumstances, 
but it is more generally the low type, espe- 
cially when consecutive to severe accident 
or operation, or during protracted child- 
birth. Generally, therefore, opiates and 
supporting measures, meat-broth, wine, and 
bark, &c. are required rather than the re- 
verse. 

It is of consequence that delirium should 
not be mistaken for insanity, as it might be, 
and has been, but scarcely ought to be by a 
medical man. The concomitant circum- 
stances of disease, &c. &c. will generally 
guide. In true delirium, the presence of 
fever more or less, the acute disorder of 
the functions generally, such as digestion, 
&c. and the disorder of the whole mind, 
generally sufficiently indicate its distinct- 
ness from insanity, in which the faculties 
of the mind are only perhaps partly affected 
or perverted, and disconnected. The in- 
sane, moreover, do not exhibit the appear- 
ance of illness which accompanies true de- 
lirium, and the functions are not usually 
impaired in the same way. Still the two 
affections may nearly approach one another ; 
and in the form of delirium which follows 
childbirth, or the delirium tremens of the 
drunkard, it may often be difficult to make 
the definition as to which the case belongs. 
Still more difficult of discrimination are 
some cases of hysterical delirium, which, 
when long continued, might well be mis- 
taken for insanity, unless submitted to medi- 
cal judgment. Indeed, in every case of 
delirium, medical assistance should be pro- 
cured as early as possible. No unpro- 
fessional person in his senses would think 
of treating a case of delirium, when pro- 
fessional assistance is at hand. In its 
absence, the foregoing article should be 
useful. 

DELIRIUM TREMENS— [" The Hor- 
rors," or Mania a Potu] — Consists of a pe- 
culiar exhausted condition of the nervous 
system, which is accompanied with more or 
less mental disorder of a peculiar kind. This 
disease is generally the result of excessive 
continued intoxication with alcoholic liquors, 
or of their withdrawal when they have been 
habitually consumed in considerable quan- 
tity. It may also, however, be produced 
by the continued use of opium, and has 
been known to arise from other causes of 
cerebral exhaustion. The first symptom of 
delirium tremens is a state of restless nerv- 
ous irritation ; if the exciting cause be 



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181 



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continued sleeplessness follows, there is no 
rest, and if there is any approach to sleep, 
it is haunted by dreams and figures, which 
seem to excite the greatest terror. The mind 
is more collected than in most other forms 
of delirium, but seems always to be more 
or less haunted with suspicions of those 
around. The entire frame is in a state of 
tremor, the closed eyelids and the pro- 
truded tongue are tremulous ; the hand 
which attempts to perform any action re- 
quiring exactness, cannot execute it for 
shaking ; the patient is exhausted, and still 
sleep does not come. Succeeding the above 
condition, the nervous excitement becomes 
so great that the person cannot be kept in 
bed, the mind becomes more disordered, a 
state of temporary insanity ensues, and 
convulsions, epilepsy, or apoplectic stupor 
closes the scene — a scene of the most painful 
nature, perhaps, which the physician is 
called to witness — the death-bed of the 
drunkard — of the man slain by his own sui- 
cidal act, by the poison of alcohol. 

It can rarely happen that an unprofes- 
sional person could have to undertake, un- 
assisted, the management of a case of de- 
lirium tremens, and never should do so, 
except under extreme necessity. The na- 
ture of the disease is, unhappily, in almost 
all cases too palpable, from its exciting 
cause. It is an exhausted condition of the 
brain and nervous system ; and the great 
effort must be to alleviate this exhaustion, 
which is too great even for sleep. Opium is 
the remedy among others, and must be given 
in full doses. A medical man will, of course, 
give it more freely at once than another 
person ; but in a confirmed case of delirium 
tremens, twenty-five drops of Battley's so- 
lution, or thirty of laudanum, should be 
given at once, and ten drops every hour 
afterward, until sleep has been procured, 
or until fifty drops of the former, or sixty 
or se. 3nty of the latter have been admi- 
nistered. A medical man would venture con- 
siderably further than this, if necessary ; 
but cases might occur in which it would be 
unsafe for the unprofessional to do so. It 
often happens that the stomach is in so irri- 
table a condition that it will retain neither 
food nor medicine ; in such a case the opium 
is better given solid, in the form of pill, one 
grain and a half at first, and half a grain 
repeated at hour intervals, if requisite. If 
the stomach is still irritable, a drop of crea- 
sote, in a little spirit and water, may be 
given, and a mustard-plaster applied to the 
pit of the stomach. In cases of delirium 
tremens, the liver is more or less affected ; 
it is loaded with dark, unhealthy bile ; and 



so much is this the case, that some have 
been inclined to attribute many of the symp- 
toms of delirium tremens to the liver dis- 
order, and to recommend a purgative treat- 
ment in preference to that by opium. The 
author has generally found the medium 
course the best, that is, the combination of 
opium with calomel, and the compound col- 
ocynth pill. Five grains of powdered opium, 
ten grains of calomel and twenty of com- 
pound colocynth pill, are to be compounded 
together and divided into twelve pills ; of 
these, two or three should be given for the 
first dose, and one at intervals of an hour 
between each, till six have been given. 
Under this treatment, after sleep has con- 
tinued for some time, the bowels are gene- 
rally acted upon, with immense discharge 
of dark, black-looking bile, much to the 
relief of the patient. After this, the re- 
maining pills may be given, two every night, 
and castor-oil in the morning, if required ; 
five, ten, or fifteen-drop doses of laudanum, 
or two teaspoonful doses of paregoric being 
given,if the nervous irritation is unsubdued, 
or threatens to return. After the nervous 
irritation has tolerably well subsided, the 
next object must be to restore the tone of the 
stomach. Eight-gx-ain doses of the carbon- 
ates of soda or potassa, combined with a bit- 
ter tonic, as columbo, gentian, or chamomile, 
may be given for this purpose, every eight 
hours ; or quinine or bark, in some form, 
will be found useful. The India bitter beer, 
with ten drops of potassa solution, may be 
very serviceable. During the whole treat- 
ment, it will be necessary to allow the un- 
fortunate subject of the disease a certain 
regulated portion of alcoholic stimulant, such 
as brandy and water, in some degree pro- 
portioned to the previous habits ; and as 
soon as the stomach will bear it, the nourish- 
ment of strong meat-broths, yelk of raw 
egg beat up with a little brandy, or gruel, 
or arrow root, with brandy, should be given. 
If the tongue is very red at the tip, and if 
the pit of the stomach is very tender, milk, 
with or without the addition of a little 
brandy, should be substituted for the 
above ; fifteen drops of the solution of potash, 
or one or two tablespoonfuls of fluid mag- 
nesia or of lime-water, may be added to the 
milk with advantage. In cases of persistent 
sickness, effervescing draughts, and ice given 
in small fragments, frequently repeated, are 
often useful. The reception of nourishment 
by the system is of the highest importance 
in this disease : so much, indeed, is this the 
case, that as long as a man continues to take 
food freely, he is not likely to become the 
subject of delirium tremens. The necessity 



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182 



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for the continuance, in reduced quantity, 
during the treatment, of the stimulant which 
has produced the disease, is evidenced by 
the fact, that many cases of delirium tre- 
mens are precipitated at least by the sudden 
withdrawal of the accustomed excitement, 
and relieved by its renewal ; and for the 
same reason the radical removal of this 
fearful disease, or indeed of intemperance 
generally, though it can only be effected by 
the abandonment of the pernicious habit, 
must, in many cases, be conducted with ex- 
treme caution ; otherwise dangerous or fatal 
consequence may result. Undoubtedly, men 
of naturally good nervous power, whose 
stomachs still retain some of their pristine 
tone, and can receive and digest food in 
tolerable quantity, and where the constitu- 
tion has not been thoroughly sapped by in- 
temperance, may, and do with impunity and 
benefit abandon at once their habits of 
drinking, and when this can be done, it is 
the safest and most certain plan ; but many 
cannot do this without risk, and must go 
more cautiously to work. Where spirits 
have been consumed, let them be exchanged 
for wine or malt liquor, in reduced and re- 
ducing quantities. At the same time, with 
all who are endeavouring to break through 
the evil habits of intemperance, some inno- 
cent and rational excitement ought to be 
substituted for the pernicious one. Excite- 
ment of mind or body of some kind must 
take the place of that which has been 
abandoned, if the full benefit of the change 
is to be derived. 

Many methods have been devised for gra- 
dually weaning the intemperate from the 
craved excitement. Perhaps one of the most 
feasible is that of commencing with a cer- 
tain quantity of the accustomed stimulant, 
taking from it a measured proportion only, 
every day, and for every measure with- 
drawn substituting an equal quantity of 
water. The plan is a good one; but no 
plan will succeed without the firmest deter- 
mination of the drinker to conquer the vice 
which is dragging him to ruin in this world 
and the next. If he will make this resolve, 
and pray to Him who alone can strengthen 
and uphold man's feeble will, then may he 
hope to overcome. Again it is repeated, 
the intemperate man, whose constitutional 
powers will enable him at once and without 
compromise to cast aside the vice, has the 
easiest task: but no man should do so ex- 
cept by medical sanction, and the further 
advanced in life, and the more confirmed 
the habits of the abstainer, the more neces- 
sary does the precaution become. But in 
any case in which a person who has been 



in the habit of taking alcoholic stimuli, 
abandons the custom, he should be under 
medical surveillance for a considerable time 
after ; otherwise formidable depression of 
some or all of the vital functions may be the 
result. 

The question of restraint in cases of deli- 
rium tremens is one of much importance ; 
at times it becomes absolutely necessary 
to exercise it, for the preservation both of 
the patient and of those around. When 
the necessity does arise, it must be put in 
force with as much gentleness as may be 
compatible with firm command. The indi- 
vidual suffering should be kept in a bed 
where there is room for persons to be on 
each side, and all efforts at violence should 
be restrained by perfectly adequate physical 
power in the attendants. It is not necessary 
to keep the hands constantly upon the pa- 
tient; if he knows — and he is generally 
conscious enough for this — and feels that 
he is mastered, he will remain quiet ; but if 
by the temporary absence of an attendant, 
he thinks he can overpower the others, he 
again becomes unruly. This conscious- 
ness of hopeless effort on the part of the 
patient is in many cases the most powerful 
means of restraint. A strong webbing band, 
made to cross over the bed about the middle, 
and to buckle at one side, is often extremely 
useful in checking sudden violence, while 
it ought to be sufficiently loose to prevent 
any feeling of restraint, such as the straight 
waistcoat gives rise to, thereby irritating the 
patient to a great degree, and inciting him 
to ceaseless and exhausting efforts to get 
free ; the latter should never be used except 
under great necessity. The question of per- 
manent restraint, where repeated attacks 
of delirium tremens occur, and where the 
patient is continually in a condition verging 
upon insanity, is a very puzzling one, in 
consequence of there being no asylum 
adapted for such cases. The person when 
at liberty will drink, and when he drinks 
he is mad ; but when sober, or nearly so, 
his mind is not sufficiently affected to class 
him with the insane. 

The difficulty of dealing with such cases 
is often extreme, both to the family of the 
patient and to the medical attendant. There 
may, it is true, be procured a keeper or 
guardian, but comparatively few can incur 
this expense, and it is but an insufficient 
safeguard after all. The consequence is, 
that numbers of such patients are kept at 
home, they cannot be prevented indulging 
their irresistible propensity to intoxication, 
and so, for a longer or shorter time, they 
are a source of danger and of terror to their 



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family, and to every one around, and run 
hourly risk of terminating their own mise- 
rable existence by a more speedy description 
of suicide than the one they are following. 
It is much to be regretted that no proper 
provision is made in this country for the 
reception of such cases, which cannot pro- 
perly be handed over to a lunatic asylum ; 
for no sooner is the stimulant withheld, or 
regulated, than they become restored to 
sufficient intelligence, at least, to make them 
unfit inmates of the place. 

Refer to Alcohol — Intemperance, §c. 

DELIVERY.— See Childbed. 

DEMULCENTS.— This name, as used in 
medicine, is applied to remedies which ex- 
ercise a soothing influence, more especially 
upon the mucous membranes and upon the 
skin, when these are from any cause in a 
state of irritation. The demulcent may 
be applied either . directly to the irritated 
and irritable surface, as in the case of the 
stomach and bowels, or indirectly, as in the 
case of irritation of the urinary passages, 
and of the bronchi or air-tubes. 

The principal demulcents are — 

Almonds (sweet.) 

Arrow-root. 

Carrageen moss. 

Eggs, in the form of emulsion. 

Gelatine and isinglass. 

Gum Arabic. 

Grains, and their preparations : barley- 
water, gruel, &c. 

Lard. 

Linseed. 

Liquorice. 

Marsh-mallow. 

Oils. 
, Sago. 

Salep. 

Spermaceti. 

Tragacanth gum. 

Wax. 

It cannot be said that any of the above 
substances act as medicines in the proper 
sense of the word ; nevertheless, they con- 
stitute a class of remedies peculiarly valu- 
able for domestic use. They are perfectly 
safe, and certainly most beneficial ; at the 
same time, it is a necessary caution that 
the prolonged use of demulcent remedies is 
liable in some persons to occasion a relaxed 
and debilitated condition of the system. 
For further information respecting the indi- 
viduals of the class, the reader is referred to 
the separate articles. 

DENTIFRICE.— See Teeth. 

DENTITION.— See Teeth. 

DEOBSTRUENTS— Are medicines which 
have, or are supposed to have, the power of 



removing unnatural thickenings or forma- 
tions from any portions of the body. Such 
medicines were formerly much more used 
and depended upon, particularly as external 
applications, than they are now. That is, 
there were many substances employed for a 
sort of mysterious deobstruent action, which 
probably possessed no such action at all. 
Mercury, iodine, codliver-oil, and friction 
are, however, deobstruents to be trusted, 
and are much employed as such in the pre- 
sent day. 

DEPILATORY— Is an application which 
removes the hair from the skin. Pitch ap- 
plied to the surface to be denuded, and then 
forcibly pulled off, so as to bring the hairs 
with it, was formerly used for this purpose, 
but has, deservedly, with other barbarous 
customs of another age, fallen into disuse. 
Preparations of quicklime and of arsenic 
have also been used for the same purpose. 
In the few cases, such as some kinds of skin 
disease, in whi«h it may be thought neces- 
sary to detach the hairs by the roots, they 
often come out easily, and the process is 
better effected by means of tweezers than 
by the wholesale, painful, and it may be 
dangerous, though perhaps- quicker methods 
above mentioned. 

DERBYSHIRE NECK.— See Broncho- 

CELE. 

DERIVATIVE.— The term, as used in 
medicine, signifies whatever tends to with- 
draw diseased action from any part of the 
body, by means of action — not necessarily 
diseased — set up in some other part. Thus, 
bleeding from the lungs may be stopped by 
the derivative action exerted by the flow of 
blood from a vein opened in the arm, or 
inflammation affecting the eyes may be re- 
lieved by a blister, or seton, at the back of 
the neck. 

Derivatives may be either natural or arti- 
ficial. The principal natural derivatives 
are either the discharge of blood or the 
increase of natural secretions ; thus, bleed- 
ing from the nose may act derivatively, as 
regards the brain, or the bleeding from piles 
as regards the liver, or parts within the 
abdomen; or an attack of diarrhoea may 
also act in the same way. Boils, cutaneous 
eruptions, ulcers, &c. also act as derivatives, 
but in many cases approach the class of coun- 
ter-irritants. The great principle involved in 
the existence of natural derivatives is, that 
they must be the effect of some cause, and, 
in many cases, of some internal disorder, 
which has thus formed for itself a safety- 
valve, through less important channels, for 
the protection of more important organs. 
Much caution is requisite in stopping, or 



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permitting to be stopped, incautiously and 
blindly, what is to be regarded as a natural 
derivative. The symptom itself should be 
regarded only as the outward sign of some- 
thing which requires rectification within, 
and the efforts should be directed to the 
discovery of this inward acting cause, and 
to its removal when discovered ; this being 
done, the external symptom will possibly dis- 
appear. But even should it not do so quickly, 
in consequence of having established an 
habitual local tendency, it may be much 
more safely attended to as a local disease, 
after the constitution has been relieved. 
Not only, however, must the constitution 
be relieved at the time, but if the natural 
derivative is done away with, it must be 
kept, if possible, free from the primary dis- 
order ; otherwise, should this recur, and 
should the constitution fail to re-establish 
the natural derivation in time, serious or 
fatal consequences may be the result. It 
not unfrequently happens that, some months 
after an old ulcer has been healed, or 
cutaneous eruption removed, that the indi- 
vidual is seized with some dangerous inter- 
nal malady, perhaps apoplexy, which might 
have been prevented, if, after the natural 
drain had been closed, strict attention had 
been paid to the regulation of the general 
health. This is a cogent reason why persons 
in whom some natural derivative action, 
such as any of those named above, has 
stopped, or been stopped, should pay the 
greatest attention to diet generally, to the 
regulation of the bowels, to the functions 
of the skin by cleanliness, of the lungs by 
fresh pure air, and of the system generally 
by exercise, and why, on the slightest symp- 
toms of indisposition, they should subject 
themselves to medical treatment. A still 
more cogent reason is it why such persons 
should beware of tampering with themselves 
with quack ointments, lotions, andoutward ap- 
pliances, which, if they do cure sores, as they 
profess, without constitutional treatment, 
must do mischief, for they would merely 
obliterate the outward symptom of disease, 
and send the latter to attack perhaps some 
vital organ. 

Artificial derivatives, such as blood-let- 
ting, blisters, &c. may be referred to under 
their proper heads. 

DESQUAMATION— Is the separation, in 
scales or flakes, of the outward or scarf- 
skin. Strictly speaking, desquamation is 
constantly going on on the surface of the 
body, and scales or scurf are constantly 
being separated in small and almost insen- 
sible quantity ; but after some inflammatory 
diseases, particularly those of an eruptive 



character, such as scarlet fever, measles, &c. 
a much more copious desquamation takes 
place, and the scarf-skin separates in large 
pieces. The same thing occurs after irri- 
tants, such as mustard-plasters, blisters, &c. 
have been applied to the skin. Desquama- 
tion, whether natural or the consequence of 
disease, is always facilitated by the use of 
the tepid or warm bath. 

Refer to Skin. 

DIABETES— Is a disease in which the 
urine is discharged in unusually large, often 
in enormous quantity, and for the most part 
contains a large amount of saccharine mat- 
ter. The serious nature of the affection 
renders it one of those which should be 
trusted for treatment only to medical hands. 
The same reason renders it important that 
its first symptoms should be known, that 
they may not be neglected. It may creep 
on a person insidiously, or be suddenly 
developed. The first and most prominent 
symptom which usually awakens attention, 
is the frequent call to pass urine abundantly, 
at the same time the thirst is extreme and 
the appetite voracious. As Dr. Watson re- 
marks, some persons, especially among the 
lower orders, are apt to think that as they 
eat and drink so well, there cannot be much 
the matter, and are thus lulled into security 
while a fatal disease is undermining their 
constitution. In addition to the symptoms 
already mentioned, the mouth is dry, and 
the tongue clammy and sticky, often very 
red ; there is flatulence and indigestion, 
and the bowels are generally constipated. 
Emaciation and general debility also occur ; 
pain and weakness in the loins, and feeble- 
ness of the limbs. The leading symptom, 
however, is the discharge of urine, which 
has been authentically known to exceed 
forty pints in the twenty-four hours. At 
the commencement of the disease the urine 
may still retain the urinous properties of 
the diluted secretion ; but this passes into 
the saccharine condition, and sugar, which 
may be obtained in a crystalline state, is 
largely discharged. If yeast be added to 
the urine, it ferments, and alcohol is formed, 
the sugar partaking more of the character 
of grape, or fermentable sugar, than of the 
cane. Diabetes is often accompanied by 
other diseases, especially by pulmonary con- 
sumption. 

A disease of the nature of diabetes can 
never with propriety be treated domestic- 
ally, and an individual who may detect in 
himself the occurrence of the symptoms de- 
tailed above, should at once seek competent 
medical assistance. The dietetic treatment 
of diabetes is probably of more importance 



DIA 



185 



DIA 



than the medicinal ; the chief precaution 
being the avoidance of whatever — either 
sugar of any kind, or vegetable starchy 
matter — is capable of being converted into 
grape or fermentable sugar. This of course 
involves the prohibition of bread made 
from ordinary flour, which contains all the 
starchy matter of the grain. This priva- 
tion is always much felt and complained of, 
and various substitutes have been proposed. 
The following, by Dr. Percy, is probably 
the best : — " Take the woody matter of six- 
teen pounds of potatoes, washed free from 
starch ; three-quarters of a pound of mutton 
suet, half a pound of fresh butter, twelve 
eggs, half an ounce of carbonate of soda, 
and two ounces of dilute hydrochloric acid. 
This quantity to be divided into eight cakes, 
and baked in a quick oven until nicely 
browned. 

" It is, as must be obvious, an expensive 
article, but with many diabetic patients this 
will not be an object of consideration. It 
is somewhat improved in taste by being 
slightly toasted." 

Bullock's semola, which consists nearly 
entirely of wheat gluten, would form a nu- 
tritious substitute for the arrow-root and 
sago mucilages. Animal diet is principally 
to be depended upon for nourishment, and 
some of the green garden vegetables, such 
as spinach, are permitted. Distilled water, 
or boiled water, but not toast-water, may be 
used for drink. Dr* Prout, in some cases, 
found porter beneficial ; and, in France, 
claret has been given with advantage. 

The tepid bath, to induce perspiration, is 
often of service. As regards medicine, its 
prescription must be left to the medical 
man. Persons who suffer from any sus- 
pected tendency to diabetes cannot attend 
too strictly to the state of the digestive 
organs. Wet feet must be particularly 
avoided, and flannel should be worn next the 
skin ; while all sources of debility, sexual 
excesses in particular, must be most strictly 
eschewed. 

Refer to Fermentation — Sugar — Urine, §~c. 

DIACHYLON PLASTER— Is the com- 
monly used adhesive plaster spread on 
calico. It was formerly prepared by hand, 
but, as now executed by machinery, is a 
beautifully uniform preparation; and, not- 
withstanding many substitutes, is still the 
most firmly adhering and most to be de- 
pended upon of the plasters for retaining 
the edges of wounds in apposition. People 
in general have a very false idea of the 
nature and uses of this and of other plas- 
ters. They attribute to them some healing 
power over the wound, whereas their only 
Q2 



use is, by keeping the edges of the wound in 
perfect apposition, to permit them to heal 
by the natural power with which the living 
tissues are endowed. This idea of the heal- 
ing properties of diachylon, however, often 
leads to mischief, from inducing persons to 
apply the plaster to abrasions and sores, 
which it seriously irritates, causing, with 
some, much increase of inflammation and 
troublesome ulceration. The practice is 
most hurtful, and should never be followed. 
This idea of the healing powers of diachy- 
lon has, also, been probably increased by 
its known use by surgeons in the treat- 
ment of the healing of ulcers. In this 
case, when used as a strapping round the 
leg, and over the sore, the latter quickly 
gets well, and it would seem under the 
influence of the diachylon plaster, which, 
however, in this case, is used only as a 
convenient mechanical agent, which will 
closely envelop the limb, and give support 
to the weakened vessels and infiltrated tis- 
sues which have encouraged and which 
surround the sore. The diachylon, it is 
true, passes over the ulcer, but it is pre- 
vented exerting any effect upon its surface 
by the intervening discharge. Sometimes, 
even when applied to the sound skin, dia- 
chylon is found too irritating, in which case 
soap or lead plaster must be substituted. 
If diachylon plaster is kept folded up in too 
warm a situation, it adheres together and 
becomes useless. 

Refer to Plasters. 

DIAGNOSIS — Is a term frequently used in 
medicine, which may be applied either to the 
"art of discovering the nature of diseases, 
and of distinguishing them from each other," 
or to the conclusion arrived at by the exercise 
of the art. In other words, when a medical 
man, after investigating a disease, expresses 
his opinion respecting its nature, it is called 
his "diagnosis" of the disease. It must be 
evident to all how much, indeed how every 
thing depends upon a correct diagnosis of 
the existing disorder ; for, unless correct- 
ness on this point be attained, treatment 
can scarcely be of much service, and if 
active, may be worse than no treatment at 
all. It is true that there are certain gene- 
ral symptoms of disease which may be 
treated, perhaps with benefit, in a general 
sort of way, without the medical attendant 
having any definite idea of the existing de- 
rangement. Such is the case with most 
febrile diseases, and many others ; and as 
the natural powers do much toward the 
removal of the malady, and promote resto- 
ration to health, a practitioner may practise 
in this loose sort of way with apparent sue- 



DIA 



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DIA 



cess : he treats prominent symptoms, attends 
to diet, &c. and his patients get well. But 
this is not the true practice of medicine : 
it is very different from the active, well- 
directed, and energetic measures of the 
man who, having both the knowledge and 
the will to truly investigate his case, and 
having done so, strikes home at once. The 
man who does not or cannot make a cor- 
rect diagnosis is working in the dark; and 
if he uses edged tools, so much the worse 
for his patients, whose safety must in some 
measure depend upon the treatment of their 
cases being conducted upon the same inert 
plan as their investigation. At the same 
time, if there be any efficiency in medical 
treatment at all — and no man who knows 
his profession and practises it conscien- 
tiously can doubt it — how much passive evil 
must result from insufficient and slovenly 
investigation of disease ; how much must be 
and is every day overlooked, which ought 
not to be so ; how often are germs of fatal 
disease undetected, which ought to be de- 
tected, until they have ripened into active 
growth that is not to be repressed ! One or 
two cases will more forcibly illustrate the 
difference between a loose and ill-defined 
treatment of disease, and that which is 
the result of accurate diagnosis. A child 
is taken ill, becomes feverish, the breathing 
quickened, and there is frequent cough, 
along with other symptoms, indicating in a 
general way inflammatory affection of the 
lungs ; and so far, perhaps, the diagnosis is 
too plain to be overlooked, even by a very 
cursory examination ; and tartar emetic, 
mercurials, &c. are remedies so generally 
useful in such cases, that they will be pre- 
scribed with probable success, and it may 
be that the little patient will get well under 
their use ; — but it may not so happen — the 
disease evidently does not yield, the fever- 
ish condition, the quick breathing, and the 
cough, all show that it is still active. It is 
evident that abstraction of blood is called 
for, but the child will not bear it from the 
arm, and it must be effected by leeches — 
where ? — of course on the chest. But on 
what part of the chest ? Here comes the 
point of diagnosis. The careless or slovenly 
practitioner will be content with the general 
indication of the forepart of the chest, un- 
less, indeed, there is complaint of pain — 
which may mislead as well as lead — to di- 
rect his aim elsewhere ; and the chances are 
that blood is taken away, comparatively 
little good is effected, and the child, not the 
disease, is weakened. The error may be a 
fatal one, which a correct diagnosis would 
have prevented. It may be that the ante- 



rior portions of the lungs are free from 
disease, which is confined to the posterior 
and lower portion of one or both. If a cor- 
rect diagnosis has been made, this should 
be known, the practitioner, by the percus- 
sion of his fingers and the application of his 
ear to the chest, will probably be able to 
lay his hand upon the skin over the seat of 
disease, and to mark out with confidence the 
limits within which blood may be abstrac'ted 
with the greatest certainty of benefit. 

Again, a patient suffers from indigestion, 
from weakness, pain in the back, and gene- 
ral symptoms of bad health ; the spirits are 
depressed ; a general diagnosis is perhaps 
made, and the round gone of various tonic 
remedies, alterative remedies, &c. ; but the 
urine, if thought of at all, is passed over 
with a cursory glance : to the unassisted 
eye it looks all right, and perhaps is pro- 
claimed so ; but place a drop of it under 
the invaluable microscope, and it is found 
laden with crystals of oxalic, or phos- 
phatic, or some other deposite. The cor- 
rect method of diagnosis affords at once 
the key to the main points of the disorder, 
and probably to its successful treatment, 
which might have been groped after in vain, 
or if stumbled upon by accident, and found 
successful, the success would give but little 
clue in the next case of the kind which 
might occur ; or it may be that false ideas of 
the nature of the disease, a false diagnosis 
having been formed, the success itself will 
constitute an abundant source of evil and 
error, not only to the individual practitioner, 
but to others. The fact being a false one, 
leads to false conclusions. The above cases 
— which might be multiplied to any extent 
— have been brought forward to show how 
much success in treatment must depend 
upon the correctness of the diagnosis which 
the attendant practitioner forms of the dis- 
ease of his patient. They have also been 
brought forward to show that this correct 
diagnosis can only be attained by time and 
patient attention and investigation, even 
by the greatest in science. In many cases, 
no extent of knowledge will enable a phy- 
sician to say what portion of a lung is 
affected, unless his sense of hearing conveys 
the exact information to his mind in a phy- 
sical examination. A physician may suspect 
from symptoms that his patient is suffering 
from disease which tends to the formation 
of oxalic gravel, but he cannot positively 
assure either himself or others that such 
is the case, unless he actually see with his 
eye — through the microscope — the peculiar 
crystal which marks the disease. From 
what has now been said, it must be evident 



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that the highest attainments in medical 
knowledge will not compensate for a hurried 
examination of cases : there must be time. 
People forget this ; attracted by some great 
name, and in all probability a really and 
truly great one, they crowd the reception- 
rooms, and are passed in quick succession 
through the consulting-room of the fashion- 
able practitioner, who cannot give time to 
the full investigation of the cases which 
come before him. Few, perhaps, attain the 
meed of popularity without having well 
deserved it, or retain it without deserving 
to retain it by their progressive attainments; 
but, withal, they are not gifted with intui- 
tion, and if the public will compel them to 
see ten cases in the time they ought to take 
to two or three, the public must suffer ; and 
they do suffer, for many a case overlooked 
is unravelled by the patient investigation 
of some less occupied practitioner. It must 
not, however, be supposed that it is here 
insinuated that time and patience alone 
are sufficient for the proper investigation 
of disease in the living body : the man of 
experience, and who to his experience has 
added accurate oservation, will undoubted- 
ly seize more quickly than one less inform- 
ed the most distinctive features of the case 
before him ; even at a single glance, in some 
cases, he may form a conclusion — and it 
may, probably, be a correct one — in his own 
mind respecting the nature of a case, and 
this conclusion will lead him at once to use 
the means of diagnosis best adapted quick- 
ly and surely to satisfy his mind. But even 
with all this, with abundant knowledge and 
ready tact, some time is required in all 
cases — often much more than is given by 
some in the full tide of practice. Nothing 
will compensate for a hasty and imperfect 
diagnosis, and evils innumerable spring from 
it. On this head, Dr. Watson, one of the 
ablest physicians of the day, remarks, "It 
is mainly to the uncertainty in the diagnos- 
tic part of medicine that we must attri- 
bute the uncertainty and variation both of 
doctrine and practice which have brought 
so much suspicion and reproach and ridi- 
cule upon the science we profess." The 
case of the fashionable London physician 
has been alluded to, overwhelmed with fees, 
and with work, which he cannot, in many 
cases, perfectly fulfil ; but there are others 
in our profession overwhelmed with work, 
with the same effect, but unfortunately with- 
out the fees, and without their patients hav- 
ing a choice of avoiding the evil. These 
others are the union surgeons, who are hired 
at a miserable pittance in many instances 
to attend an unlimited number of poor. Un- 



able to maintain an assistant out of their 
wretched salaries, they cannot, within the 
bounds of physical possibility, if they are 
to get through their day's work at all, give 
time to investigate their cases properly : it 
needs not to point out how this must con- 
vert a miserable economy into extravagant 
and unnecessary expenditure. There is yet, 
however, another essential — in many cases 
at least — either to facilitate or enable the 
formation of an accurate opinion of a case 
of disease, — and this is, perfect candour on 
the part of the patient toward the medical 
man consulted; and not only candour, but 
thoughtful consideration and communica- 
tion of every circumstance which is, or may 
appear to be, connected with the illness. 
Whether it be hereditary predisposition or 
personal transgression, nothing should be 
concealed. Females often permit prudery 
or mistaken feeling to interfere with their 
communications with a medical adviser. 
But one thing can be said upon this matter : 
if they cannot confide in him on these 
points, he is unworthy of their confidence 
at all; but the same resolution which in- 
duces the consultation, ought at the same 
time to give this resolve, to leave nothing 
untold connected with the state of health. 

So much has been said Avith regard to the 
necessity for a well-defined diagnosis, that 
it may lead some to suppose that this can 
be made out in all cases, which is not possi- 
ble. Many diseases are, it is true, so dis- 
tinctively marked, that there is no difficulty 
in assigning them their true name and cha- 
racter ; but there are many diseased condi- 
tions of the human frame, which will not 
fall under any classification, and which baf- 
fle the best-directed efforts of our present 
knowledge for their elucidation. In this 
case, the diagnosis must be what has been 
called "empirical;" it is imperfect, because 
the science of medicine is yet an imperfect 
one, and if it do not inform us of the real 
nature of the disease, it must, taken in con- 
nection with experience, be used as a guide 
to treatment. These observations are made, 
that too much may not be expected from 
medical men by the public, and to show, 
that because a medical man will not or can- 
not give a defined diagnosis of a disease, he 
is not necessarily ignorant of its proper, 
or, at all events, best-ascertained mode of 
treatment. Further, when it is reflected 
how strict an investigation is required at 
the hands of those whose lives are and have 
been devoted to the subject, it ought to make 
unprofessional persons doubly cautious in 
dealing with disease. To quote from the 
"prefatory address" to this work, — "When 



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it is remembered how the nicest judgment 
that observation and experience can form, 
the most patient attention, aided by prac- 
tised ear and eye, by microscope and test- 
tube, are frequently necessary, to enable 
the conscientious physician to judge of his 
case before he can apply the remedy, it is 
evident how great must be the responsi- 
bility of those who, in rashness or ignorance, 
venture upon the treatment of serious dis- 
ease, either in their own persons or in those 
of others." This is not meant as a discour- 
agement, but as a caution; for the real ob- 
ject of a work like the present can only 
be fulfilled, when the good it oflers is safely 
and judiciously employed. 

Lastly, either our physicians, most of 
them men of Christian character and of high 
honour, make a parade of their diagnosis 
of disease, and devote their lives of labour 
to deceive the public, or are themselves 
deceived, or quackery and quack medicine 
must be impudent lies and wicked deceits. 
The individual who purchases a quack nos- 
trum can either have no idea of the dis- 
ease — if he has one — under which he is suf- 
fering, or only the crude idea — diagnosis — 
of his own judgment; and upon the faith of 
this, he prescribes for himself the unknoAvn 
compound of — to him at least — an un- 
known individual, on the faith of some 
lying advertisement. Is the diagnosis of 
the physician a delusion and a snare, or 
does the patronizer of the quack remedy 
exercise the same judgment in the treat- 
ment of his body that he would in his 
worldly business ? To our readers we leave 
the answer. 

Refer to Advice, Medical — Disease, §c. 

DIAPHORETICS— Are agents used in the 
practice of medicine which " determine to 
the skin" or produce perspiration or sweat- 
ing. When it is considered how extensive 
the surface of the skin is, how largely it is 
supplied with blood, and how abundantly 
with means for exhaling moisture, (see 
Skin,) it must be evident how powerful an 
influence its excitation or depression must 
exert upon the condition and functions of 
the body. This influence is so undoubted, 
and so marked, that in all ages, and in 
almost all nations, even the most uncivil- 
ized, the cure by promoting the flow of the 
sweat has been a common and favourite 
mode of treatment. Among the tribes of 
North American Indians it is employed, as 
described by Mr. Catlin, both as a curative 
and as a sanitary agent. The most general 
mode of exciting perspiration, particularly 
among the more uncivilized portions of 
mankind, is by means of hot vapour or the 



vapour-bath ; but they also employ abun- 
dantly decoctions of various herbs as as- 
sistants to the process. 

The effect which the constant insensible 
perspiration from the body exerts in dimi- 
nishing its temperature must, of course, be 
augmented as the excretion and evapora- 
tion of fluid from the surface is increased, 
furnishing an active agent for lowering the 
temperature of the body in states of fever. 
Every one knows how much and distress- 
ingly the dry heat of the skin is felt, and 
how grateful the sensation of moisture upon 
the surface. In addition to the reduction 
of temperature, however, the action of dia- 
phoretics must tend powerfully to relieve 
congestion or collection of blood, or in- 
flammatory action in internal organs; and, 
indeed, the fact is every day manifest in 
the treatment of disease, not as regards 
general perspiration only, but also as a 
consequence of the effect of local agents — 
such as the bran-poultice so often mentioned 
in this work — which produce sweating of 
the part to which they are applied. The 
most useful diaphoretics for domestic pur- 
poses are — 

Ammonia — In the form of carbonate, when 
stimulation is required at the same time, 
and in the form of acetate or "spirit of 
mindererus," which is one of our most cer- 
tain diaphoretics. 

Antimony — In the form of the tartrate 
of antimony, in small doses, when fever is 
excessive, and the true James's powder, 
which is the safest form for children. 

Baths — Tepid, warm, or vapour, or used 
as in hydropathic establishments, by means 
of the wet sheet and blankets. 

Ipecacuanha — In any of its combinations. 

Opium — Particularly in its combination 
with ipecacuanha, named Dover's powder. 

To the above may be added sweet spirit 
of nitre, gin, and diluent drinks of all kinds, 
sometimes cold, but generally warm, and 
exercise. There are many other agents 
employed in medicine as diaphoretics, but 
they are not likely to be used domestically, 
unless, indeed, we except the dulcamara, or 
bitter-sweet, also called woody night-shade, 
which, being a common native plant, might 
be used in the absence of other remedies 
of the class. — See Dulcamara. For infor- 
mation respecting the other diaphoretics 
mentioned, the reader is referred to their 
respective articles. 

When perspiration is thought to be desir- 
able, it is immaterial What agent is selected 
to produce it ; thus, if there is very hot, 
dry skin, and quick, hard pulse, antimony 
will generally be most useful ; if there is 



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189 



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depression, spirit of mindererus, sweet spirit 
of nitre, or carbonate of ammonia will be 
most suitable ; and with any of these ipeca- 
cuanha or opium may be combined. To 
form one of the most useful and certain siveat- 
ing draughts, take of spirit of mindererus 
half an ounce, of antimonial or ipecacuanha- 
wine fifteen to thirty drops, and water four 
tablespoonfuls, adding or not, as circum- 
stances dictate, ten drops of laudanum or 
a teaspoonful of paregoric. 

As there is always a degree of uncer- 
tainty, especially in some constitutions, as 
to the action of diaphoretic medicines, when 
they are taken every means should be used 
to assist and promote the desired effect. 
Confinement to bed is absolutely necessary, 
and before retiring there it is always well 
to put the feet in hot water for twenty 
minutes. The diaphoretic medicine should 
be used on getting into bed, and nothing- 
more for three-quarters of an hour, when 
the warm diluent drinks are to be com- 
menced with, and may after that be taken 
very freely, and continued as long as the 
sweating process is kept up. If the warm 
diluent drinks are taken too soon after the 
medicine, sickness will probably ensue, and 
so the object in view be defeated. Purga- 
tive medicine, which is likely to act during 
the operation of a diaphoretic, should be 
avoided, for the disturbance occasioned 
thereby will not only effectually counteract 
the desired process, but may, by checking 
it, aggravate the disease it was intended to 
benefit. Some persons promote the action 
of sweating by cold instead of warm drinks. 
In cases of much febrile heat and excite- 
ment they may be useful ; but, as a general 
rule, it is the safer plan to keep to the warm 
fluid. When sweating is produced, the 
person should always have flannel next the 
skin, never linen; and of course there must 
be sufficient covering to maintain the requi- 
site temperature. If the person is labouring 
under infectious disease, .additional care is, 
of course, requisite in the after disposal and 
purification of the woollen clothing. When 
it is thought desirable to check the sweat- 
ing process, every source of chill must be 
avoided, the skin is to be dried with warm 
towels, and fresh clothing, previously slight- 
ly warmed, put on, the coverings lightened, 
and the hands and arms gradually exposed. 
There is sometimes great difficulty in pro- 
ducing perspiration in certain constitutions. 
When such is the case, the medicines should 
be given, and other means resorted to, to- 
ward four o'clock in the morning, that is, 
just previous to the time in the four-and- 
twenty hours, when the body, either in 



health or disease, appears most liable to 
perspiration. 

Refer to Skin. 

DIAPHRAGM, or Midriff— Is the partly 
muscular and partly tendinous and mem- 
braneous partition, which extends between 
the chest and the abdomen, (fig. lii.,) sepa- 

Fig. lii. 




rating the heart and lungs on one side from 
the liver and stomach on the other. The 
diaphragm assists materially in theprocessof 
respiration, descending and pressing down- 
ward upon the contents of the abdominal 
cavity each time a breath is drawn. This is 
more particularly seen in some cases of 
chest-disease, when the respiration becomes 
almost entirely dependent upon this action 
of the diaphragm. From this it must be 
evident to all how important it is that this 
muscle should have free play, and how much 
its essential movements must be impeded 
by any thing, such as tight lacing, which 
presses the contents of the abdomen up- 
ward. 

Refer to Lungs — Respiration, §c. 

DIARRHCEA— Consists in frequent and 
urgent calls to relieve the bowels, the 
evacuations being for the most part more 
liquid than usual. The causes of diarrhoea 
are very numerous, but may, perhaps, be 
classed under three heads — nervous causes, 
causes which act upon the surface of the 
body, and irritating causes which act di- 
rectly upon the bowels themselves. Per- 
haps the simplest form of diarrhoea is that 
arising from nervous causes, such as some 
experience on the approach of thunder, or 
from electrical disturbance generally, or 



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190 



DIA 



sucli as arises from emotions of the mind, [ 
as, for example, fear. In these cases the j 
bowels would appear to be simply "relax- ; 
ed," the evacuations being healthy, with ex- ' 
ception of being thinner, from their more 
rapid passage through the bowels. The 
simple salutary diarrhoea in teething chil- 
dren is an example of the same kind. 

Influences affecting the surface of the 
body, particularly cold, and especially cold 
feet, often produce diarrhoea. Cold nights 
succeeding hot days are often said to occa- 
sion the disease ; but it is also remarkable, 
that diarrhoea is apt to occur at the breaking 
up of a long frost — indeed to be epidemic, 
that is, of general prevalence. 

By far the most frequent cause of diar- 
rhoea, however, is irritation in the bowels 
themselves, caused either by undigested or 
indigestible food, by acid, by acrid, morbid 
bile, or by the deficiency of that fluid per- 
mitting the digested food to become unduly 
changed. It may also be caused by an ac- 
cumulation of hardened feculent masses, or, 
as they are called in medical language, 
"scybalse;" or by the lodgment of such 
matters as the skins of old peas or beans, or 
of raisins, in the folds of the large bowel : 
the above are frequent causes of teasing 
diarrhoea in children. Lastly, diarrhoea 
may be dependent upon disease of the 
bowels themselves, such as affection of 
their minute glands, when it constitutes 
dysentery, or ulceration of the glands and 
of the lining membrane, such as occurs in 
fever and consumption. 

It must be remembered, however, that to 
some persons an habitually relaxed condition 
of the bowels is natural, and at the same time 
essential for health, and that to check it is 
dangerous. It is evident, that in a disease 
depending upon so many and various causes, 
a due discrimination of these is requisite for 
proper treatment. It must not, either, be 
lost sight of, that diarrhoea is in many cases 
salutary, an effort of nature to free the con- 
stitution from some morbid matter which, 
if retained, would produce disorder or dis- 
ease. On this account, the simpler forms 
of diarrhoea are better left to right them- 
selves, so long as they keep within moderate 
bounds. This caution is particularly to be 
observed with regard to that which occurs in the 
teething of children, which, when moderate, 
is a safeguard ; but when it becomes so fre- 
quent that the child is evidently weakened 
by it, and especially if the evacuatious ap- 
pear to be losing their feculent character 
and become like shreds of skin, or streaked 
with blood — in such cases, a warm bath for 
six or eight minutes, of the temperature 92°, 



should be used for two or three evenings in 
succession ; isinglass or gelatine given in 
the milk-food, and the castor-oil emulsion 
with yelk of egg (see Castor-Oil) given 
three or four times a day, each dose con- 
taining from a quarter to half a drop of 
laudanum. Of course medical assistance 
being procured if the complaint is not 
quickly moderated, for checked entirely it 
should not be. 

In diarrhoea resulting from exposure to 
cold, the best plan of treatment is to mode- 
rately re-excite the skin according to the 
system recommended in the article "Dia- 
phoretics," and also, if requisite, to adminis- 
ter the remedies prescribed for continued 
diarrhoea generally. 

When diarrhoea is caused by irritating 
matters in the bowels, one thing is evident — ■ 
it cannot be properly relieved unless the 
bowels are freed from the irritant matters. 
It may, it is true, be stopped under these cir- 
cumstances, but it will recur, unless indeed 
the irritating substance has been removed by 
the purging, previous to the use of the astrin- 
gent medicine, and the continuance of the 
diarrhoea is merely the consequence of the 
previous irritation. In many cases in which 
the diarrhoea is owing to irritant matters in 
the bowels, particularly to acrid bile, all that 
is requisite is to diminish the acridity by 
means of demulcent drinks largely used, to 
which, if there is acid in the stomach, 
a little carbonate of soda is to be added. 
In other cases, when the action of the 
bowels is constant, painful, and exhausting, 
it is absolutely necessary to check these 
symptoms in the first place, and to soothe 
the bowels, before means are resorted to for 
freeing them from the irritant cause. For 
the former purpose, the common chalk-mix- 
ture, in three tablespoonful doses, with the 
addition of five drops of laudanum to each, 
may be given at short intervals till the dis- 
ease is checked ; or the compound chalk- 
powder — dose thirty to sixty grains — and 
the same powder, with opium — dose five 
to twenty grains — are both useful. Or 
aromatic confection may be given in half- 
drachm doses in water, with or without 
laudanum. If the active diarrhoea does not, 
from its comparative mildness, require these 
remedies at first, or when it is sufficiently 
moderated, the bowels should be thoroughly 
cleared out with a tablespoonful dose of 
castor-oil, to which ten drops of laudanum 
have been added ; this will probably clear 
away the irritating matters, if they consist 
of indigestible substances, hard feculent 
matter, or the like. When castor-oil cannot 
be, or is not taken, the best substitute is 



DI A 



191 



DIG 



twenty grains of rhubarb and fifteen of cal- 
cined magnesia, with some aromatic, such 
as half a teaspoonful of sal-volatile, or a 
teaspoonful of tincture of rhubarb, and, if 
there is much pain, five to ten drops of lau- 
danum, the dose being repeated, if requisite. 
After the action of the opening medicine, 
one or two doses of astringent may again be 
required, as the bowels are apt to keep up 
acting simply from irritability. Medical 
men sometimes give more active purgatives 
to clear away irritant matter ; but the prac- 
tice is not safe in the hands of the non-pro- 
fessional. 

When diarrhoea has been permitted to 
pass into the stage of irritation, when there 
is tendency to fever, the belly tender, the 
tongue red, and the motions resemble shreds 
of skin, or pieces of jelly, and are mixed 
with blood, the case is of that serious nature 
that medical assistance should at once be 
obtained, if it has not been so before. In 
the mean time, the emulsion of castor-oil 
with yelk of egg will be found the safest and 
most effectual medicine ; two tablespoonfuls, 
with five drops of laudanum, being given 
every four hours, and starch and laudanum 
clysters, the diet being as unirritating as 
possible, and containing abundance of gela- 
tine. A most excellent drink in these cases is 
rice-water, in each pint of which from a quar- 
ter to a whole ounce of gelatine or isinglass is 
dissolved, with a piece of toasted bread in- 
troduced to flavour it, or a little cinnamon. 

In the more severe forms of diarrhoea, 
such as that connected with consumption 
or fever, or when fever is present, medical 
attendance should alone be trusted to, but 
when unattainable, the disorder must be 
treated according to such of the methods 
above detailed as may appear most suitable. 
In all probability the soothing and astringent 
plan, such as chalk with opium, will answer 
best. The author has found Bismuth of much 
service in some of these cases. Creasote 
has been recommended in cases of intract- 
able diarrhoea. In case of much tenderness 
of the bowels, a few leeches might be used, 
but pain generally should be treated with 
the hot bran-poultice. The use of diluted 
sulphuric acid in frequently repeated doses 
has lately been highly recommended in the 
treatment of diarrhoea. 

Diarrhoea may occur as a chronic, or long- 
continued affection, lasting for months or 
years ; but these cases depend on such a 
variety of causes and influences, and require 
so much care in treatment, that they can only 
be advantageously managed by a medical 
adviser, and ought as soon as possible to be 
put under the care of one. In these and 



j in all cases of bowel complaint, diet exerts 
| great influence ; generally speaking, the 
! preparations of milk and of the grains are 
most suitable, such as arrow-root, sago, 
tapioca, rice, &c. When broth is given, 
it should be in small quantity and of to- 
lerable strength ; it is improved by the addi- 
tion of gelatine and of well-boiled rice. Alum 
whey is sometimes found useful in these cases. 

Refer to Alimentary Canal — Bile, and Bilia- 
ry Disorder — Digestion, Qc. §c. 

DIASTASE— According to Liebig, is a 
portion of vegetable gluten in a state of de- 
composition, which possesses the power of 
converting starch into grape-sugar, in fact, 
of acting as a sort of yeast or ferment. 

DIATHESIS — Is a term used in medicine 
to indicate states of constitution peculiarly 
predisposed to certain diseases, such as 
scrofula, cancer, gout, &c. Peculiar dia- 
thesis is for the most part hereditary. 

DIASTOLE— Is the dilating action of the 
heart, or that by which its cavities are 
opened to attract and receive a portion of 
the current of blood, after a previous por- 
tion has been expelled by the systole or con- 
tracting action of the organ. 

Refer to Circulation — Heart. 

DIET.— See Food. 

DIGESTER, or Papin's Digester— Is a 
strong iron pot, the lid of which is fastened 
or screwed down, so as to be steam-tight, 
and is provided with a valve. By these ar- 
rangements, when the digester is placed near 
to or over the fire in cooking, the steam is 
confined, and by its pressure prevents the 
contents from boiling at the ordinary boil- 
ing temperature of 212° ; consequently it is 
possible to raise the temperature above this 
point, or that at which the amount of heat 
carried off by the evaporated steam balances 
that received by the fluid. This power of 
elevating temperature confers of course 
upon the water which must be used in the 
vessel increased power of acting upon bones, 
or any other substances immersed in it. The 
use of the digester, either in an economical 
or dietetic point of view, is to be strongly 
recommended. The valve, of course, pre- 
vents all danger from bursting. The price is 
moderate. Bones which have been well acted 
upon in a digester have their animal matter 
so thoroughly exhausted that when taken 
out they fall in pieces, little being left except 
the earthy constituents. The amount of 
animal nourishment in the form of gelatine 
thus extracted from bones is very consider- 
able, quite sufficiently so to make it an object 
to the poor in their own homes, and, in the 
houses of the rich, as the foundation of soup 
for distribution. Refer to Heat — Gelatine, §c. 



DIG 



192 



DIG 



DIGESTION*— Is the process by which 
food is fitted for the nourishment of the 
animal body. The whole process may be 
divided into— 

The mastication or chewing of the food, 
and its mingling with the saliva or spittle. 

The swallowing of the food. 

The digestion of the food in the stomach, 
by means of the gastric juice. 

The mixture of the food with the bile and 
juice from the pancreas, and its conveyance 
through the small intestines. 

The passage of the remains of the food 
into and through the large intestine or colon, 
during which it becomes acid and mixed 
with the feculent excretions from glands of 
that bowel. 

The discharge of the remnants of the food 
from the body along with other exGrementi- 
tious matters. 

To the above may be added the passage 
of the digested and nutritious part of the 
food into the blood. 

The first process of digestion, the masti- 
cation or breaking down of the food by the 
teeth, and its mixture with the saliva, is one 
of extreme importance [but often entirely 
overlooked by many in the United States]. 
The teeth of man are evidently adapted for 
the two processes of cutting and bruising; 
the front, or " incisor teeth," being construc- 
ted for the former purpose, the back, or molar, 
for the latter. These adaptations are well 
seconded by the action of the powerful mus- 
cles of the lower jaw, which give it a direct 
cutting, and a side to side or grinding motion. 
The morsel of food submitted to this mecha- 
nical action being at the same time kept ad- 
mirably under it by means of the extraordi- 
nary mobility and sensibility of the tongue, 
it is thoroughly moistened by the saliva or 
spittle, which is poured out abundantly from 
the " salivary glands," which lie imbedded 
around the mouth and jaws ; the same me- 
chanical action which grinds the food serv- 
ing also to press out the secreted saliva. 
This fluid, however, does not act simply as 
a moistener of the food ; it exerts a distinct 
chemical or digestive power upon its starchy 
components, acting in the same manner as 
the "diastase" mentioned a few articles 
back, and converting them into sugar, in 
which state they become fitted for absorption 
into the blood — a -capability which starch 
does not possess. It has also been imagined 
that air becomes mixed with the food during 
mastication, and that its presence in the 
stomach was in some degree connected with 
the process of digestion ; this, however, is 



* In connection with this article, the reader is re- 
quested to refer to that under " Alimentary Canal." 



doubtful. "When the food-morsel has been 
masticated, and moistened sufficiently — at 
least such ought to be the case — it is col- 
lected by the action of the tongue into a 
ball, and conveyed to the back of the throat 
or fauces, where it is consigned to the care 
of involuntary muscles, and passes for the 
most part from under man's direct control. 
Passing from the throat into the gullet, it is 
carried by the wave-like action of that tube 
into the stomach. This action is not, as 
some might imagine, a simply mechanical 
one, that is, the food does not drop into the 
stomach as it would into a bag, by means of 
its own weight, but it is carried thither by 
the muscular movements of the oesophagus, 
or gullet, by the same power that water is 
conveyed upward through the gullet of the 
horse or cow when drinking, or indeed in our- 
selves, as any one can testify who has drunk 
from a spring by stooping down to the 
water, f The entire process of swallowing, 
particularly that part of it by which the top 
of the windpipe is protected during the pas- 
sage of the food over it, is a series of beau- 
tifully connected actions. 

When the food has been passed down the 
gullet, and has reached the stomach, it 
lodges in its left or larger extremity. As 
soon as the lining membrane of the organ 
feels the contact of nutriment, it becomes 
reddened, there is evidently increased flow 
of blood to it, and quickly its peculiar se- 
cretion, the "gastric juice," or solvent 
fluid of the stomach, begins to be poured 
out. This fluid is "clear, transparent, and 
viscid, without smell, slightly saltish, and 
very perceptibly acid," its characteristic 
power being that of dissolving the chief 
components of the food, and reducing the 
varied ingredients of a common meal to one 
homogeneous, gray-looking, pulpy, acid 
mass, which is called the "chyme." This 
uniform mass, when formed, varies but 
slightly in perceptible character; when 
the food has been farinaceous, it is like 
gruel, but when much oily or fat nutriment 
is mixed with it, it has more of a creamy 
appearance. 

The solution of the food, and its forma- 
tion into chyme by the powers of the gas- 
tric juice, is much assisted by the muscular 
movements (alternate contractions and re- 
laxations) of the stomach, which turn the 
mass over and over, and thoroughly incor- 
porate it with the solvent fluid. When the 
chyme is fully formed, it is probable that 
the gelatine components of the food have 



f One of the African barbarian despots has been said 
to administer drink to his subjects — as an honour con 
ferred— while they were placed head downward. 



DIG 



193 



DIG 



been dissolved, and what are called its albu- 
minous components, such as the curd of 
milk, or cheese, or the muscular flesh of 
meat, or the gluten of grain, have for the 
most part been reduced to the condition of 
a soluble albumen, fitted for absorption into 
the system. The action of the acid gastric 
juice, however, puts a stop to the conver- 
sion of the starchy ingredients of the food 
into sugar by the saliva. But this is re- 
sumed in the small intestines, when the acid- 
ity of the chyme has been neutralized by 
the alkalinity of the bile and juice of the 
pancreas or sweetbread, with which it be- 
comes mingled, immediately after it passes 
or is passed through the opening at the 
right^ or smaller extremity of the stomach 
into the duodenum, or first portion of the 
small intestines. This passage of the chyme 
from the stomach into the intestines is ef- 
fected as each successive portion is perfectly 
formed, that is, has become of semi-fluid, 
perfectly smooth consistence ; for in a 
healthy condition of the digestive organs, 
should a portion of solid food attempt to 
pass the muscular valve at the "pylorus," 
or place of exit, it is immediately closed 
against it, and the morsel passed back into 
the stomach. As already mentioned, the 
chyme has no sooner passed from the sto- 
mach into the small intestines than it be- 
comes mingled with the bile, which is con- 
tinually distilling into them from the liver, 
and with the juice from the pancreas or 
sweetbread. The effect of this admixture 
is to neutralize the acidity of the chyme. 
The action of the saliva in converting 
the starchy matters into sugar is now re- 
sumed, and is probably assisted by the 
fluid from the pancreas, and the oily prin- 
ciples of the food are converted into a 
milky-looking emulsion, in which state they 
are fit for absorption into the system. The 
digested and altered food mass is now passed 
slowly through the small intestines by their 
muscular, " vermicular," or wave-like move- 
ments. During this passage, the nutrient 
portions are absorbed, partly by the blood- 
vessels, and partly (more particularly the 
oily emulsion portion) by the lacteal absorb- 
ent vessels, until the now almost exhausted 
food, reaching the valve-like opening into 
the large bowel, or colon, is discharged 
into it. Here the food mass again becomes 
acid, and this change is supposed by some, 
and not improbably so, to be of the nature 
of a second digestion, to insure the perfect 
solution of any, matters which may have 
escaped the first acid digestion in the sto- 
mach. A more striking change, however, 
is effected, for here the contents of the 
R 



bowels assume their natural faecal or excre- 
mentitious character, and acquire their cha- 
racteristic odour from being mingled with 
used-up matters thrown out or excreted 
from the system at large, from the small 
glands with which the lining membrane of 
the large bowel is studded. , The absorption 
of the nutrient matters from the chyme 
requires a little explanation. The process 
is now considered to be largely shared in by 
the blood-vessels, but much of it is doubtless 
effected by the lacteal vessels, which, in- 
deed, were at one time considered to be the 
sole agents for the purpose. These little 
vessels (fig. liii. 1) are abundantly distri- 
buted over the small intestines, (fig. liii. 3.) 



Fig. liii. 




The lining membrane of this portion of the 
alimentary canal is thrown into folds for the 
purpose of increasing the surface for ab- 
sorption, and this lining membrane has a 
velvety appearance, from innumerable small 
elevated points, or " villi," which cover it — 
each of these villi contains a small lacteal 
vessel. These vessels were formerly thought 
to absorb the nutrient portion of the food or 
"chyle" by means of open mouths, but it 
is now ascertained that the absorption is 
effected in the first place by minute cells, 
which burst when full, and deliver up their 
contents to the lacteal twigs in contact with 
them. By the lacteals, the "chyle," or 
milky-looking fluid absorbed from the intes- 
tines, is conveyed through a set of small 
glands, (the mesenteric, fig. liii. 2,) after 
passing through which, the chyle, this ex- 
tract from dead food, seems (if we may so 
speak) to become in some degree vitalized ; 
it acquires power of coagulating, and as- 
sumes a red tinge when exposed to the air. 
The chyle from the various smaller lacteal 
vessels is now collected in the larger trunks, 
which coalesce at one point, and form one 
main vessel, the "Thoracic duct," (fig. liv. 1,) 
which runs up and lies close upon the spine, 



Dia 



194 



DIG 



Fig. liv. 




till, arriving at the neck (2), it turns down 
and opens to discharge its contents into the 
general current of the circulation at the 
junction of the large veins of the head and 
neck (3, 3) with that from the arm. 

Such is the marvellous process by which 
man's material body is daily nourished, and 
its strength preserved and renewed ; such, 
at least, is the healthy process, as it ought 
to be. The most generally prevalent causes 
of its disorder, and they are very general 
and very prevalent, it remains now to point 
out. Of course the nature of the food must 
exert great influence, for good or evil, over 
digestion ; but as that will be fully discuss- 
ed under the article Food, it need not be 
entered into here. 

One of the most frequent causes of dis- 
order of the digestive function is insufficient 
mastication, either from want of teeth, from 
a habit of hurried eating, or from careless- 
ness : many persons but half, or indeed 
scarcely at all, chew their food, which is 
swallowed in lumps, and, of course, not 
being broken down, is unmixed with the 
due proportion of saliva. Fortunately, the 
solvent powers of the gastric juice are suffi- 
ciently active to compensate, in the course 
of time, for the imperfect performance of 
the first of the digestive operations. But it 
must be evident to all how much longer 
and more laborious the process must be of 



dissolving a solid lump of meat or potato, 
than of one well broken up and opened up 
to the operations of the gastric juice. It 
must also be evident, that in the case of 
farinaceous and vegetable food, insufficient 
admixture of saliva must occasion insuffi- 
cient digestion, or conversion of the starchy 
matter into sugar, and that, therefore, a 
portion of the food consumed may become 
useless. 

Another evil resulting from imperfect 
mastication is the rapidity with which food 
is introduced into the stomach, so that, pro- 
bably, the organ is overloaded before the 
natural sensation of appeased hunger can 
make itself felt. 

Many persons, again, hurry over their 
meals with minds intently engaged on some- 
thing else ; the food is swallowed as quickly 
as possible, and the scarcely interrupted 
mental effort or business anxiety is re- 
sumed, or, it may be, active exertion at 
once engaged in. Now, it is a law of the 
animal economy, that all the functions of 
the living body, and those which are only 
periodically called into exercise more than 
others, require, for their perfect perform- 
ance, some additional access of nervous 
power, and some increase in their usual 
supply of blood, while the peculiar function 
is in active operation. With the stomach 
this is peculiarly the case ; the disinclina- 
tion for exertion and the slight sensation 
of cold which generally follow a full meal, 
are the results of the call made upon the 
nervous energies, and upon the circulating 
blood, by the stomach during the first stages 
of digestion. These sensations are more 
felt if the individual remains quiet after a 
meal; less so, or not at all, if active exertion, 
either of mind or body, is at once engaged 
in ; and the reason for this is evident. In 
the first instance, the person who remains 
quiet permits the nervous power and the 
blood to be, as they ought, directed to the 
performance of the digestive function, and, 
consequently, their supply to the other por- 
tions of the body being diminished, inca- 
pacity for exertion, both of mind and body, 
is experienced. If, however, before the 
nervous and circulating energies have be- 
come fully directed toward the stomach, 
(or, indeed, if, after they have, exertion is 
made by a strong effort of the will,) they are 
attracted by a still stronger power, either of 
muscular movement or mental exercise, the 
inclination for rest is not experienced ; but 
this disinclination is attained at the expense 
of the stomach and of its digesti«ve powers, 
the food being more slowly, and perhaps 
imperfectly, digested. It is true that many 



DIG 



195 



DIG 



persons go on for a great length of time, 
without apparent bad results, violating the 
laws of their own constitution, snatching 
hurried meals, and running off to business, 
or study, or exertion, immediately after ; 
but the practice tells, in the course of time, 
and the extreme prevalence of disorder of 
the digestive organs, amid the commercial 
and professional classes in this country, is 
evidence sufficient of the hurtful tendency 
of such practices. There is, of course, much 
variation in the injury which the diges- 
tive powers sustain, for some have these 
naturally much more active than others, 
and can with much more impunity impose 
upon them ; but, as a general rule, moderate 
rest, both of body and mind, is requisite for 
a short period after a full meal has been 
taken, to insure the perfection and the con- 
tinued healthy operation of the digestive powers. 
If exertion is requisite, the meal should be 
made a light one, and the full supply of food 
delayed till rest can be taken. Somewhat 
similar consequences and enfeeblement of 
the function of digestion are apt to occur 
if an individual makes a hearty meal when 
in a state of fatigue or exhaustion from 
exertion previous to the taking food, even 
though quiet is observed after it ; the nerv- 
ous power being exhausted, cannot be suf- 
ficiently supplied to the stomach to support 
its efficient action. 

Another frequent cause of disordered di- 
gestion is excess of food, either at once or 
by its too frequent repetition. It would 
seem that the healthy digestive power and 
secretion of the gastric juice is dependent 
in some degree upon the requirements of 
the system; and, as the gastric juice can 
only dissolve a certain proportionate quan- 
tity of aliment, if more is taken than there 
is gastric juice to act upon it, it must be 
imperfectly or not all digested, and if it is 
not, it becomes subject to the same chemical 
laws as if exposed to heat and moisture out 
of the living body. Fermentation, and, it 
may be, putrefaction, take place ; gas — 
"wind" — is generated, acids are formed, 
both in the aliment itself, and thrown out, 
probably by the efforts of the irritated sto- 
mach, and heartburn, pain, and the many 
other uneasy sensations connected with indi- 
gestion are developed. Many of the causes 
of indigestion are undoubtedly traceable to 
other sources, but the consideration of those 
will be taken up in the articles devoted to 
the subject. ' The digestive power of the 
stomach is remarkably interfered with, or 
even negatived, in many diseases, especially 
those of an acute or febrile character; it 
seems to lose almost entirely its power of 



secreting the gastric juice, and with it, of 
course, all power of digesting. If food is 
put into it, it is unacted upon, and is pro- 
bably vomited after many hours almost 
unchanged. There can be no question that 
this instinctive sympathy, as we may call 
it, of the stomach with the constitution at 
large, is wisely intended to prevent nutri- 
ment being introduced into the system, and 
into the blood, when it would either only 
tend to embarrass the curative powers of 
nature or to aggravate' the disease. 

From the review now taken of the nature 
of the process of digestion, and of the more 
general causes of its disorder, the reader 
must have been made rationally aware of 
the necessity and reasons for attending to 
those requirements which have been pointed 
out as imperative for the immediate proper 
performance or for the continued health of 
the function. The food must be prepared 
for the stomach in the mouth, and the 
stomach must not have the nervous energy 
and blood supply, requisite for the im- 
portant office it performs for the system at 
large, abstracted from it by unseasonable 
exertion. The food must, too, be propor- 
tioned to the wants of the system. If a 
man will be sedentary, if he will not use up 
his blood, his muscle, and nerve in active 
exertion, he must not expect to enjoy food 
like one who does ; he may eat the food, 
and, if he possess naturally strong digestive 
powers, his stomach may dispose of it with- 
out giving him much inconvenience ; but 
when the excess of nutriment reaches the 
blood, it must either be deposited as fat — 
itself, when in excess, a disease — or it must 
be developed in the poison of gout, gravel, 
or biliary or other disorders. 

Hitherto, the processes of the first or pri- 
mary digestion have been considered, being 
the changes of the food from its introduc- 
tion into the mouth, to the discharge of its 
refuse on the one hand, and the passage of 
its nutrient materials into the blood on the 
other. Physiologists, however, recognise a 
secondary digestion, embracing the changes 
undergone by the blood and tissues in the 
performance of the various functions of 
the living body, and the final discharge 
of their components after they have fulfilled 
their offices. As the consideration of these 
changes is entered into in various articles, 
such as "Animal Heat," "Nutrition," "Re- 
spiration," " Motor Change," &c. it is un- 
necessary to pursue it further in this place. 

It may, perhaps, have puzzled the unpro- 
fessional reader that at times the digestive 
operations have been alluded to as if they 
had been actually witnessed by the eye, 



DIG 



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DIL 



and such is the fact ; for it happened that, 
between twenty and thirty years ago, an 
American physician — Dr. Beaumont — enjoy- 
ed the rare opportunity of experimenting 
and witnessing with his eyes the results of 
his experiments, upon the healthy stomach 
of a living, healthy man. 

The subject of Dr. Beaumont's experi- 
ments was Alexis St. Martin, a young Cana- 
dian of good constitution and robust health, 
who was accidentally wounded by the dis- 
charge of a musket, which carried away a 
portion of the skin and muscles covering 
the stomach, and perforated the organ : by 
good treatment, St. Martin recovered from 
the injury, but the opening into the stomach 
never closed. The case coming under the 
notice of Dr. Beaumont, he, fortunately for 
science, availed himself most fully and in- 
telligently of the unique opportunity it af- 
forded ; and, by numerous well-conducted 
and accurately recorded experiments, he 
cast light upon many unascertained points 
connected with the process of digestion, to 
some of which allusion will be made in 
future articles, particularly in that upon 
food. Those who wish further information 
respecting the case will find all its details 
in Dr. Beaumont's work. 

Refer to Absorbents — Alimentary Canal — 
Chyle — Food — Indigestion, fyc. 

DIGITALIS, or Fox-Glove— Is well 
known, and one of the handsomest of our 
native plants. It is biennial, that is, the 
first year a tuft of leaves only is formed, and 
the flowers do not appear till the second 
summer. About the middle of June, the 
wand-like stem, rising from two to four 
feet high from the centre of the root-leaves, 
begins to expand its purple blossoms, re- 
sembling in some degree, in shape, the finger 
of a glove, from which resemblance the plant 
is named. 

Digitalis is a very powerful medicine, 
and, except in skilled and careful hands, a 
dangerous one, and can never be employed 
with propriety as a domestic remedy, al- 
though in Ireland it is used by the peasantry 
for the cure of epilepsy. 

Fox-glove acts powerfully upon the kid- 
neys in many cases, but its most marked, 
and at the same time, most dangerous 
property, is that which it possesses of de- 
pressing the action of the heart, the hazard 
being increased from the tendency of the 
medicine to accumulate in the system, and 
suddenly to develop its depressing or poi- 
sonous effects. There are but few cases of 
direct poisoning by fox-glove recorded, but 
accidents sometimes happen from the in- 
cautious administration of it as a medicine : 



in these cases, great languor and depression 
of the action of the heart, yawning, giddi- 
ness, nausea, and a sense of anxiety are the 
usual symptoms. The best antidotes would 
be wine or brandy, small doses of opium, 
ammonia, and strong infusion of green tea. 

DILL, or Dill-Seed — Is the fruit of an 
umbelliferous plant, the Anethum Graveolens. 
It is a native of South Europe, but is culti- 
vated in England. The distilled water, or 
" dill-water," is one of our best carmina- 
tives for infants, in one or two teaspoonful 
doses, either alone or combined with mag- 
nesia or chalk. 

DILUENTS — Are agents used medicinal- 
ly for diluting the fluids of the body, and 
in many diseases their employment is a 
subject of much practical importance. In 
most cases, either in health or disease,, the 
necessity for the use of diluents is made 
known by the occurrence of thirst. This 
sensation, which is perceived in the mouth 
and throat principally, is evidently only felt 
from sympathy with the body generally, 
for it is not relieved by the mere moistening 
of these parts, but only by a supply of 
fluid afforded to the system at large, either, 
as in most cases, by the stomach, or through 
the medium of the skin. Diluents may, 
however, be very serviceable in the treat- 
ment of some diseases when thirst is not 
felt, as in gravel ; they are much more 
largely used, and perhaps abused, as medi- 
cinal agents, in Europe, than they are in 
this country. Many reputed mineral waters 
act most beneficially by their diluting ef- 
fects : under the hydropathic system, the 
treatment is carried to a most unlimited and 
often injurious extent. 

There is no question, however, that the 
employment of diluents is too generally 
neglected in the treatment of disease in this 
country, although it is more resorted to now 
than formerly. Dr. Holland classes the 
beneficial action of diluents under three 
heads : — First, the dilution and washing 
away of excrementitious and morbid matter 
from the alimentary canal ; secondly, as 
acting upon the blood by dilution ; and 
thirdly, by influencing the various secre- 
tions and excretions of the body. Diluents, 
therefore, are useful in many affections of 
the stomach and bowels, in which their 
contents — as in bilious cholera — are acrid ; 
in fever generally, and in those cases in 
which natural secretions and excretions, 
such as the urine, are diminished in quan- 
tity and irritating in quality. In health, 
a certain amount of fluid, or of diluent, is 
required periodically by the body to supply 
the waste continually going on by the dis- 



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DIN 



charge of vapour from the lungs and skin, 
and by the excretions from the kidneys and 
bowels. The amount must, of course, vary 
somewhat according to the conditions of 
the surrounding atmosphere as to tempera- 
ture and dryness, and also according to the 
amount of exercise taken ; a man making 
much active exertion, and perspiring pro- 
fusely, requiring a much larger supply of 
diluent than one who is not. Stokers, iron- 
founders, and others who work hard under 
great heat, consume an almost incredible 
amount of fluid. The unnecessary use of 
diluents by persons in health is undoubted- 
ly hurtful, particularly when the amount is 
taken along with food; the gastric juice is 
thereby diluted too greatly, and its digestive 
powers impaired. Moreover, persons who 
drink largely with their food are apt to 
wash it down in a half-masticated condition, 
and to take more than is necessary. A 
certain amount of dilution is, nevertheless, 
requisite for digestion, and error on this side 
also is undoubtedly committed ; but these 
are points connected with individual consti- 
tution, which every man's sense and experi- 
ence ought, as far as he himself is concern- 
ed, to determine better than another can do 
for him. 

All dilution must, of course, be due to 
water, and the various forms of diluents 
used in illness are but varied modes of ad- 
ministering the pure element disguised. In 
many cases this is too largely practised, 
and patients very commonly, after having 
gone the round of -the various artificial 
drinks, are found to prefer and to adhere 
to the simple water as their most grateful 
and only drink. How often does the child 
with fever ask for " water from the pump, 1 ' 
in preference to every thing else. 

Water may be used as a diluent in its 
purest condition, that of distilled water, or 
rain-water, or as procured from the various 
sources of spring, well, river, or lake, in 
which cases it is more or less impregnated 
with foreign matters. Its temperature may 
be modified, for it may be used either ice- 
cold, or tepid, or warm ; or it may be ad- 
ministered in the form of some of the arti- 
ficial drinks, such as toast-water, barley- 
water, thin gruel, or, as on the Continent, 
as ptisan of various kinds. Weak tea is a 
common and favourite diluent with many. 
But diluents are not necessarily unstimu- 
lating, though most generally so : as a diete- 
tic diluent, beer, or wine, or spirit and 
water, may be more serviceable than the 
simpler forms, and the same may be the 
case on occasions, where there is intense 
thirst along with nervous exhaustion. Per- 
r2 



sons who have become exhausted by severe 
labour, having at the same time been ex- 
posed to heat, may often with greater bene- 
fit and safety take a small quantity of 
slightly stimulating diluent, than a larger, 
or even the same amount, of plain water. 
This must not be understood as a recom- 
mendation of stimulants under circum- 
stances of ordinary labour, but as applying 
to cases of exhaustion; and even in these 
the stimulant must be in very moderate 
proportion. 

The instinctive desire for fluid in cholera, 
and in diseases generally which are attended 
with fever, ought not to be neglected. There 
appears to be almost a superstitious fear with 
many, particularly of the poorer classes, 
of allowing the sick to "drink cold water," 
and muny a sufferer regards most grate- 
fully the unlimited permission of the medi- 
cal attendant to take it freely, after it had 
perhaps been begged for, but withheld by 
mistaken friends. There are few safer pre- 
scriptions, none perhaps which may be more 
freely carried out by unprofessional per- 
sons, than the unrestricted allowance of 
simple, unstimulating drink, in all acute 
diseases in which thirst exists, and especial- 
ly if fever be present. 

As mentioned in the first part of this ar- 
ticle, diluents may be administered through 
the medium of the skin, and thirst and dis- 
tress allayed in this way, when the power 
of swallowing is impaired, or lost either tem- 
porarily or permanently, or when the only 
diluent at command, such as sea-water, 
is unfit for drinking. Diluents may also be 
administered by injection into the bowels. 

Refer to Cold — Cookery — Heat — Thirst — 
Water, §c. 

DINNER — Is the meal of the twenty-four 
hours, the principal occasion on which the 
daily waste of the body is restored by food. 
At dinner, for the most part, the articles 
either of food or drink taken, are stronger 
and more stimulating than at any other 
meal; consequently its disposal makes the 
greatest demand upon the digestive powers. 
It matters not that what some persons call 
dinner others would call supper, for by the 
designation is here meant the principal 
meal of the day. The regulation of the 
meal as to time and circumstances, often 
requires more attention and care, in rela- 
tion to health, than is bestowed upon it, 
either by medical men or the public. In 
more primitive times, and where primitive 
habits prevail at the present day, the tim- 
ing of this principal meal must obviously 
be very different from what it should be 
when taken in connection with the habits 



DIN 



198 



DIN 



and modes of life of many in this country, 
particularly in our large cities. When per- 
sons, such as those engaged in country and 
agricultural work, rise very early, break- 
fast early, and are engaged in active mus- 
cular exertion in the open air, there can be 
no question that, by the time of noon, the 
system is ready for, and requires a full sup- 
ply of good nourishment ; and the powers 
of digestion are fully equal to the task, 
even though the interval of rest be not 
very great; and that, further, half a dozen 
hours' work afterward, pave the way for 
another substantial meal. Such being the 
case with our agriculturists, the healthiest 
and strongest, probably, of our population, 
and people seeing this, have jumped some- 
what hastily to the conclusion that the early 
dinner is the secret of health, forgetting the 
other accessories of fresh air and exercise, 
and, in case of the labourer, not over-active 
minds. The case of mechanics and arti- 
sans generally, who begin the day early, is 
nearly, but not quite similar to that of the 
labourer. They require a good meal tolera- 
bly early in the day, but not having the ad- 
vantage in many cases of the fresh air of 
the agriculturist, many of them might with 
advantage divide the meals a little more 
equally, diminish the dinner, and add to 
the meal made after work is concluded, 
more particularly when the dinner-hour is 
short, or shortened by the necessity of walk- 
ing home from the place of employment to 
the meal. 

When the cases of the higher classes is 
considered, it must be evident how com- 
pletely the time for their principal meal 
must be altered by circumstances. Begin- 
ning the day, for the most part, some hours 
later than the operatives, making, general- 
ly, much less physical exertion, and work- 
ing the head more, there is not the necessity 
for the principal meal being early in the 
day ; moreover, the employments generally 
of the class in question being more of the 
mind than of the body, and often of an 
anxious and thought-engrossing nature, 
they cannot in the midst of them cast loose 
the mind, or place it in the same careless 
ease as the physical labourer can do — conse- 
quently the digestive powers are interfered 
with. If these observations are taken in 
connection with those upon "Digestion," in 
the article devoted to that subject, their 
force will be seen. From them the follow- 
ing deductions may be drawn ; that although 
those engaged in physical exertion, either 
of business or pleasure, particularly if 
early hours are observed generally, require 
and ought to have the principal meal of the 



day early, those engaged in occupations of 
mental rather than of bodily exertion, 
ought to delay it till the necessity for the 
mental stretch is passed over. This sub- 
ject has been more dwelt upon, from its so 
frequently being the case, that early dining 
is prescribed in cases of stomach disorder 
as a sort of a panacea, which it does not 
prove. It is not counselled that the dinner- 
hour should be thrown too late in the even- 
ing — probably six o'clock should be the limit; 
but it is far better that it should be late, 
than interpolated in the midst of the tur- 
moil and anxieties of business or mental 
strain of study. It is objected that a late 
dinner involves either too long an interval 
between breakfast and dinner, or a luncheon. 
This is matter of constitution simply. Some 
persons of good constitutional powers, who 
can make a substantial breakfast between 
eight and nine in the morning, do not re- 
quire, and indeed are better without food 
between that meal and a five or six o'clock 
dinner ; those who cannot take so much at 
a time, are much more likely to do well 
with a light luncheon, not a meat one, in the 
midst of their work, than with a heavy 
meal, as even the lightest dinner must be. 
It is no real objection against a late dinner, 
that its being made after work, induces 
people to indulge in the pleasures of the 
table more than if they dined early : abuse 
will neutralize the good of any thing, how- 
ever beneficial, but it is not an argument 
against its use. Further, there are un- 
doubtedly invalids, and certain impaired 
states of health, in which an early hour for 
dinner is found beneficial ; but these must 
be cases in which either the state of health 
or circumstances require or permit all ar- 
rangements to be made conformable to the 
one object — health. An early dinner al- 
most certainly involves supper of some kind, 
and this may or may not be an objection, 
according to circumstances. 

Undoubtedly, modern habits and luxury 
tend frequently to make even this principal 
meal a much too abundant one, chiefly by 
tempting the appetite with a variety of food ; 
and it is impossible to lay down any set 
rules on this head beyond that which every 
rational man must be well aware of, that 
none can perseveringly transgress the 
bounds of temperance, either in eating or 
drinking, without sooner or later disease 
being the result. 

Sleeping after dinner may suit a few per- 
sons, but it is not advisable for those of full 
habit of body. For the reasons already 
mentioned, the time immediately succeed- 
ing dinner should be one of easy relaxation, 



DIP 



199 



DIS 



to the man of mental toil in particular. The 
use of wine, beer, or any stimulant falls 
of course to be considered under the other 
articles more directly bearing on these sub- 
jects. A cup of coffee is sometimes taken 
shortly after dinner; opinions differ as to 
the propriety or not of the practice. It will 
probably be found to be best regulated by 
individual experience. The practice, how- 
ever, of taking tea or coffee two or three 
hours after the meal is unquestionably a 
serviceable one amid the usages of civilized 
life, and assists the perfection of the latter 
stages of digestion. These diluents, how- 
ever, ought not to be taken too strong, or 
too late in the evening; otherwise their effect 
upon the nervous system will interfere with 
sleep. 

Some individuals of weak digestive powers 
are in the habit of taking a "dinner-pill," 
for the purpose either of exciting the appe- 
tite, of stimulating the digestion, or of both. 
As a habit, the practice is bad, because it 
must be a substitute for more efficient and 
permanent means of improving appetite and 
digestion; occasionally, however, in some 
cases the dinner-pill is useful as a temporary 
remedy. Eighteen grains of compound rhu- 
barb pill, six grains of cayenne pepper, and 
twelve grains of extract of gentian, made up 
into twelve pills, of which one or two may 
be taken a quarter of an hour before dinner, 
will be found useful. The practice of taking 
spirits, or stimulant cordials or bitters, before 
dinner, is highly injurious to the stomach, 
exhausting and irritating in a way that must 
interfere with digestion. A draught of cold 
water is a much better preparative ; with 
persons of very weak powers, however, cold 
water, either before or during the meal, de- 
presses too much. 

Eefer to Digestion — Food — Stimulants, §c. 

DIPLOE — Is the name given by anato- 
mists to the more cellular or porous portion 
of bone (fig. lv. 2, 2) which intervenes between 

Fig. It. 




the more condensed and solid, but thinner, 
outer and inner "tables," or plates (fig. lv. 
1, 1) of the skull. 
Refer to Skull. 



DIPSOMANIA— Is a state when habits 
of intemperance have reached such a height 
that the unfortunate victim becomes partly 
insane, or at least so much so as to lose ail 
self-control on the one point, and to become 
affected with the species of monomania to 
which the term " dipso-mania" has been ap- 
plied. Sir Alexander Morrison describes it 
as a "morbid craving for drink which gene- 
rally occurs at intervals, in which persons 
are seized with an irresistible propensity to 
drink to excess, although conscious at the 
time of their misconduct, but are unable to 
control themselves." 

Eefer to Delirium Tremens — Intoxication — 
Stimulants, Sfc. 

DISCHARGE— Used as a medical term 
generally, means any thing cast out from the 
body ; it is often applied, however, in a more 
restricted sense, to the excretion of purulent 
matter solely. 

DISEASE — Is any departure from the 
naturally healthy actions of the system at 
large, or of any structure or organ in par- 
ticular. The divisions and subdivisions of 
diseases, generally according to their nature, 
causes, &c. are very numerous. A distinc- 
tion is made into organic and functional 
diseases — the former being such as are ac- 
companied with perceptible and appreciable 
change from the natural structure or com- 
position of any component of the body — the 
latter those in which the actions are not 
healthy, but in which, as far as present 
means of investigation go, no appreciable 
departure from the ordinary structure can 
be detected. As, however, it may be doubted 
whether disordered action can take place 
without change of structure, temporary or 
permanent, its non-detection is probably 
owing to the deficiency of our present 
means of investigation ; and, indeed, chemi- 
cal analysis and the use of the microscope 
have demonstrated, and are daily demon- 
strating, the nature and tendencies of many 
alterations in the composition and structure 
of the bodily constituents which had pre- 
viously escaped notice. 

Perfect health consists in the uninter- 
rupted action and perfect balance of all the 
functions of the body — this involving of 
course perfection of structure ; the slightest 
pain or ache must be indicative of a hitch 
somewhere in the machinery. In this view, 
perhaps, none are free from disease for a 
day, for few can boast of such perfect un- 
deviating health as to pass four-and-twenty 
hours without some slight twinge of pain, 
without some ache or weariness to remind 
them that their bodies are mortal ; and 
from this slightest passing uneasiness to 



DIS 



200 



DIS 



the confirmed and fatal malady, disease 
passes through every gradation. Many of 
the most painful and deadly disorders are 
not more felt at their commencement than 
as a slight sense of discomfort ; and perhaps 
numberless of the lesser pains felt during 
what is considered health, might pass on 
to real disease, were it not for the natural 
tendency to cure with which our bodies are 
endowed — that which is called the " vis 
medicalrix naturae,'''' — the same tendency 
which restores the fractured bone to sound- 
ness and heals the ' wound. There can be 
no question, that, but for this tendency 
toward health, this power of resisting and 
casting off disease, our bodies would quickly 
succumb to the innumerable causes of dis- 
order to which they are hourly exposed. 
This power of resisting disease is without 
doubt much greater in some persons than 
others, and even in the same person at dif- 
ferent times, often without any perceptible 
reason why it should be so. The power of 
the system in casting off disease, when 
forming or formed, is for the most part more 
plainly exercised, but of this more will be 
said hereafter. 

Again, it it must be remembered that con- 
stitution and other causes occasion so much 
variation in the actions of the body, that 
what would be disease in one man is health 
in another. For instance, one man's pulse 
may average sixty in a minute, another's 
eighty ; and it is certain that the former 
could not rise to the level of the latter, or 
the latter sink to that of the former, with- 
out disease or disorder being present. Such 
considerations are important in judging of 
the real state of a person labouring under 
disease. To judge accurately of disorder, 
we must know the whereabouts of the level 
of health ; and in this consists the great 
advantage of the regular medical attendant 
over one who is casually consulted, and who 
first sees the patient when suffering under 
illness. In popular language, the regular 
attendant "knows the constitution" of his 
patient ; the other has it in many respects to 
learn. But if there is a tendency toward 
health, there is also a tendency, more or less, 
toward certain forms of disease, existing 
with every one — this tendency being either 
hereditary or acquired. The power of here- 
ditary tendency toward certain forms of dis- 
ease, such as scrofula and consumption, 
gout, gravel, and rheumatism, paralysis, &c. 
is so generally recognised as to be a matter 
of popular information ; that is to say, when 
these diseases have affected parents, or rela- 
tives of parents, they are regarded as here- 
ditary in descendants. There is, however, 



an hereditary predisposition not so apparent, 
which requires more notice than it receives : 
it is that which devolves upon children in 
consequence of the habits, &c. of the parents. 
The latter may be of healthy families, but 
if there has existed much inequality of age 
— especially if the father has been advanced 
in years, or if marriage has been contracted 
too early in life, or if either parents have 
lowered the standard of health by dissipa- 
tion or by any other means, their sins, in 
obedience to those laws which the Almighty 
has connected with our being, are visited 
upon the children, in tendencies to certain 
diseases. The offspring of drunkards are 
very frequently the subjects of affection of 
the brain and nervous system ; the child of 
the woman who gives way to indolence, or 
indulges in undue excitements, will in all 
probability fall below the standard of health. 
Tendency to disease may also be given in 
persons previously healthy, by whatever 
lowers their own standard of health. Dis- 
sipation of any kind, deficient food or sup- 
ply of pure air, exhaustion from whatever 
cause, depressing passions of the mind, &c. 
all give that tendency to disease which 
renders the constitution more susceptible 
of its attacks. Even the time of day exerts 
some influence ; for it is well known that 
a person is much more liable to become 
affected with any malady, either of a con- 
tagious or malarious character, such as 
ague, if exposed to its influences in the 
early morning, before the powers of the 
constitution have been invigorated with 
food, especially with that, such as warm tea 
or coffee, which affords the gentle stimula- 
tion of heat. Further, individuals are never 
so liable to succumb to disease as they are 
during the stage of depression succeeding a 
debauch. Every day adds to our experience 
of the way in which the ill-ventilated and J 
badly- drained dwelling gives the tendency to 
fever and to cholera, while at the same time 
it fosters their deadly germs into activity. 
Lastly, nothing predisposes more to disease, 
or increases the tendency to it, than the de- 
pressing passions, such as fear, despondency, 
&c. Those tvho give way to the fear of taking any 
malady, open the readiest door for its incursion; 
and even without the fear of the disease 
itself being the cause of the depression, the 
fact of the mind being depressed increases 
greatly the susceptibility to any causes of 
disorder in active operation at the time. 
This is often strikingly exemplified in the 
case of troops ; it is always observed that 
sickness is more prevalent among the men 
of a retreating and desponding army than 
under the reverse circumstances. Perhaps, 



DIS 



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under no circumstances is the worldly ad- 
vantage of a firm reliance upon Providence 
more palpable than when that reliance sus- 
tains the mind in cheerfulness, hope, and 
resignation — resistants to diseases which 
come to the aid of those who hold them, 
when other help seems to have vanished. 

There is a kind of mixed tendency to 
disease, partly hereditary, and partly ex- 
cited by external circumstances. It is this 
form which the children born in India and 
other hot climates, of English parents, suf- 
fer, particularly if the parents have been 
long resident. They cannot be retained 
in the clime of their birth, without the 
greatest risk to life, before the age of puberty 
is attained. 

Most of those causes which give a ten- 
dency to disease, also, in themselves, when 
acting with increased intensity, tend to pro- 
duce it, or to aggravate it when existing. 
The influences of climate, of air, whether 
pure or impure ; of food, whether deficient 
in quantity or quality ; of occupation, of 
habits, or mental influences, are all power- 
ful excitants of disease. The remittent 
fevers of the tropics and the typhus of 
England, the scrofula, the rickets, and cuta- 
neous eruptions, the consumption of the 
metal-grinders, the delirium of the drunk- 
ard, are all instances which might be multi- 
plied, of diseases produced by external in- 
fluences. The diarrhoea of fear, the nostal- 
gia or home-sickness (which is actually ac- 
companied with disease in the lungs) of the 
Highlander or of the Swiss, the diseases 
of the heart which result from the agitation 
of political or commercial excitement, are 
all examples of the production of disease 
by the internal agency of the mind. 

When disease has established itself in 
the constitution, were it not for the "ten- 
dency to health," it must run on to a fatal 
termination. The wound would remain un- 
healed, the inflammation would extend, or 
its effect remain unrepaired, were it not for 
these curative powers existing in the consti- 
tution itself. If, then, whatever tends to 
lower the standard of health favours the 
inroads of disease, so the preservation of 
that standard, as far as may be consistent 
with the safety of the patient and the re- 
duction of his malady, insures a more 
certain and speedy throwing off of the 
effects of the disorder, or in one word — con- 
valescence. Patients who have been pro- 
fusely bled are often very long in recover- 
ing, and during the period of recovery are 
liable to relapse, and to be attacked by other 
forms of disease. 

Moreover, during the progress of disease, 



nothing assists more the powers of the con- 
stitution which tend toward health, and 
to throw off the enemy, than a cheerful and 
hopeful mind ; as the people call it, a "good 
spirit." It may make all the difference be- 
tween recovery or the reverse. Indeed, 
every medical man must have met with 
cases of illness, in which the patient seemed, 
as it were, resolved not to give in — seemed, 
even under unfavourable circumstances, 
determined not to die, if they could help 
it — and did not die. Even when physical 
powers tended to death, the mind tended to 
life, and the mind succeeded. Were it not 
for the tendency to health, or to cure, ex- 
isting in the body, our medicines would be 
in vain ; and he is the best physician who 
can detect those tendencies to recovery, 
permit them to act when they seem strong 
enough, and assist them when they do not. 
The patient in the lowest stage of fever 
still has the tendency to health existing, 
and acting within, and battling with the 
disease ; the powers of a good constitution 
may of themselves be sufficient to conduct 
him over the crisis ; but they may not, and 
unassisted, the patient must sink ere the 
tendency to throw off the disease gets the 
mastery. But the physician steps in ; he 
gives his help to the constitution ; his wine, 
and bark, and nourishment, and regulation 
of- the functions, support the frame till the 
struggle is over, and the disease is van- 
quished. This power of throwing off dis- 
ease, this tendency to health with which 
the living body is endowed, requires to be 
impressed upon the mind of people gene- 
rally ; for they are too apt to attribute that 
to the action of medicine, which medicine 
only gives its assistance to, and to despise 
the simpler modes of treatment, which place 
the natural powers in the most favourable 
position for curing. The vulgar attribute 
the healing of the wound to the plaster 
which merely holds it together, and cold 
water is too simple to do good. 

The aggravation of existing disease, both 
by physical influences and mental emotions, 
is one of the most serious enemies the phy- 
sician has to contend with. The subject is 
sufficiently entered into in the various 
articles of this work. 

Lastly, disease is often established as a 
secondary affection: it occurs in consequence 
of some previously existing morbid con- 
dition of, or in, some part of the body. 
Dropsy is a disease peculiarly of this class. 
Affection of the heart, liver, kidneys, or 
other disorders, all tending to produce it. 
Apoplexy may result from disease of the 
heart. In these cases the secondary disease 



DIS 



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appears simply a result, without beneficial 
influence — but in many cases it exerts a 
tendency to remove the primary one ; and 
this fact is one of great importance in the 
treatment of all disorders of the body, for 
rash interference with the natural effort 
may throw the diseased action back upon 
the previously affected, or upon some more 
vital part. The healed-up ulcer, or cured (?) 
eruption, may occasion head disease, or the 
stopped diarrhoea may throw back upon the 
constitution, with serious or fatal effect, the 
blood poison of which the vital fluid was 
endeavouring to relieve itself. Even that 
alarming incident, spitting of blood, though 
in itself a grave symptom, may tend to re- 
lieve from worse evil. These efforts of the 
constitution, therefore, to cast off or cure 
disease, are to be cautiously interfered 
with. 

In the treatment of disease, two very 
different methods have to be pursued : the 
one is that which exerts itself directly to 
cure by the direct action of certain medi- 
cines. Of this, the cure of ague, of neu- 
ralgia, and other periodical diseases, by 
quinine or iron, is an example. Experience 
has unfolded to us that in these and similar 
cases, the medicine has the power of curing 
by some relation established between it and 
the disease by the Author of all things — and 
in nothing is his mercy more strikingly ex- 
emplified. But why quinine should cure 
neuralgia, why opium should allay pain, we 
cannot tell, at least in the present state of 
our knowledge ; the only approach to any 
explanation being one given by Liebig. 
The other method in the treatment of dis- 
ease is not so much of the active as of the 
expectant or passive character. There are 
many (perhaps the majority belong to this 
class) forms of disease for which we know 
of no cure, such as quinine is to ague. The 
throwing off the malady must be by the na- 
tural powers, and our only resource consists 
in putting and keeping those natural powers 
in as favourable a state for this purpose as 
possible. Of this, many forms of fever are ex- 
amples. We cannot hope to cure, we can only 
hope to pilot the body through the rocks and 
untoward currents which arise in the course 
of the disorder, to allay secondary diseases 
which show themselves, to alleviate painful 
symptoms, and to support the constitution. 
These facts should be made plain to the 
minds of unprofessional persons generally, 
for the most erroneous notions prevail upon 
the points just alluded to, and often lead to 
dissatisfaction with medical men. One who 
is content with guiding the course of -a 
fever, either with the gentlest treatment, or j 



with what people may consider no treat- 
ment at all, is looked upon as inefficient, 
while the busy meddler, who interferes 
without aim or object, and probably thwarts 
with uncalled-for medicine the natural tend- 
ency to cure, is regarded as the "active"(?) 
practitioner. 

The reference from this article must be 
to the work at large, for it bears upon the 
whole. 

DISINFECTANTS— Are any agents which 
detroy the power or means of propagation 
of such diseases as spread by infection or 
contagion. Purification of every kind, there- 
fore, either by fresh air or by water, is a 
disinfectant, these agents acting by dispers- 
ing or diluting the morbific germs, whatever 
these may be. A high temperature doubt- 
less acts as a disinfectant, by destroying 
their chemical composition, and chlorine 
and muriatic acids probably exert a similar 
influence. Quicklime and charcoal, on the 
other hand, most likely owe their disinfect- 
ing properties to their power of absorbing 
various gases. These chemical agents are 
all useful, but cleanliness and ventilation are 
disinfectants in the power of all, and their 
operation is both continued and conducive 
to comfort. 

Refer to Air — Contagion — Chlorine. 
• DISLOCATION— In medical, or rather 
surgical language, means the displacement 
from their natural positions of bones or 
portions of bones, at the points where they 
are connected together by means of joints 
or "articulations." There is not, perhaps, 
a bone in the body which may not be dis- 
placed by violence, but some are much 
more liable to the accident than others. It 
would answer no good purpose, in a work 
of this kind, to enter into details respecting 
the varied dislocations which may and do 
occur : a few, therefore, only of the com- 
monest, most easily recognisable, and most 
readily remediable will be noticed. There 
is some difficulty in treating the subject of 
dislocation in a popular work ; for, although, 
from the nature of the accident, and of the 
circumstances in which it is apt to occur, 
it is highly desirable that some knowledge 
should be possessed by the unprofessional, 
both as regards the signs and symptoms of 
dislocation, and its more immediate treat- 
ment, the difficulty that occasionally pre- 
sents itself, even to the skilful surgeon, in 
determining whether dislocation actually 
exists or not, or whether it is complicate^' 
with some other injury, such as a fracture 
renders the matter a delicate one for . la^ 
interference. With this caution, therefore, 
that unless tolerably clear upon the point, 



DIS 



203 



DIS 



it will be "better to wait even days for the 
arrival of skilled advice, than to make 
attempts to remedy an uncertainty ascer- 
tained injury, the following hints may be 
useful, particularly in those cases in which 
the accident does not happen for the first 
time, and this will often be the case ; for, 
having once occurred, it is very apt to do so 
again, even from slight causes. In such 
cases, the doubt as to the nature of the mis- 
hap' will be most materially diminished; 
indeed, the patient himself is generally 
perfectly well aware of what has occurred, 
and can often give directions accordingly. 
The symptoms of a dislocation having oc- 
curred after violence or accident are pain 
with loss of power over the limb or member, 
and its becoming fixed in one position, so that 
it cannot be moved, either by the patient or 
by others, at least not without occasioning 
severe suffering; numbness is felt in the 
limb, the person becomes faint and sick, 
and if the shape of the joint be examined, it 
will be found deformed. 

Whenever doubt exists as to whether dis- 
location has or has not happened, the case 
should be examined by a competent surgeon 
as early as possible, and no time wasted in 
fomentations and rubbings, which are per- 
fectly useless. If a bone is "out of place," 
it cannot be too soon restored to its proper 
position, and nothing will give relief, at 
least for a long period, if this is not effected. 
A bone certainly may remain permanently 
dislocated, and the member attain, in the 
course of time, a very considerable amount 
of motion, by the formation of a new joint ; 
but it is long before it does so, the power 
of movement is never equal to what it was 
was before, or would have been had the in- 
jury to the joint been properly rectified, 
and much unnecessary pain is suffered. 
The necessity for the speedy reduction of a 
dislocation is great, from the fact that every 
day increases the difficulty of its perform- 
ance ; and when a certain time has elapsed, 
no force which can be exerted — consistent 
with safety to life and limb — will be ade- 
quate to return the displaced bone, partly 
owing to the resistance of the muscles, but 
also to obliteration or doing away with the 
cavity which formed the one portion of the 
joint. When dislocation occurs, two differ- 
ent actions take place ; one, that by which 
the bone is driven from its usual position ; 
the other, the action of the muscles, which 
tend still further to draw it from its proper 
site as soon as the balance of resistance of 
bone against bone is removed. It is, too, 
in most cases, the action of the muscles 
which tends to keep the bone displaced, 



and to resist the efforts made to replace it. 
This is evident from the fact, that if a per- 
son be seen immediately after a dislocation, 
and while suffering from the faintness which 
almost invariably accompanies the accident, 
and while the muscles are necessarily in a 
state of weakness and relaxation ; the dis- 
location may often be reduced with the 
greatest possible ease, even by the unskill- 
ed ; and further, when the surgeon has to 
deal with a case of dislocation in a strong 
and muscular subject, he endeavours to 
produce this faintness — if that following 
the accident has passed away — by bleeding, 
nauseating medicines, warm baths, &c, [or 
by causing the patient to inhale aether or 
chloroform. These articles are, however, 
too dangerous for an unprofessional person 
to use ; and the necessary relaxation had 
better therefore be accomplished, when it 
is essential, by making the patient "dead 
drunk."] When, therefore, a dislocation 
occurs, the bone is not simply pushed out 
of its place, but is drawn for the most part 
upward, or toward the body ; the dislocated 
bone of the finger is drawn upward over its 
fellow ; the arm-bone, in dislocation of the 
shoulder, may be drawn upward, or into 
the armpit — in this case downward, it is 
true, as regards the joint, but still toward 
the body ; and the same will be found to be 
the case in most forms of dislocation. The 
first object, therefore, in treating a disloca- 
tion, must be to draw it down from or out 
of the situation to and in which it has been 
drawn and is retained by the muscles of 
the limb, and to get it as near the corre- 
sponding part of the joint, or, in other words, 
as near the part from which it has been dis- 
located, as possible. If the dislocated bone 
is thus drawn down to, or near to the level 
of the other portion of the joint from which 
it has been removed, the muscles will of 
themselves tend to draw it into its old posi- 
tion. A good deal is often said about the 
adjustment, &c, &c. of the bone in reducing 
dislocations ; and though, perhaps, useful 
in some cases, in many nothing of the kind 
is required, at least unprofessional persons 
should not attempt it ; all that is to be done 
is, give the muscles the chance of drawing 
the bone into its old place, by bringing it 
to a position in which this can be effected. 
This is often exemplified in cases in which 
much force is used in the reduction of a 
dislocation ; if the force be kept up strongly, 
the bone cannot be drawn into its socket, 
because the force is stronger than the mus- 
cles of the patient ; but relax the external 
force for a moment, and without any fitting 
or adjustment, the bone is instantly drawn 



BIS 



204 



DIS 



into its proper position by the power of its 
own muscles. The above principles will be 
better understood by a reference to the an- 
nexed cut — for which the author is indebted 
to Professor Fergusson's Manual of Surgery. 
In this, (fig. lvi.,) 1 is the shallow cup 
Fig. lvi. 

2 

/ 




[glenoid cavity] attached to the shoulder- 
blade, (3,) in which the round extremity or 
head (2) of the arm-bone (4) ought to rest, 
but from which it is represented as dis- 
placed or dislocated. The muscles are not 
here represented. It is evident, that before 
the round head (2) is replaced in the cavity 
(1) it must be forcibly drawn down to its 
level ; this drawing down the muscles 
strongly resist, but also tend by the same 
power to draw the head of the bone into its 
place, as soon as it is drawn down sufficiently 
for them to do so. 

These principles respecting the nature 
and management of dislocations have been 
dwelt upon, from the author thinking that a 
knowledge of them would be more likely to 
lead an intelligent non-professional person to 
judge correctly and act efficiently on such 
emergencies, than the bare enumeration of 
certain sets of symptoms, often sufficiently 
obscure, which characterize the different 
forms of dislocations, and which he could 
not carry in his mind. There is, however, 
yet another important principle involved in 
the reduction of dislocations. It has been 
pointed out how the bone farthest from the 
body — which is usually drawn up — is to be 
drawn down; but, that this may be done 
properly, the bone above it must be fixed, 
otherwise it will be drawn down too. This 
is easily effected in such cases as the ankle 
or the wrist, by any one grasping and hold- 
ing firmly either the leg or the forearm ; 
but in the case of the hip or the shoulder, 
more management is requisite. In the lat- 
ter, which is the most likely to fall under 
non-professional treatment, the shoulder- 



blade must be fixed or prevented from 
giving way with the "extending" force ap- 
plied to the arm-bone ; how this is to be 
done will be pointed out when the particu- 
lar dislocation is treated of. Again, in 
"making the extension," that is, using the 
forcible effort to return the dislocated bone 
to its place, the extending force will best be 
made in the direction in which the limb is 
fixed, and in the manner most likely to 
bring the joint portion, or "articulation" 
of the displaced bone, as near to the old 
position as possible, and it must be applied 
directly to the bone which is displaced. 
Thus, in dislocation of the shoulder, the 
reducing force is applied to the arm-bone ; 
in dislocation of the hip to that of the thigh. 
This extending power may simply be by the 
hand, but a cloth, or band of some kind, 
put round the member to be replaced, is 
often more advantageous. In order to put 
this band on most efficiently, it is applied in 
the form of what is called the clove-hitch, 
[or knot often tied by sailors,] (fig. lvii.,) 
Fie;, lvii. 




which will be better understood from an 
examination of the cut than from any 
description. This double noose, which may 
be formed of any suitable material, such as 
a large soft handkerchief, being fitted to 
the part to which force is to be used, with 
a piece of cloth interposed between it and 
the skin, is not liable to tighten when its 
loose ends are used to pull by. The particu- 
lar dislocations most likely to be recognised 
and to be remedied by unprofessional per- 
sons, are those of the small joints, such as 
fingers and toes ; of the wrist and ankle ; 
of the elbow, shoulder, and lower jaw. 

Dislocations of the fingers or toes may 
generally be made out by any person, and 
should, if possible, be reduced at once ; the 
dislocated bone being grasped as represented, 
(fig. lviii., also taken from Ferguson's Sur- 
Fig. lviii. 




BIS 



205 



DIS 



gery,) and forcibly pulled into place ; or 
the clove-hitch noose, made with a piece of 
tape, may be used. Dislocation of the 
thumb, it should be known, is extremely 
difficult of reduction, and should this not be 
effected at once, the attempt ought to be given 
up until the surgeon's arrival ; it is, more- 
over, one of the dislocations which may be 
left unreduced with less subsequent incon- 
venience than many others. Dislocation of 
the ankle is very generally accompanied 
with fracture, but the distortion is often so 
great and evident, and the suffering so se- 
vere, that when the accident does occur far 
from proper aid, some attempt ought to be 
made to put the displaced parts in better 
position. For this purpose, while one indi- 
vidual grasps the leg firmly, another, put- 
ting one hand on the heel and the other on 
the instep, should endeavour, while steadily 
pulling downward, to bring the joint into its 
natural position. 

Dislocation of the wrist is reduced by the 
forearm being tightly grasped by one indi- 
vidual, the surgeon laying hold of the pa- 
tient's hand in his, and endeavouring by 
steady traction downward, and slight up and 
down movement, to bring the joint into its 
proper condition. 

Dislocation of the elbow, if attended to 
quickly after the accident, may often be 
easily reduced by seating the person in a 
chair, carrying the arm well behind the 
back, and pulling, not very forcibly, upon 
the forearm. 

Both these dislocations — of the wrist and 
elbow — may be suspected, when, after vio- 
lence — particularly such as is calculated to 
push either the hand or lower arm upward 
— inability to use the limb below the seat of 
the injury, and distortion and impaired mo- 
tion of the joint, are unaccompanied with 
any grating sensation, such as occurs when 
a bone is fractured. 

Dislocation of the shoulder is most generally 
occasioned by violence applied to the elbow, 
or by falls, while the arm is not close down 
to the side of the body. Sometimes the 
exact discrimination of an injury to the 
shoulder joint is a matter of much difficulty, 
for fracture alone or fractures with disloca- 
tion may occur. At other times, particu- 
larly in thin persons, it is tolerably easily 
made out — more so if the examination is 
made before swelling comes on. In addition 
to the general symptoms of dislocation al- 
ready enumerated, the injured shoulder will 
be perceptibly altered in shape ; it will ap- 
pear more depressed and flatter than the 
sound one, and if the hand is placed upon 
the spot which ought to be occupied by the 
S 



round head of the arm-bone — and this may 
be discovered by examination of the unin- 
jured shoulder — it will be found hollow; 
and further, if the arm be now gently moved 
about, and its bone traced up toward the 
shoulder, it will be found moving in some 
unusual position, most probably in the arm- 
pit. Supposing, therefore, that the case is 
sufficiently clear, and that the sufferer from 
the accident, in the absence of proper surgical 
assistance, is content to risk the matter upon 
non-professional judgment, or that, from 
having been the subject of the accident 
on some previous occasion, he is tolerably 
certain of its present nature, the means for 
the reduction ought to be set about as 
speedily as possible — if it can be, while faint- 
ness from the injuries continues. These 
means vary considerably. Hanging over 
doors or gates, the arm-pit being placed on 
the edge, have been employed and recom- 
mended; and, in persons who have been the 
subjects of frequent dislocations in the same 
shoulder, may be efficient ; but in a first dis- 
location should never be resorted to. One 
method of reducing dislocation of the arm- 
bone into the arm-pit frequently employed is 
for both patient and surgeon to lie down upon 
the ground side by side, but with their 
heads different ways, and so that the sur- 
geon having previously taken off his boot, 
can place his heel in the arm-pit of the pa- 
tient, while he grasps the hand, or a towel 
fixed to the arm of the affected side ; in 
this way, while the heel is used to push 
against the displaced bone in the arm-pit, it, 
combined with the traction exerted by the 
surgeon upon the limb of the patient, tends 
to give a leverage by which the bone is so 
placed that it can be drawn into the socket 
by the muscles. This method may be a con- 
venient one, when only one person is in com- 
pany with the individual to whom the acci- 
dent has happened. The following is the most 
useful and most generally resorted to method 
of reducing a dislocation of the shoulder. 
The patient being seated on a chair, a large 
towel or a table cloth, folded broad, is to 
be passed round the chest, close under the 
arm-pit of the affected side, crossed over 
the opposite shoulder, and held either by a 
strong assistant or fastened to some fixed 
point. By this application, the shoulder 
blade is fixed; the arm itself is then to be 
pulled, chiefly in the direction in which it 
has been fixed, firmly, steadily, and slowly; 
this being done, either directly by the hands 
of assistants, or by a towel fastened round 
the arm by the hitchnoose, (fig. lvii.) If 
when this steady pull has been persevered 
in for some time, the displaced bone does 



DIS 



206 



DOT 



not get into place, the effect of suddenly- 
taking off the attention of the patient may- 
be tried, either by some sudden exclamation, 
or by dashing a little cold water in the face. 
By such a proceeding, the muscles which 
resist the reducing or pulling force applied 
to the arm, are for a moment, so to speak, 
thrown off their guard, and that moment 
may suffice to permit the bone to pass into 
its socket. 

Dislocation of the lower jaw is not a very 
unfrequent occurrence, and happens from 
persons opening the mouth very wide, 
either in laughing or gaping ; the jaw slips, 
and its articulations or joint portions on 
both sides are drawn forward ; the person 
cannot close the jaws, but remains with 
the mouth wide open, a most inconvenient 
position should skilled assistance be far 
distant. The accident, however, can scarcely 
be mistaken, and may be rectified without 
much difficulty by a bystander. For this 
purpose, the thumb or thumbs, according 
to whether the joint is entirely dislocated 
or only on one side, are to be placed by 
the acting party upon the upper portions of 
the back teeth, and strong pressure exerted 
downward, while the chin is drawn upward 
by the fingers at the same time. As the jaw 
returns to its place, its powerful muscles 
draw it upward with a sudden snap, and if 
the fingers of the operator are not covered 
with a handkerchief or some other material, 
[or quickly slipped to the sides of the teeth,] 
they may get smartly bitten. 

After the dislocation of any part has oc- 
curred and been reduced, a bandage, or 
some application which will confine the in- 
jured members, should be worn for some 
days, not simply from fear of the accident 
recurring at the time, but to keep the parts, 
which must have been more or less lace- 
rated, quiet, and to permit the internal traces 
of the injury to be as much as possible ob- 
literated. In conclusion, although the sub- 
ject of dislocations has been dwelt upon at 
some length, it is chiefly for the reason that 
these accidents, painful at the time, and, if 
unremedied, productive of deformity and 
impaired usefulness for the future, are often 
overlooked, or are apt to occur at great dis- 
tances from skilled assistance. In such 
cases, the information given in the fore- 
going article may prove a useful guide, 
either by directing attention to the import- 
ance of the injury and of its speedy rectifi- 
cation, or, if acted upon with care and pru- 
dence, by pointing out the most effective 
treatment. — Refer to Joints — Muscles. 

DISORDERED FUNCTION— A term very 
frequently used in medical language, means 



departure from the usual healthy action of 
any portion of the body, either unaccom- 
panied with perceptible change of structure, 
or as a consequent of altered structure of 
the part. 

Refer to Disease. 

DISTILLED WATER.— See Water. 
DIURETICS— Are medicines which in- 
crease the flow of urine. The class em- 
braces very many substances, but it will be 
sufficient to notice only those which may be 
most safely and generally used ; they are — ■ 

Broom, 

Dandelion, 

Fir Top, } 

Gin, I which contain turpentine, 

Juniper, j 

Parsley, 

Potash — Solution or Liquor Potassee, 
" Acetate, 

< ' Bitartrate, or Cream of Tartar, 
" Carbonate, 
" Nitrate of Saltpetre, 

Soda — Carbonate, 

Spirituous Liquors, 

Spirit of Sweet Nitre, 

Squill, 

Turpentine. 
There is always some degree of uncer- 
tainty in the action of diuretic medicines, 
but with some more than others. The au- 
thor has found the two first on the list 
(broom and dandelion) as certain, or more 
so, than any others, and, as domestic reme- 
dies, they have the advantage of being 
easily procurable in this country, and of 
being perfectly safe. Fluids should be 
given freely during the action of diuretic 
remedies. It sometimes happens, that diu- 
retics which would not act before, act after 
the administration of an active purgative. 
Similar effects are found in the hands of 
medical men, before and after bleeding. 
As mentioned under the article Coffee, the 
infusion of the raw berry is diuretic. Men- 
tal emotion such as fear, and nervous dis- 
orders such as hysteria, it is well known, 
give rise to great increase in the flow of 
urine. 

Refer to the various separate articles, for 
the uses, &c. of the diuretics mentioned. 

DOVER'S POWDER— Is a compound of 
one grain of opium, one of ipecacuanha, 
and eight grains of sulphate of potass, 
well powdered together ; ten grains conse- 
quently contain one of opium. It is much 
used as a remedy to produce perspiration, 
(in which, however, it often fails,) and in 
cases generally where opium is requisite. 
The ipicacuanha may occasion sickness. 
Refer to Opium. 



DOU 



207 



DRA 



DOUCHE — Is a stream of water directed 
upon any part of the body, and "is most fre- 
quently performed while the patient is in 
the bath. Douches are of various kinds, as 
the descending, the lateral, and the ascend- 
ing. The water in the first kind falling 
from a reservoir, at a greater or lesser 
height, upon the patient in a single or di- 
vided stream, the size of which may be va- 
ried according to circumstances. The lateral 
douche is produced by a man's pressing the 
water through a tube, as with a fire-engine, 
the stream being directed against any part 
of the body that is indicated. The strength 
of this can be regulated by the attendants 
pumping with a greater or less degree of 
force, and also by a finger placed over the 
aperture, by which the stream is divided. 
In the ascending douche, the column of 
water is directed upward, and is usually 
taken in a sitting posture ; this douche 
being almost exclusively employed in com- 
plaints of the organs contained within the 
pelvis. 

" Douches are directly exciting remedies, 
and are mostly used to produce a greater de- 
gree of vitality and activity in the parts, as 
in cases of local debility, scrofulous swell- 
ing, muscular rigidity, paralysis, contracted 
joints, neuralgic pains, &c. They are mostly 
administered while the patient is in the 
bath, and are often advantageously com- 
bined with friction. The employment of 
the douche requires to be carefully super- 
intended." — Extracted from Lee's "Baths of 
England." 

Refer to Bath. 

DRASTIC— A medical term applied to 
purgative medicines, which act strongly and 
produce watery evacuations. 

Refer to Purgatives. 

DRAINAGE — Is the important process by 
which superfluous moisture is removed from 
the soil, through the soil itself, or by means 
of channels made in or through the earth. 
It may be either natural or artificial, to 
carry off the simple excess of fluid resulting 
from atmospheric moisture, such as rain, 
or to remove the impure and deteriorated 
fluids, which more or less result where man 
and the domestic animals are congregated. 
The salubrity of a district is always 
closely connected with its natural drainage. 
Whenever moisture accumulates, either from 
position, that is, want of inclination or 
slope to run it off, or from the nature of the 
soil, disease is apt to prevail. Professor 
Ansted* remarks, "there can be no doubt 



Professor of Geology, King's College, London. 



that the district where sand and gravel 
allow the water to drain off at once beneath 
the surface, and that where hard and im- 
permeable rock permits the rain to escape 
readily into the nearest running stream, 
will be on the whole the most healthy ; 
while, on the other hand, that in which the 
tough clays retain the water in ponds on 
the surface will be exposed to marsh fevers 
and various disorders affecting the throat 
and lungs. These remarks apply chiefly to 
temperate climates, but when the conditions 
of vegetation are taken into account, they 
are no less true than important for warm 
countries, where the rankness of the vege- 
tation must, no doubt, be connected with 
the nature of the sub-soil over which it 
grows." 

These considerations are important for 
all, and especially for the emigrant and 
settler in new districts, who ought always 
to fix, if possible, upon a site for his dwell- 
ing, where the water has or may be made 
to have an efficient drainage in every di- 
rection and way ; and to exercise caution, 
also, that the dwelling of himself and family 
is not so placed that any generally prevail- 
ing wind can blow upon it from a marshy 
or badly drained tract of country. The 
effect of draining the soil, in rendering a 
country more salubrious, and in removing 
disease, is well exemplified in the disap- 
pearance of ague from many parts of 
England in which it formerly prevailed, a 
circumstance which can only be accounted 
for by the increased attention to the drain- 
age of those districts. As might be ex- 
pected, low situations are not likely to be 
so well drained as those situated on elevated 
ground. The latter does not alone, how- 
ever, suffice in all cases, if the drainage is 
improperly managed, and some of the worst 
local forms of typhus have been known to 
prevail in such places. 

The drainage of houses or collections of 
houses, where day by day there must be 
removed the excretions, both solid and 
fluid, of man and animals, is one of the 
most important points connected with the 
preservation of health ; it might almost be 
added, and one of the most neglected ones. 
Both in town and country, the necessity for 
sufficient drainage, whether of the natural 
moisture of the soil, of the results of animal 
life, or of domestic habits, has been, if not 
entirely overlooked, most insufficiently pro- 
vided for. It might shame the boasted 
civilization of our era, to learn that in Mr. 
Layard's researches in Nineveh, he found 
the buildings (of an age estimated at 1200 



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years before Christ) provided with a com- 
plete system of sewerage. Each room had 
a drain connected with a main sewer. 

It is generally thought that in the coun- 
try less necessity exists for perfect drainage 
than there does in large towns, and to some 
extent the idea may be correct, in so far as 
the smaller number of individuals collected 
in a given spot and the freer circulation of 
air must tend to preserve greater purity 
of atmosphere. But this idea, by lulling 
suspicion, has proved a dangerous one, and 
the single homestead or small isolated 
hamlet has been desolated by the scourge 
of fever, which a little precaution might 
have prevented. One most striking instance 
has been recorded by Dr. Christison, which 
occurred in and close round a farm-house 
occupied by an extensive farmer, in "a 
thinly-peopled rural district, in Peeble- 
shire." With respect to situation, Dr. 
Christison, after describing it, concludes 
with, "a healthier locality could not well 
be chosen ;" and yet, in, and close to this 
healthily-situated house, and in no other in 
the district, fifteen cases of a severe and 
peculiar form of fever occurred within the 
space of a few weeks, and three proved 
fatal. Such a well-marked visitation could 
not well escape searching investigation, 
which brought to light the fact that the 
house was completely surrounded by drains, 
which had, in the course of time, become 
filled up with the drainage of the farm- 
yard, of the necessaries, &c. &c. Such 
cases are by no means uncommon, even 
in country situations which would be at 
a first glance esteemed most salubrious, 
and indeed would be, but for the shame- 
ful neglect of the inhabitants. The author 
cannot recollect during ten years' prac- 
tice in a rural district, any invasion of 
fever going through a house, or collection 
of houses, which has not been traceable 
to deficient drainage and neglect of sani- 
tary measures generally. It is not fever, 
however, as generally so called, which 
alone occurs in consequence of deficient 
drainage, but bad health generally. And 
whatever case of disease or accident may 
remain within the tainted locality, ac- 
quires a certain unfavourable tendency 
and type; even recovery from childbed is 
affected by it, and perhaps more cases of 
childbed fever and death than would be 
imagined, might be traced to the unhealthy 
influences originated by habitations situated 
in a badly-drained locality. Surely this 
last consideration, if no other, might rouse 
men to act. The point touches the wealthy 
citizen as well as the poor one. 



Inflammation of the eye, or rather of its 
covering membrane, the "conjunctiva," has 
been found occurring commonly in parti- 
cular localities, no cause being assignable 
beyond that of stagnant and putrefying 
ditches or unwholesome drains. The con- 
tamination of wells which supply water 
used for drinking and cooking, by badly 
arranged or imperfect drainage, is a very 
fertile source of disease ; many of the worst 
invasions of fever, and cholera also, have 
been traced to this disgusting source. 

Whatever has been said respecting drain- 
age in country places, applies with increased 
force to the provision in towns, with their 
dense populations. On this head, Mr. 
Grainger, in his pamphlet published by the 
"Health of Towns Association," remarks, 
" The most prolific source of disease in 
towns is, certainly, defective drainage and 
sewerage. Where large numbers of human 
beings are collected together, it is apparent 
that there must result a vast amount of 
refuse matter of every description, to which 
must be added the solid and fluid excre- 
tions of the body, the former of which alone 
amount in a town like Liverpool to nearly 
six thousand tons annually." 

The first essentials for proper drainage 
are well-constructed sewers, that is, such 
as will not promote the deposition of solid 
matter in their interior. That the majority 
of the old sewers and drains do this has 
been proved before the Health of Towns 
Commission. It was shown that " by their 
unnecessary size and defective form, most 
of the old sewers being flat at the bottom, 
they cause a retardation in the flow of their 
muddy contents, and thus, of necessity, 
produce a lodgment of putrefying animal 
and vegetable matter. Another source of 
deposit is the improper direction of these 
conducts, the sharp angles and curves of 
which, especially where the smaller sewers 
enter the main trunks, lead to obstruction, 
and to these must be added the various 
irregularities of surface connected with the 
masonry." Again, drains are frequently 
placed too near the surface, and leave the 
under-ground premises either undrained, or, 
what is worse, receptacles for their leakages, 
should they get out of order ; then the gut- 
ters, the most superficial drains of all, are 
full of holes and crevices ; the entire sys- 
tem, including the gratings over the under- 
ground drains, being calculated rather to 
foster disease than to remove the causes of 
it. In addition, however, to construction, 
a full supply of water is requisite, one that 
can thoroughly and periodically, at not too 
distant intervals, be sent in full volume— 



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"flushed" — through the passages so as to 
sweep every thing before it. 

One gentleman, Mr. Guthrie, examined 
before the Health of Towns Commission, 
gives the following important points of evi- 
dence. He says, "My attention has been 
more especially directed to private drainage, 
or the sewerage of individual tenements ; 
for I am satisfied the public health is more 
deleteriously influenced by the exhalations 
which arise from pent-up matter in them, 
than by those which issue from the great 
main or common sewer. I hold every 
system of flushing to be imperfect which 
merely hurries along the contents of the 
principal or main sewers, while the putrefy- 
ing debris of inhabited tenements is left 
undisturbed in house-drains. The reason 
why house-drains act so imperfectly, that 
they frequently get entirely choked up, is 
simply because their too limited supply of 
water is spread over so great a surface that 
its power to carry along matter in suspen- 
sion is lost. 

Choking from accumulation seldom takes 
place in the small iron or lead soil pipe, 
neither would such a circumstance ever take 
place if the calibre of the tube or drains 
intended to carry off the soil were not made 
so great that the usual allowance of water 
is unequal to the task of washing out its 
interior. " The tubes made for house- 
drains should be circular, and not more, for 
any ordinary tenement, than from three to 
six inches in diameter. The form of main 
sewer most recommended by those who 
have paid much attention to the subject, is 
the oval, (fig. lix. 1,) or with a lesser curve at 
Fig. lix. 




bottom than at top, (fig. lix. 2.) It is calcu- 
lated that this latter form " gives full action 
to the water at the time it is most needed, 
namely, when the quantity is smallest. 
Drain-tiles or bricks may be used to form 
these oval sewers ; but tubes in moderate 
lengths are most strongly recommended. In 
addition, it is advised that whatever mate- 
rials are used for drains should be glazed in 
the inside, as tending less to promote depo- 
s 2 



sition of solid matter, and also being mora 
easily cleansed. Sufficient fall for the fluid 
is of course requisite for a complete drain. 

EfiTuvia are very apt to escape from drains 
" by the improper position of the gully 
gratings, and from these not being trapped. 
By improper position is meant the top of 
an eminence, where no surface-water can 
properly accumulate." Gratings and gullies 
are therefore injurious in such situations ; 
and, indeed, should only be placed where 
absolutely necessary to carry off surface- 
water, which will clear them out ; and they 
should be trapped. The inmates of houses 
close to gully-holes have been known to be 
attacked with fever which could in no way 
be accounted for, except by the emanations, 
proceeding from the sewers, through the 
gratings. 

Lastly, all those parts of a house which 
are connected with sewers and drains, such 
as water-closets, sinks, &c, ought to be so 
constructed that they do not allow effluvia 
to escape. This may be simply and cheaply 
done by means of earthenware soil-pans, 
with siphon-pipes, as represented, (fig. lx.,) 
Fi£. lx. 




in which the stratum of water, (fig. lx. 1,) 
which always must remain in the lowest part 
of the pan, acts as a valve against all efflu- 
vium from the pipe, (2.) AVhere a sink is 
not attainable, a simple funnel-like pipe, 
with a cover, (fig. lxi.,) may be fitted into 

Fig. lxi. 




the floor, and made to lead into the drain. 
The subject of drainage generally is so im- 



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portant, and its connection with health is 
so intimate, that it might be extended to 
a much greater length than the limits of 
this work will admit of. Enough, it is 
trusted, has been said to direct attention to 
it; and those in whom a spirit of inquiry 
has been excited, and who desire more ex- 
tended information, cannot do better than 
seek it in the valuable and cheap publica- 
tions of the Health of Towns Association. 

DREAMING— Is the wakeful and sentient 
condition of some of the faculties of the 
mind, while the others are asleep. The 
whole subject of dreaming is highly interest- 
ing in a psychological point of view ; but it 
is only in its connection with the body that 
we have here to do with it. Some persons 
naturally dream more than others ; but 
there is no question that the occurrence 
and, more particularly, the nature of 
dreams are both much influenced by the con- 
dition of the body. Few are so fortunate as 
to have escaped an attack of incubus, or 
nightmare, arising from disordered diges- 
tion : and all who have been much with 
children, know well how liable they are to 
suffer from disturbing dreams, whenever the 
stomach and bowels are disordered. It may 
be safely asserted that a large proportion 
of uncomfortable dreams are connected with 
disorder of the digestive functions — gene- 
rally overloading, but sometimes the re- 
verse. Some people always dream if they 
do not take some slight refreshment just 
before retiring to rest. Mental excitement 
during the previous day is of course a fre- 
quent cause of dreaming. Organic diseases, 
which give rise to oppression within the 
chest, such as diseases of the heart, are 
peculiarly liable to occasion uncomfortable 
dreams and nightmare. Uneasy and pow- 
erful sensations excited upon any portion 
of the body occasion what are called sug- 
gestive dreams ; that is, the sensation seems 
to start some thought in relation to itself 
from which a train of incongruities, such 
as occurs in dreams, appears to arise ; 
a blister is the foundation for some dream 
of torture ; or a loud sound for one of 
tumult. 

Although made the subject of much cre- 
dulity, dreaming, not only in its general 
character, but as regards the nature of the 
dreams, is not to be altogether disregarded 
with respect to the indications it affords of 
the bodily condition. When natural sleep 
is thus disturbed, particularly by dreams 
which cause alarm and uncomfortable sen- 
sations, or which occasion children to start 
and scream, the cause should be investi- 
gated ; some error, simply as regards diet, 



either as to time, quantity, or quality, may 
be the reason ; or disease may be forming. 
One or two smart purges will frequently 
remove the symptom. Whether in child or 
adult, should much mental exertion be going 
on, and sleep become unusually disturbed by 
dreaming, mental relaxation and a greater 
amount of physical exercise should be com- 
bined with attention to all the functions. 
The shower-bath, either generally or as a 
local application to the head alone, will be 
useful in such cases. 

Refer to Sleep. 

DRESS.— See Clothing. 

DRESSING.— This word is employed by 
the surgeon to express the application of 
various substances or agents to diseased or 
wounded parts, to protect them from the 
action of the air and from external injury, 
and, either by mechanical action or other- 
wise, to promote their healing or cure. It 
is, of course, also requisite both for clean- 
liness and for the comfort of the patient 
and of those around. 

In former times, the process of a surgical 
dressing was a much more formidable and 
complicated affair than it is now under the 
modern, simpler, and more efficient practice 
of surgery, which is sometimes too simple 
to please patients. As the treatment and 
mode of dressing burns and wounds is re- 
ferred to in the articles on these and similar 
subjects, it is unnecessary to reiterate them 
here, and for what is requisite respecting 
the application of bandages, the reader is 
referred to the article itself. At present it 
is proposed to give rather the principles 
on which dressings generally should be con- 
ducted, than their details. 

The first essential in dressing is gentle- 
ness and lightness of hand. Parts which 
require the process are generally in a state 
of greater or less inflammation, and conse- 
quently of increased sensitiveness ; and the 
patient, owing to the weakness which ac- 
companies or follows disease or accident, is 
most probably in an irritable and nervous 
condition ; for these considerations, if for 
no other, the dressing, which is so often 
dreaded, should be conducted with the 
utmost gentle care. The next essential is 
to have at hand whatever is likely to be 
wanted; warm, soft water, with a sponge — 
or in its place some soft material — scissors, 
and lint, or linen. A piece of waterproof 
material to place under the part is often 
useful. If plasters, bandages, &c. are re- 
quired, they should not have to be sought 
for or cut when the wound is exposed and 
the patient waiting. If the old dressings 
have become in the least hard or adherent, 



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or, if plasters form part of the applications, 
they should all be well softened by the warm 
water before the attempt is made to remove 
them, and they should not be pulled away. 
When strips of plaster are to be taken off 
a wound, the lips of which they hold to- 
gether, they should be lifted at both ends, 
so that the detaching process meets just at 
the wound; the object of this proceeding is 
to prevent the newly-healed and adhering 
surfaces from being torn asunder, which 
they are likely to be if the plaster is pulled 
off from end to end. For taking dressings 
off wounds, a pair of "forceps," as repre- 
sented, (fig. lxii,) will be found useful. 

Fig. lxii. 



When the old dressings have been removed, 
the parts around the wound should be 
gently but thoroughly cleansed. If there 
are any loose, mortified, or "sloughing" 
substances upon the wound, they may be 
lifted off; but its surface must not — as is 
too frequently done, even by medical men — 
be washed and deluged with water. The 
matter which covers the surface of a wound 
is the protective covering provided for it by 
nature, and if this be removed, it is much 
more likely to become irritable and painful, 
and to be longer in healing. When the 
proper cleansing has been effected, the re- 
quisite dressings should be put on without 
delay, leaving room, if there is likely to be 
much formation of matter, for its due dis- 
charge — the part being so placed, when the 
dressing is finished, that the discharge can 
easily escape. 

The various dressings requisite for inju- 
ries will be mentioned in their proper places 
and articles, but one often recommended in 
this work requires notice here : it is the 
simple water-dressing. This is at once the 
most convenient, agreeable, and universally 



applicable dressing to wounds of every kind. 
The popular fallacy, that the applications 
have in all cases something to do with the 
healing of wounds, is very apt to make 
people, especially the poor, look suspiciously 
on so simple an agent as pure water. It is 
true, the interference of art is frequently 
requisite, either to stimulate or to repress 
action while wounds or diseases are in pro- 
cess of cure; but in the majority of in- 
stances the cure is the work of the natural 
powers alone. All that has to be done is 
to place these in as favourable a position 
for exerting their agency as possible, and 
nothing answers this purpose so well as 
pure, soft water. The application is made 
either by linen or lint soaked in the water 
— warm, tepid, or cold, as most agreeable 
to the sensations of the patient — and is in 
most cases covered over with some material 
which will prevent evaporation. Oiled-silk 
has generally been used for the purpose, 
and oiled-calico where economy is an object, 
but latterly thin sheet gutta-percha has been 
employed, and answers extremely well. If 
linen or common lint is used, it will require 
folding at least double to enable it to retain 
moisture sufficient. As a dressing, Taylor's 
new patent lint is a much thicker and more 
spongy, and, for this purpose, better adapted 
material than the others. Water-dressing 
is not necessarily covered with waterproof 
material ; if the part requires keeping very 
cool it is better not so, but then it will re- 
quire much more frequent wetting, either 
by a nurse or by the system of irrigation 
recommended under article Cold. When 
waterproof material is put over the wet 
linen or lint, it of course prevents evapora- 
tion, and keeps in heat ; it should always 
be larger than the lint. A mistake is very 
commonly made in this matter. A great 
piece of linen or lint is put on with its edges 
sticking out beyond the oiled-silk, or what- 
ever is used; and these edges, or even a 
very slight protrusion, are sufficient to 
drain off the entire moisture, leaving what 
ought to be a most soothing dressing, a dry 
and irritating one. Among the poor the 
most complete ignorance respecting the use 
of water-dressing prevails — it is too simple 
to get much of their confidence, and very 
often, unless the most particular and re- 
peated directions are given, the waterproof 
material — mistaken for a plaster — is put 
next the sore, and the wet lint on the top 
of it ! Of course, when requisite, any de- 
scription of lotion can be used as a dressing 
in this way in place of the simple water. So 
universally applicable is the water-dressing, 
and lotion applied in the same way, that 



DKI 



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they may almost entirely supersede oint- 
ment, to which there are many objections. 
A greasy application is seldom as pleasant, 
and never so cleanly, as the fluid one ; 
moreover, ointments are very often indeed 
used rancid, and thus become sources of 
irritation rather than of benefit. When a 
simple greasy dressing is required, a little 
perfectly fresh lard, or olive-oil, is as good 
as any. 

Refer to Adhesion — Bandages — Blisters — 
Burns — Wounds, tyc. 

DRINKS.— Fluids taken by the mouth 
may be simple, medicated, nutrient, or sti- 
mulant. The only simple drink is -water. 
When agents which act medicinally upon 
the body are dissolved in that fluid, as in 
the case of mineral waters, either natural 
or artificial, when it is rendered alkaline or 
is acidulated, or is impregnated with car- 
bonic acid gas, as in the case of soda-water, 
it becomes a medicated drink. Barley- 
water, toast-water, milk, &c. are examples 
of nutrient, and alcoholic liquors, tea, cof- 
fee, &c. of stimulant drinks. It is difficult, 
however, to draw the line between these 
classes. Many drinks which might be called 
medicated are in daily use ; those which are 
stimulant are in many cases nutrient, and 
vice versa. As drinks come under the head 
of " Diluents," the reader is referred to the 
article under that head. 

DRIPPING. — As this article is often used 
for household purposes, or given away, it 
should be known that symptoms of lead- 
poisoning, or colic, have been induced by 
the drippings from meat which had been 
baked in a newly-glazed earthen vessel ; 
the lead-glaze being soluble in the fatty- 
matter. Neither should what was said of 
the power of fatty matters to act upon cop- 
per, when kept in vessels composed of that 
material, and especially if mixed with salt, 
be forgotten in connection with this subject. 

DROPSY — Is the effusion or accumulation 
of the serous or watery portion of the blood 
(such as we see thrown out in a blister) in 
any of the tissues or cavities of the body. 
Thus the watery effusion may take place 
in the cellular tissue, (see Cellular Tissue,) 
which connects the various portions of the 
body, and fills up their interstices, in which 
case it will show itself in the eyelids and 
other portions of the face, or swell the feet 
and legs, hands and arms, or the body gene- 
rally. This form of dropsy is called by 
medical men "Anasarca." The effusion, on 
the other hand, may be into some of the 
larger cavities, as into the abdomen, when it 
is named "Ascites ;" or into the cavity of the 
chest, between the lungs and ribs, when it 



is known as " Hydrothorax," or water in 
the chest. Again, effusion may take place 
into some of the smaller cavities, or rather 
"sacs," as into the bag which surrounds the 
heart. Whenever it occurs, dropsy is always 
to be regarded seriously. It is not, as the 
unprofessional generally think, a disease in 
itself, but it is almost invariably a symptom 
of disease, either constitutional or local, ex- 
isting in the system. It is not here meant 
that dropsy is not a disease, but that it is 
generally a secondary one, not the original 
affection, which may, however, be so ob- 
scure, that nothing is left for the practi- 
tioner to treat but the dropsy, and that he 
must get rid of, if possible ; for though in 
itself an effect only, it tends to produce other 
diseased actions, by impeding or stopping 
the functions of important or vital organs. 

Anasarca, or effusion into the cellular 
tissue, may be simply the result of general 
constitutional debility, of which the blood- 
vessels, both large and small, and the heart 
partake ; this form of dropsical swelling 
usually shows itself in the feet or ankles 
toward night, especially after long standing ; 
many delicate persons are subject to it as a 
temporary ailment, when from any cause 
the general health has become impaired. 
When it shows itself and continues in the 
weakly, as in delicate girls, along with weak- 
ness generally, pallor, &c. it is only to be got 
rid of by measures which restore the tone 
and vigour of the system, such as good diet, 
with port wine and porter, tonic medicines, 
exercise, and change of air. Should the 
error be made of confounding it with an in- 
flammatory condition of body — and the quick 
irritable pulse might mislead — and lower- 
ing measures be resorted to, the disease will 
be greatly aggravated. Local anasarca, or 
dropsical swelling, may arise from any 
cause which impedes the return of the 
blood through the veins, and is a very 
common accompaniment of disease of the 
liver or heart, or of tumours which press 
upon the great veins : of this, pregnancy, 
which often occasions swelling of the legs 
during its continuance, is an example, the 
effect passing off as soon as the cause is 
removed. The lower limbs are the most 
frequent seat of anasarcous, or, as it is often 
called, " ©edematous" swelling ; but the 
hands, face, &c. are also occupied by it; 
indeed, swelling of the eyelids in the morn- 
ing, with stiffness on first trying to open 
them, is often one of the first symptoms of 
the tendency to dropsical effusion, whatever 
the cause. Again, anasarcous dropsical 
swelling may be occasioned by an affection 
of the kidneys, which cannot carry off the 



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fluid from the body with sufficient rapidity. 
The above are all instances of what are called 
"passive" dropsies; the cause generally 
acting slowly, and unaccompanied with a 
marked feverish state of the system ; there 
are, however, forms of dropsy which are 
attended with this feverish state, and in 
which the watery effusion takes place rapid- 
ly — sometimes surprisingly so. The best 
instance of this is the acute form of dropsy, 
which is apt to happen to convalescents 
from scarlet fever, and which is traceable 
to cold. Whatever occasions "anasarca," 
or effusion of watery fluid into the cellular 
substance of the body generally, may also 
cause its occurrence in the cavities, as of the 
abdomen or chest; but it may also take 
place both in the large and small cavities, 
as a consequence of local inflammation. 
Their lining "serous" membrane becomes 
inflamed, and pours out a watery secretion 
in greater or less abundance. It is matter 
of popular information, that dropsy in the 
belly is apt to follow inflammation, and that 
water in the chest results from pleurisy. 

From what has now been said in expla- 
nation of the nature and causes of dropsy, 
it must be evident that its serious treat- 
ment is not for the unprofessional; the 
I causes are often too obscure, and the proper 
and efficient remedies too active, to be in- 
trusted to non-medical hands, particularly 
as it can rarely be an emergency. A case 
of inflammatory dropsy, such as occurs after 
scarlet fever, might of course happen at a 
distance from medical aid ; and for the 
measures to be adopted the reader is referred 
to the article Scarlet Fever. 

No matter what form dropsy assumes, the 
case should at once be put under medical 
superintendence. As temporary palliative 
measures, the bowels should be kept either 
simply open or actively purged, according 
as the patient is of weak or strong habit of 
body ; and the effusion of water may be kept 
in check by the use of diuretic remedies. 
(See Diuretics.) Of these, infusion of broom 
or dandelion, cream of tartar, sweet spirit 
of nitre, or saltpetre, will be found the most 
suitable. 

Refer to Blood — Diuretics — Urine, §c. 

DRO WNING— Is death by suffocation from 
immersion in fluid. Few subjects treated of 
in this work are more important. Accidental 
drowning is so frequent an occurrence, and 
it so often happens that no medical assist- 
ance is at hand during those first few precious 
moments after the body of a drowned person 
is recovered from the water, that some by- 
stander, who is possessed of the knowledge, 
not only of what ought to be done, but of 



what ought to be avoided, may have the 
satisfaction of saving a life which must 
otherwise have been lost. When an indi- 
vidual falls into the water, especially from 
a height, there may or may not be consi- 
derable shock, from the body striking the 
surface ; or the head or other parts may 
have struck against a stone or some hard 
body ; or there may have been fainting 
caused by the fright : all these circumstances 
must, of course, modify the effects. The 
last has been said to account for those cases 
which have been reported as recovered, after 
very long immersion, that is, half an hour 
or longer. 

The longest well-authenticated time of 
complete immersion, after which recovery 
has been effected, is fourteen minutes, and 
this case stands by itself. Other cases of 
ten, six, and five minutes are recorded, but 
there is always doubt whether immersion 
has been complete during the whole time; 
this doubt, however, which must occur in 
most cases, is the very reason why hope 
should not be abandoned, even after persons 
may be thought to have been in the water 
a considerably longer period ; and though 
it might be established that none could be 
entirely under water for five minutes, and 
recover, this is not to be acted upon ; half 
an hour's supposed immersion, or even 
longer, should be no barrier to efforts at 
restoration. When an individual falls into 
water, the body generally rises again to the 
surface, when an effort to breathe is made ; 
air may be drawn in to some extent, and 
with it water, more or less, which passes 
into the stomach ; this may be repeated two 
or three times, or efforts to breathe may be 
made beneath the surface. However this 
may be, the contact of the water in the 
breathing effort causes closure of the " glot- 
tis" or chink at the upper part of the wind- 
pipe ; a small portion of fluid may pass in ; 
but the principal effect is the exclusion of 
the air, and thus the drowned person is 
effectually suffocated, and the lungs in a 
considerable degree emptied of their air, 
which is pressed out in the vain respiratory 
efforts, and rises in bubbles to the surface. 
The amount of water which may have been swal- 
lowed is comparatively of little moment, andean 
have but little, if any thing, to do tvith the fatal 
consequence. A person, therefore, who is 
rescued from the water after immersion, if 
not dead beyond recall, — and here is the 
doubt of which they should be given the ad- 
vantage, — is partially suffocated; the vital 
powers are also depressed by the action of 
cold, and probably also by the struggles and 
shock, both mental and bodily ; but still the 



DRO 



214 



DEO 



machinery is perfect, — the pendulum may be 
stopped, but the spring may yet be capable 
of action. In other words, vitality, though 
apparently suspended, may yet linger in a 
frame of which the structures are as capable 
as ever they were of acting as its agents ; 
the mysterious link which binds them in ac- 
tion may be almost severed, but our efforts 
may restore it. 

The first thing to be done when a person 
apparently drowned is rescued from the 
water, is to wipe and cleanse thoroughly 
the mouth and nostrils — the next to apply 
warmth to the body. This last cannot pos- 
sibly be done as long as it is covered with 
wet clothing ; and if this is the case, it 
should be removed — cut off, if necessary for 
haste — as quickly as possible. If there is 
a house or shelter of any kind very near the 
spot where the body is got out, it may be 
taken to it at once and before the clothes 
are removed ; but if such is not the case, 
provided dry coverings are at hand, the wet 
clothes should be stripped off on the spot. In 
removing the body, it is best done by laying 
it on the back or side, on some flat board, 
such as a door or shutter, the head and 
shoulders being well raised ; but if there is no- 
thing at hand on which the body can be laid, 
care should be taken in carrying it that 
the head is well supported, neither allowed 
to fall back, nor forward upon the chest. 
As soon as may be, warmth is to be ap- 
plied to the entire external surface ; if a 
warm bath — temperature 98° — is available, 
it should be used ; if not, the body is to be 
covered up with warm things ; bags of hot 
bran, hot salt, or sand, or any other con- 
venient vehicles for heat are to be placed 
wherever they can be, without interfering 
with the necessary manipulations ; to the 
pit of the stomach, and to the feet espe- 
cially, their application is to be used. 
Frictions with stimulants of some kind, 
such as camphorated oil, brandy, or any 
other spirit mixed with oil, or turpentine, 
should any of them be used warm, and 
rubbed in with a flannel ; a warm stimulant 
clyster, consisting of gruel — temperature 
100° — containing a tablespoonful of tur- 
pentine, or double the quantity of brandy, 
may be given, and strong-smelling salts 
held to the nostrils at intervals. Artificial 
respiration, recommended by some, is con- 
demned by others! Certainly the old me- 
thod of using bellows and other means to 
inflate the lungs was much more likely to 
do harm than good, particularly in the 
hands of the unprofessional, who would be 
much more likely to inflate the stomach, 
and thus impede respiration. Attempts to 



imitate the natural process of respiration 
may, however, be made by pressing inward 
the ribs and pit of the stomach, and allow- 
ing them to rise again by their own elas- 
ticity, repeating this process twenty or five- 
and-twenty times in the minute. Galvanic 
and electric shocks passed through the chest 
and upper portions of the spine would pro- 
bably be useful, if the apparatus chanced 
to be at hand — but this will seldom be the 
case. The new electric belts will probably, 
however, afford greater facility in this re- 
spect. These are, however, but accessary 
means, which may be employed or not, as 
available and convenient, and as far as they 
do not interfere with those essential remedies 
which are most to be relied upon: these are, 
external warmth and continued friction, with 
care taken that the shoulders and head are 
raised, the mouth and nostrils free. For 
the more easy application of remedies, the 
body should be laid on a table of convenient 
height. 

Having now mentioned what ought to be 
done in cases of drowning, it is necessary 
to notice what ought not to be done ; for many 
old and most injurious modes of treat- 
ment are still apt to be resorted to by the 
ignorant and prejudiced. Most of these have 
originated in the idea that water swallowed 
was, or had something to do with the cause 
of death ; hence patients have been hung 
up by the heels, rolled on barrels, choked 
with emetics, under the idea of making them 
disgorge the water. 

Undoubtedly, if there is much water swal- 
lowed — as sometimes happens — it would be 
better to remove it ; but any means which 
unprofessional persons can use for its re- 
moval would only be a worse evil. If a 
medical man is present, and thinks well to 
use the stomach-pump quickly, remove the 
water and replace it with a small quantity of 
hot brandy and water, it may be of service; 
but no attempts should be made to administer 
any thing by the mouth as long as uncon- 
sciousness continues. 

In cases of drowning, the motto should 
be, — never despair : when all hope seems 
to have vanished, and no sign of life been 
given for one, two, four, six, or even eight 
hours, the perseverance of those around 
has been at last rewarded, and existence 
preserved. 

After a person has been restored to con- 
sciousness, there may be considerable con- 
gestion of blood about the head, which may 
require leeches. In all cases of recovery, 
the greatest care must be taken to preserve 
the re -excited actions ; if stimulants are 
thought requisite, they must be given most 



DRU 



215 



DYS 



cautiously, and all sources of excitement, 
such as visits from friends or relatives, 
guarded against ; hot fluids, tea, coffee, and 
the like, should be given moderately, and 
the strength supported by nourishing meat 
soups. — Refer to Lungs — Suffocation, §c. 

DRUG — Is the general term applied to 
medicinal agents used in the treatment of 
disease ; it is, however, more generally em- 
ployed with reference to the crude or com- 
mercial substances ; after these have under- 
gone preparation, they are usually called 
medicines. Although, undoubtedly, many 
medicines are largely adulterated in this 
country, many are impure in consequence 
of the adulteration of the drug in its collec- 
tion or preparation by the natives of the 
country of which it is a product. Thus, 
senna is largely mixed with the leaves of 
other plants, opium with seeds and leaves, 
and sometimes with small stones, &c. &c, to 
increase its weight; scammony is mixed 
with chalk. As, however, the adulterations 
to be guarded against are mentioned under 
the respective articles, the reader is referred 
to them. [The recent appointment by Con- 
gress of an inspector of drugs will do much, 
it is hoped, to prevent or detect adulteration 
in drugs imported into the United States.] 

Refer to Medicines. 

DRUM of the EAR, or Tympanum — Is an 
anterior portion of the organ of hearing, 
which contains the small bones and air. 
See Ear. 

DRUNKENNESS.— See Intoxication. 

DRY CUPPING.— See Cupping. 

DUCT — Is a medical term applied to a 
tube or " canal," adapted to convey fluid 
from one part of the body to another. Thus, 
the "hepatic duct" conveys the bile from 
the liver into the intestines, the "salivary 
ducts" carry the saliva into the mouth from 
the glands, by which it is secreted from the 
blood; the "thoracic duct" (see Digestion) 
conveys the chyle into the blood, &c. &c. 

DULCAMARA, or Solanum Dulcamara, 

OR BITTER-SWEET, OR WOODY NlGHT-SHADE 

— Are all names for the same native plant, 
which is, however, widely distributed over 
the temperate portions of the globe. It is a 
shrubby climbing plant, bearing clusters of 
flowers, closely resembling, but smaller than 
those of the potato, which belongs to the 
same family. Under its name of "bitter- 
sweet" it is well known in the country. It 
flowers in June, and in the autumn bears 
clusters of red, somewhat transparent, ber- 
ries. The twigs are used in medicine, and 
arc directed to be gathered when of the 
thickness of a goose-quill. The medicinal 
use of dulcamara is as a soothing diapho- 



retic, producing perspiration, and it might 
be used in the absence of other remedies for 
this purpose. To make the decoction, one 
ounce of the twigs, chopped, is to be boiled 
in twenty-four ounces, or a pint and a half, 
of water, till it is reduced one-third. Of 
this, the dose is two to six tablespoonfuls 
twice or thrice a-day. [Dulcamara tea re- 
duces the venereal desires, or is an " aphro- 
disiac." In this way it is highly useful. It 
is also employed in the treatment of "Tet- 
ter."] 

Refer to Diaphoretics. 

DUMBNESS— Or inability to utter arti- 
culate sounds, may arise from absence of 
the tongue, or from defect in the formation 
of the organs of voice ; probably, also, from 
causes affecting the nerves which supply the 
organs of speech ; but most generally from 
complete deafness, either congenital, that is, 
dating from birth, or as the result of disease 
before the power of speech had been acquired 
and fixed in the memory. 

Refer to Deafness. 

DUODENUM.— The fifet portion of the 
small intestines, and that immediately con- 
nected with the stomach. It derives its 
name from the idea that it did not exceed 
twelve finger-breadths in length. 

Refer to Alimentary Canal. 

DURA MATER— Is the term applied to a 
firm white fibrous membrane which lines 
the skull on the one hand, and invests the 
brain. Between it, however, and that organ, 
two other membranes lie: the "arachnoid 
membrane," so named from its extremely 
fine texture, which lines the dura mater, 
and also covers the brain, forming a double 
layer, or "shut sac," in the interior of 
which a watery fluid is exhaled ; and the 
"pia mater," or vascular membrane of the 
brain, which lies directly upon and covers 
the organ itself. 

The " dura mater" is prolonged into va- 
rious "processes," or projections, which 
pass between and give support to the differ- 
ent portions of the cerebrum, or brain, and 
cerebellum, or little brain, which are in fact 
partially separated from each other by a 
fold of the dura mater. This membrane, 
and the others above mentioned, are con- 
tinued from the interior of the skull down 
the spinal column. 

Refer to Brain — Spine, Src. 

DWELLINGS.— See Houses. 

DYSENTERY— Or, as it has been popu- 
larly called, "bloody flux," is a disease 
characterized by severe diarrhoea, fever, 
&c. the accompaniment of a peculiar in- 
flammation of the mucous membrane lining 
the large intestines. It is much more fre- 



DYS 



216 



DYS 



quent in tropical climates and marshy dis- 
tricts than it is in this country at the pre- 
sent day, although formerly it was very 
prevalent, forming a large item in the bills 
of mortality of a hundred or a hundred 
and fifty years back ; and at times showing 
itself in a fatal epidemic form. It is pro- 
bable that the diminished occurrence of 
dysentery in England at the present day is 
owing to the increased comfort of the popu- 
lation, the drainage of the land, and some 
attention to sanitary influences ; for, defi- 
cient as the regulations attached to these 
still are, they are certainly better than they 
were a century ago. A kind of dysenteric 
affection — that is, severe diarrhoea, with 
fever, tenderness of the bowels, indicative 
of inflammation, and bloody stools — is fre- 
quently met with in autumn during the 
prevalence of the common cholera morbus. 
Dysentery appears to be engendered by 
exposure to cold, wet, and to privations 
connected with food ; hence it has been one 
of the greatest scourges of armies. " In two 
years and a half tne British army in Spain 
lost no less than 4,717 men by this com- 
plaint." The same causes and its connection 
with variations in climate, particularly with 
a hot one, must render dysentery a disease 
respecting which the emigrant ought to 
possess information ; for it may happen, 
and it often does, that the disorder attacks 
those far removed from medical aid, and it 
is not one which brooks much delay in 
treatment. Medical men in this country 
have comparatively so little experience of 
the disease, that the author gladly avails 
himself of the recent valuable work of Dr. 
Parkes in the compilation of this article. 
By this author the symptoms of dysentery 
are thus succinctly described: — "Dysentery 
commences either gradually or suddenly ; 
the general commencement is, however, by 
diarrhoea. 

" First, as to the kind of stools. 

"These are, first, simply numerous, per- 
haps feculent, in a few very rare instances 
scybalous — (that is, containing hard black- 
looking lumps, about the size of beans or 
nuts, called by medical men scybalse.) 

"After this the stools become numerous, 
slimy, gelatinous, bloody ; blood in streaks, 
or mixed with a dark watery fluid ; in an- 
other form pure, perhaps clotted. After- 
wards, stools watery, muddy, like the wash- 
ings of meat, or gelatinous-looking, shreddy, 
offensive in odour. Sometimes after this 
the stools present an appearance some- 
thing like pus, (matter,) or this is mixed 
with mucous slime and blood, in such a way 
as to form a variously coloured stool, which 



causes great griping and tenesmus when 



With respect to the causes of dysentery 
Dr. Parke says — " We may admit as both 
predisposing and exciting causes, according 
to circumstances, the following agents : — 

"1st. All acrid agents, whether pro- 
duced by irritating ingesta, or secretions ; 
as bad or too rich food, bad water, fruits, 
or retained excretions, or derangement of 
the biliary secretions, &c. 

" 2d. Suppression of secretions rapidly 
accomplished, as that of the skin by cold, 
wet, sudden changes of temperature from 
hot to cold, &c. 

"3d. Epidemic states of the atmosphere, 
and probable alteration of the blood, either 
from food or its digestion." 

The power of these causes to produce 
dysentery should be well fixed in the minds 
of all those whose lot it may be to be ex- 
posed to their influences ; for by their avoid- 
ance the disease may probably be escaped ; 
and there can be few misfortunes greater 
than for a new settler, whose welfare, and 
that, perhaps, of a family, depends upon 
his health and strength, to be attacked with 
dysentery. 

The treatment of dysentery which may 
most safely be practised by an unprofes- 
sional person, in the absence of a medical 
man, would be, in the first instance, if they 
were procurable, the application of leeches 
to the belly, [near the groins or around the 
fundament,] a dozen or more at once, and 
repeated according to the strength of the 
patient, if the symptoms remain unrelieved. 
Should leeches not be obtainable, and even 
if they are, a warm bath once or twice (if 
it did not exhaust too much) in the twenty- 
four hours, would be found useful, \or hot bran 
poultices to the bowels.'] To allay pain and re- 
lieve the disease generally, opium is the 
most valuable remedy ; but as there may 
be irritating matters in the bowels, they 
must not be confined, which the opium 
alone might do, and thus, though relieving 
apparently for a time, aggravate the disease 
ultimately. To avoid this, the opium should 
be combined with castor-oil, or olive-oil, 
either simply or in emulsion with yelk of 
egg. If castor-oil is procurable, it should 
be trusted to ; if not, Epsom salts, in tea- 
spoonful doses, each dissolved in from half 
a pint to a pint of gruel or barley-water, or 
some other demulcent, with four or five 
drops of laudanum added, may be given 
every four or five hours. Ten grains of 
Dover's powder, given once or twice in the 
twenty-four hours, may probably be of ser- 
vice, or a pill composed of half a grain of 



D YS 



217 



EAR 



opium, a grain and a half of blue pill, 
and half a grain of ipecacuanha, may be 
given every six or eight hours. The safest 
course, however, will be the treatment by 
the oily aperients and laudanum. In ad- 
dition [an enema of half a wineglassful of 
thin starch, with the addition of fifty drops 
of laudanum for an adult] will give much 
relief. Sometimes the lower bowel is too ir- 
ritable to bear the clyster, or even the clyster- 
pipe, in which case, a suppository, a pill, 
made with a grain of opium, mixed with a 
little flour and water, may be passed into the 
bowel. The food requires much attention, 
and should be of the mildest character : milk, 
and preparations of the grains, and sago, 
arrow-root, &c, combined with gelatine or 
isinglass, will be most suitable. [Fresh 
buttermilk, when agreeable to the patient, 
is an excellent article of diet, and has by 
some been regarded as a specific in the treat- 
ment of the complaint.] If the strength is 
much reduced, strong concentrated animal 
soup will perhaps be required. 

Of course so serious, and it may be fatal, 
a disease as dysentery should be put under 
medical care as shortly as possible. In the 
meantime the above directions may be of 
much service. 

" The first appearance of recovery is evi- 
denced by the stools becoming less slimy, 
perhaps copious and feculent, or bran-like, 
or dark and slightly beaten up ; or while 
one part of the stool is slimy, the remainder 
consists of natural feculence." A person 
convalescent from dysentery will, of course, 
require the greatest possible care in diet ; 
and also with respect to all exposure to the 
causes which originated it. 

Refer to Castor-oil — Clyster — Diarrhoea — 
Suppository — Tenesmus, §c. 

DYSMENORRHEA.— Difficult or painful 
menstruation. — See Menstruation. 

DYSPEPSIA — Indigestion.— See Indi- 
gestion. 

DYSPHAGIA.— Difficulty in swallowing. 
— See Sivallowing. 

DYSPNCEA.— Difficulty in breathing.— 
See Respiration. 

DYSURIA. — Difficulty in passing water. 
— See Urine, Bladder, Sfc, 

THE EAR — Is the organ of hearing, by 
means of which man and animals are made 
sensible of what we call sound, that is, of 
certain vibrations communicated to the at- 
mosphere, or surrounding medium, which 
give rise to the sensation of sound, by acting 
upon the organ fitted by structure to receive 
them, which organ is connected with the 
brain, or agent of the sentient mind, by 
nerves special to the purpose. The entire 
T 



organ of hearing is called the ear. Its ana- 
tomy and functions constitute a wide and 
interesting branch of study ; but here it 
will be sufficient to explain just so much as 
is requisite to give the unprofessional read- 
ers some idea of the nature of the organ — 
some rational view of the disorders to which 
it is subject; sufficient, it is trusted, to 
guard them against submitting so valuable 
an agent, of which the varied structures 
must give rise to varied forms of disease, to 
be tampered with by ignorant quackery. 
Any one who will for a moment consider in 
how many ways deafness may be produced, 
must see there can be no specific to effect 
its cure, but that the means of cure must 
vary with the cause of the disease. 

The human ear consists of an external, 
middle, and internal. The external being 
composed of the flat folded organ attached 
to the head, usually called the ear, (fig. 
lxiii. 1,) and of the ear-passage, or "me- 
atus," (2.) The external flap of the ear is 
divided by anatomists into various parts, 
which it would answer no good purpose to 
go over here ; its evident function is to col- 
lect as much as possible the body of sound. 
Its adaptation for this purpose is more 
plainly evidenced in the movable ears of 
the lower animals than it is in man. The 
air-passage, or meatus, is oval in form, 
curved upon itself, and rather narrowest in 
the middle ; it contains a few small hairs, 
and glands which secrete the peculiar bitter 
wax, or "cerumen," which is probably a 
provision to prevent insects entering the 
air-passage. 

The inner extremity of the ear-passage 
is closed by a membrane, (fig. lxiii. 3,) that 
of the tympanum, or drum of the ear : it is 
placed obliquely. The cavity of which it 
forms the external boundary, is the portion 
of the middle ear named the drum, or tym- 
panum, (4;) it contains air, and communi- 
cates with the atmosphere by means of the 
Eustachian tube (5) which opens into the 
throat. The tympanum contains three very 
minute bones, articulated or jointed together 
so as to admit of slight motion ; these, 
which are represented magnified, (fig. lxiv.,) 
extend across the cavity ; the small bone 
(fig. lxiv. 4) — which resembles a stirrup in 
shape, and, indeed, derives its name, " sta- 
pes," from that resemblance,) being at- 
tached at a small opening to a portion of the 
membrane which lines the inner ear or 
"labyrinth," as it is called from its com- 
plex construction. The "labyrinth," or 
inner ear, is composed of three parts, the 
vestibule, (fig. lxiii. 7,) the "cochlea," or 
shell-like portion, (10,) and the semicircular 



EAR 218 

Tig. lxiii. 



EAR 




Fig. lxir. 




canals, (8.) Both the middle and inner ears, 
and indeed part of the external ear-passage, 
are accommodated in a portion of the tem- 
poral or temple bone, excavated for the 
purpose. To the small bones of the tym- 
panum are attached four minute muscles, 
which by their agency act upon the mem- 
brane of the drum. The office of these 
bones being evidently at the same time to 
conduct the vibrations of sound from the 
membrane of the tympanum, which is ex- 
posed to the external air, to the membrane 
of the vestibule, which, with the other parts 
of the labyrinth, constitute the essential 
organ of hearing. Within the labyrinth, a 
watery-like fluid is the medium for conduct- 
ing the vibrations of sound to the nervous 
expansions which are also contained within 
the cavity. 

The disorders to which the organ of hear- 
ing is most liable are loss of function, or 
deafness, noises in the ear, neuralgia or 
affection of its nerves, abscess within the 
meatus or in the cavity of the tympanum, 
chronic discharges, polypus ; and further, 
the meatus in children is very apt to be 
chosen as the receptacle for peas, small 
buttons, or indeed any thing they can poke 
in easily, but which are often extremely 
difficult to get out again. 

The subject of deafness has been already 
treated of, but the attention of the reader 
is again called to the many causes which 
may produce the one effect. The malforma- 
tion at birth of the inner ear, as a cause 
of complete deafness, is also connected with 
dumbness ; or accident may at any time of 
life injure the delicate structures contained 
within their cover of bone. The passage of 
the air through the external ear-passage 



may be obstructed or prevented by an ac- 
cumulation of wax or other matters ; the 
membrane of the drum may be perforated ; 
the bones may have been discharged by 
disease ; or the Eustachian-tube be blocked 
up by swelling temporarily, or permanently, 
by thickened mucus. There are no diseases, 
perhaps, which require — as must be evi- 
dent to all — more tact in their discovery 
and in their treatment than those of the 
ear; and yet, till lately, they have been 
almost entirely left in the hands of ignorant 
assumers, and the name of "aurist" has 
almost been synonymous with quack. The 
anomaly is now passing away, and the 
labours of talented and scientific men are 
placing the knowledge and treatment of 
these disorders upon a more rational and 
scientific basis. 

Noises in the ears, such as singings, ring- 
ing of bells, roaring as of the sea, &c. &c. 
are often extremely troublesome, and may 
arise from many and different causes. Mere 
temporary derangement of the digestive 
organs will in some persons produce them. 
They are often indicative of determination 
of blood to the head, and, when accompa- 
nied with symptoms of this tendency, ought 
not to be neglected. Partial obstruction 
of the Eustachian-tube by cold, or accumu- 
lation of wax in the external ear-passage, 
are apt to occasion these noises, and they 
are accompanied with some degree of deaf- 
ness. Of course the remedy must vary with 
the cause. If the digestive organs are de- 
ranged, they must be regulated ; if cold be 
the cause, the symptoms may be left to 
pass away with the temporary ailment. In 
some cases of chronic or continued noise 
in the ears, regularly bathing the head 



E AE, 



219 



MR 



with cold water every morning will, after a 
time, remove it. 

Ear-ache, or neuralgia of the ear, is 
treated of under the head of Neuralgia ge- 
nerally. 

Abscess in the meatus is often also called 
ear-ache. It is one of the most painful dis- 
orders, and is generally the result of cold. 
It is characterized by intense throbbing pain 
in the ear, with, frequently, perceptible 
swelling externally, and more or less fever. 
There is no relief to pain till the abscess 
bursts, and this result is to be encouraged 
by the assiduous use of fomentations, poul- 
tices, &c. After the matter has discharged, 
the ear ought to be gently syringed out three 
or four times a day with warm water, till 
the discharge ceases. It will be advisable 
to give a few doses of aperient medicine 
during the progress of the case. 

The abscess may form within the tympa- 
num, and the membrane be perforated in 
giving exit to the matter. Inflammation of 
the ear ending in abscess differs from true 
ear-ache, or neuralgia, in the pain being 
comparatively slight at first, and gradually 
increasing in intensity as the disease pro- 
gresses : whereas in neuralgia it commences 
with full severity. 

When the discharge after an abscess does 
not disappear, or when running from the 
ears shows itself after acute diseases, such 
as measles, scarlet fever, &c. the symptom 
must not be neglected, and should be ex- 
amined into by a medical man. It is most 
general in children of weak or scrofulous 
constitution, and may be with or without 
disease of the bone ; in the latter case the 
discharge is extremely fetid, and often stains 
the linen black. These discharges must not 
be too quickly stopped, neither can they be 
allowed to go on without risk ; in the former 
case, the sudden stoppage may throw back 
the disease upon the brain ; in the latter, 
this organ or its membranes may become 
affected by its gradual extension to them 
through the bones. Counter-irritation, by 
blisters or tartar emetic, behind the ears; 
strict attention to the bowels ; the general 
tonic treatment recommended under the 
article Scrofula ; and syringing with slightly 
astringent washes, such as one grain of 
lunar caustic, or two of white-vitriol, to 
the ounce of water, will constitute the most 
appropriate treatment. The safest plan, 
however, is to submit the case to medical 
inspection. Bodies of various kinds are apt 
to be thrust into the external ear-passage 
by children, or to find their way there by 
accident ; and farm-labourers sometimes get 
grain, peas, &c. projected into the ear dur- 



ing threshing. If the introduced body is 
much smaller than the passage, its removal 
may be attempted by syringing freely, and 
with a strong syringe ; but if the body fills 
up the meatus, or nearly so, this will not 
succeed; and, in the event of its being a 
pea, or any thing which will absorb fluid 
and swell, will do mischief. Neither, in 
case of a large body, which the syringe 
will not disengage, is it well for friends 
to attempt the removal in any other way ; 
they never do any good, and only push the 
obstruction farther in, rendering its extrac- 
tion by the surgeon more difficult, particu- 
larly if it is passed beyond the middle and 
narrowest portion of the canal. [When an 
insect gets into the ear, it may be quickly 
killed or made to come out, by turning the 
head to one side and pouring sweet-oil into 
the ear until the canal is full — a change of 
position will soon empty it, and then the 
canal should be syringed out with weak 
soap and water.] 

Refer to Cerumen — Head^Indigestion, §c. 

[EAR-ACHE.— See Neuralgia.] 

EARLY RISING. — There can be no ques- 
tion, as a general rule, that the habit of 
early rising is conducive to health ; but, 
like many other similar matters, the general 
application would, by many, be converted 
into a universal law, and much fallacy and 
no little mischief has been done by the pro- 
pagation of the dogma. The poets have 
given their strains, the philosophers their 
aphorisms, and the hearty centenarian his 
experience, to eulogize early rising as a sort 
of elixir of life, and preventive of illness 
and disease. It is a great good, but not a 
universal one. 

It is generally said that all those who 
have attained great and green old age hare 
been early risers ; therefore, say others, 
early rising is a promoter of health ; there- 
fore, it might be whispered, those whose 
constitutions have carried them through a 
long life have been able to be early risers. 
As in many other things, the truth probably 
lies between the two ; there have been good 
vital powers on the one hand, and good 
habits, of which early rising is often an 
indication, on the other. The wrong de- 
duction, however, that early rising is an 
unmixed good, has occasioned much erro- 
neous practice, and many a delicate person, 
either in consequence of the false idea, or 
badly advised by others, has injured their 
health materially by perseverance in the 
practice ; this, however, is more common 
among the young, than among the aged, 
who require less sleep. 

There is no question but that the bodily 



EAR 



220 



EDU 



powers and constitution undergo marked 
and regular changes during the twenty- 
four hours — changes which are probably 
influenced by electrical and other causes 
not at present understood. At all events, 
in disease, evening brings fever if it is pre- 
sent at all, and toward morning excitement 
abates if it does so at all : further, in health, 
the body, it is well known, is more obnoxious 
to the causes of disease in early morning 
than it is at other times ; and lastly, per- 
sons of weak nervous power generally feel 
better toward evening than they do in the 
morning, even when the refreshment of a 
night's rest might be expected to have given 
strength. The reason of these differences 
it is, perhaps, not possible fully to explain, 
but we may reasonably conclude that the 
same influence which causes or aggravates 
the evening fever, and abstracts excitement 
toward morning, may also act as the eleva- 
tor or depressor of the constitution gene- 
rally, although only felt when it is not in 
full vigour ; it may, or it may not, be owing 
to the presence or absence of solar influ- 
ence, but still it is so, and the fact is one of 
general experience. The fact, too, explains 
why early rising is not only not good for all 
persons, but why to some it is positively 
hurtful, and why those who are able to 
practice it are generally of strong and good 
constitution. Moreover, the fact tells that 
the person who cannot rise early with im- 
punity is not in full vigour, but requires 
means for attaining a better state of health. 
When the powers of life are raised to the 
proper level, then, by all means, let them 
be kept to it, and early rising used as one 
of the preservative means. 

What is meant by early rising is getting 
up from rest before the sun has exerted some 
power upon the earth ; the exact period to 
suit the invalid it is impossible to specify — 
it ought to be matter of experience : that 
is to say, retiring to rest at a reasonable, 
early hour, such as ten o'clock, the person 
should rise as early as can be done without 
creating feelings of sleepiness, languor, &c. 
during the day. There are certainly evils 
consequent upon continuance in bed in the 
morning, such as perspiration, &c. but 
they may be greatly obviated by the non- 
use of feather beds or too much clothing ; 
they are less, however, than those which 
result from a nervous system exhausted at 
a period of the day before it had come into 
full activity. The same arguments which 
apply to early rising, also do so to exer- 
tions or continuance without food by weak 
individuals in the first part of the morning; 



they can practice neither with impunity. 
There is no time of the day so pleasant, and 
the hale and strong can enjoy it to perfec- 
tion and gather health in its fresh breezes ; 
and their description will often tempt the 
unwary invalid to leave his couch and fol- 
low the example ; and he really does enjoy, 
for a short time, the novelty ; but shortly 
languor creeps over him ; the breakfast 
which disappears before the appetite of the 
strong morning-walker has no charms for 
his exhausted weaker companion, who pays 
with a day of listless languor for this ill- 
advised attempt. These hints will, it is 
trusted, not be taken as an encouragement 
to laziness, but as pointing out a very com- 
mon error in popular belief and popular 
practice. The person of weak vital power, 
who cannot be an early riser, must guard 
well that he does not mistake sloth for ina- 
bility, nor encourage the inability by in- 
dulging in late hours, which are often to 
him the most vigorous. Persons who suffer 
much from debility in the morning, and 
who are constrained to be up early, ought, 
as soon as possible, to have some warm re- 
freshment — a cup of warm milk if it agrees, 
or tea, coffee, or cocoa. In some cases, the 
popular addition of a teaspoonful of rum or 
brandy to milk is undoubtedly useful, parti- 
cularly where there is tendency to faintness ; 
but the cordial must be taken as a medicine, 
and abandoned as soon as possible. 

Refer to Bed. 

EATING. — See Food, Digestion, Indi- 
gestion. 

ECCHYMOSIS— Is a medical term ap- 
plied to discoloured swelling, caused by 
effusion of blood beneath the skin or in the 
tissues of the body. A common bruise is 
the most familiar example. 

ECTHYMA.— A disease of the skin in 
which pimple-like pustules containing mat- 
ter are developed. — See Skin. 

ECZEMA. — A disease of the skin in 
which minute vesicles are developed. [This 
disease is sometimes called " chronic ery- 
sipelas" by the public] — See Skin. 

EDUCATION — As applied to man, means 
literally the bringing forward or encourag- 
ing and regulating the qualities or proper- 
ties of which his whole being is capable. 
The natural division of the process is into 
mental and physical — the education of the 
mind and of the body. Strictly, in a work 
like the present, it is with the latter only we 
have to do, but the two are so intimately con- 
nected that it is impossible to separate them. 

So much that is applicable to the subject 
of physical education is said in the article 



EDU 



221 



EDU 



"Children;" and also in the various arti- 
cles on "Air," "Clothing," "Food," &c, 
&c. that it leaves but little to be added 
here ; and to the above-mentioned articles, 
and to those bearing upon sanitary mea- 
sures generally, the reader is referred for 
information. 

The great difference between the physical 
education of the male and female sex com- 
mences when children leave the nursery. 
The boy, much less hampered by the mode 
of clothing, and permitted much more free- 
dom in physical exertion than the girl, 
has, as far as these are concerned, a better 
chance of attaining his full measure of 
health, provided the mind be not over- 
worked, and constitution and surrounding 
circumstances are not absolutely deficient 
or adverse. The girl, on the other hand, 
is submitted to many artificial restraints 
and modes of education which militate 
strongly against the chance of her making 
a perfectly healthy woman. The diffusion 
of a knowledge of those principles on which 
health depends has, of late years, tended 
to ameliorate many of the most injurious 
practices connected with the bringing up 
of girls, but many yet require to be cor- 
rected. 

The bad results which are often brought 
about by the use of stays have been so 
often exposed and condemned, that the 
subject has become almost hackneyed, and 
yet by a majority of the female sex the 
practice is still followed to an injurious 
extent. It seems as if people imagined 
that the Creator had made the body of the 
adult female so weak that it cannot support 
its own weight ; for either on this account, 
or without reason, they case it up in artificial 
supports. This abuse extends even among 
the poorest; and girls of ten or twelve 
are kept from bending naturally by a stiff 
piece of wood stuck down the front of what, 
at least, stands instead of stays. True, 
these articles of dress do at last become in- 
dispensable, but it is only after the muscles 
of the frame have been weakened, in con- 
sequence of not being permitted to exert 
their appointed and regular action. Any 
muscle or set of muscles of the body, if not re- 
gularly exercised, becomes diminished both 
in substance and power. The human frame- 
work or skeleton is so constructed that the 
muscles with which it is furnished, and 
particularly those connected with the spine, 
preserve its equilibrium ; supersede these 
muscles by artificial support, and they be- 
come weakened. But as their artificial sub- 
stitutes cannot act with the perfection of 
the natural supporters, the defect sooner 
12 



or later shows itself; the unsupported 
spine gives way somewhere, and curvature, 
more or less, ensues. It would astonish most 
persons, if they were made aware of how 
many curved spines there are — in how many 
the deviation exists — who even do not them- 
selves suspect it; and how often it is the 
occasion of impaired health, palpitation of 
the heart, hysterical and other affections. 
To the above assertion it is only necessary 
to add the high testimony of Dr. John 
Forbes, who says, in a note to the article on 
" Physical Education," in the Cyclopaedia of 
Practical Medicine — "We lately visited, in a 
large town, a boarding-school containing 
forty girls ; and we learnt, on close and 
accurate inquiry, that there was not one of 
the girls who had been at the school two 
years — and the majority had been as long — 
that was not more or less crooked!" True, 
the Avhole of this enormous evil is not en- 
tirely due to the use of stays, but much of 
it is so coupled with long standing lessons, 
seats without backs, and too many hours 
devoted to the education of the mind, by 
which the constitutional powers generally 
are enfeebled. Moreover, the above spinal 
weakness is not the only evil consequence, 
for it is too often mixed up with disorders 
of the digestive and circulatory organs, 
originated by their compression by the 
clothing. The too prolonged hours of study 
inflicted upon girls have been alluded to, 
and are unquestionably a great evil, but 
they would be less so were the hours of 
relaxation and exercise more rationally 
conducted. No exercise can be beneficial 
j unless the mind be actively interested, or 
j at least pleasantly occupied during the 
| time of exertion ; but little good can result 
I from demure walks, taken without interest, 
and almost without enjoyment. 

Nothing perhaps is more certain than 

that, for the full development and healthy 

exercise of all the powers of the mind, a 

healthy body is required. The Almighty 

I has connected our mental manifestations in 

this world with a material organ, the brain, 

: and this organ, like every other in the* body, 

I is dependent for its healthy action upon 

that of the other organs: how evident, then, 

! that to preserve this wonderful instrument 

in harmonious and vigorous exercise of its 

] powers, the whole body must be in health ! 

But modern fashion and fallacy, and many 

modern educationists, say, No ; let the body- 

and instrument take care of themselves, our 

part is to elicit as many tones from the 

latter as possible. And elicit them they do, 

but they often sadly jar ; moral perceptions 

and acts, influenced by bodily disorder, 



EEL 



222 



EFF 



often war with moral and religious pre- 
cepts. The precept "slow to anger" cannot 
always control the irritabilities of a mor- 
bid nervous system ; and the not "slothful 
in business" cannot at all times rouse the 
body, oppressed by morbid and narcotizing 
blood, to the active and vigorous discharge 
of its duties. As long as our abode is in 
this world, our bodies and minds must be 
in intimate relation, in action and reaction 
with one another ; God has joined them, 
and man cannot dissolve the union without 
paying the penalty of his transgression. A 
perfectly healthy mind is only compatible 
with a perfectly healthy body ; and, in 
civilized life, with its many causes of dis- 
order, the latter can only be insured by 
attention to the laws of physical health and 
education. The mind, on the other hand, 
has its influences upon the physical health ; 
but these will be considered in the article 
devoted to the subject. 

EEL — Is one of the oily fishes, and is 
peculiarly indigestible. 

EFFERVESCENCE— Is the rapid extrica- 
tion of gas or vapour from a liquid; hence, 
foiling is effervescence : medically, however, 
the term is generally applied to the extrica- 
tion of carbonic acid gas solely. Many 
mineral waters, such as Seltzer water, are 
effervescing, from containing the gas na- 
turally; soda water and other effervescing 
drinks are impregnated with it by mecha- 
nical means, while in fermented liquors it is 
generated in the process of fermentation. 
In the practice of medicine, effervescing 
draughts are most frequently, perhaps, 
formed by the direct separation of the gas 
from one of the alkaline carbonates, such 
as the carbonate or bicarbonate — which 
latter contains the gas in greatest abun- 
dance — of potass, soda, or ammonia ; the 
solution of bicarbonate of magnesia, or 
"fluid magnesia," is also used for the pur- 
pose. In many forms of illness, particu- 
larly those attended with thirst, no kind of 
medicine is so grateful to the patient, or so 
readily taken, as that which is given in a 
state of effervescence. If the stomach is 
irritable, and a tendency to sickness present, 
medicines given in this way are more likely 
to be retained, the carbonic acid apparent- 
ly exerting a quieting and soothing effect 
upon the organ ; at the same time, the taste 
of medicine is considerably obscured by its 
administration by this method. When the 
tongue is much furred, and particularly in 
cases of sore throat, when medicine in any 
effervescing form can be swallowed, none 
appears to exert a more cleansing effect, in 
removing thick mucus and incrustations; 



and if it does this for the mucous membrane 
of the mouth, it must probably have the 
same effect on that of the stomach. 

Some persons who are liable to suffer 
from difficulty of breathing, whether from 
asthmatic or other causes, and those who 
do not easily get rid of flatulence, cannot 
take effervescing drinks without incon- 
venience; this, too, occurs if patients to 
whom they are administered are confined 
to bed, and lie down too soon after taking 
the close. A minute or two ought always 
to be allowed for the eructation of the gas, 
before a patient who has taken an effer- 
vescing draught resumes a recumbent posi- 
tion. 

One of the alkaline carbonates above men- 
tioned being made the effervescing agent, 
many medicines may of course be given in 
combination. The acids most generally and 
beneficially used to combine With the alkali 
and set free the gas are lemon-juice, citric 
acid, and tartaric acid ; they ought to be 
used in the following proportions : — To 
thirty grains of bicarbonate of potassa, a 
small tablespoonful of lemon-juice, or twenty 
grains of either tartaric or citric acid. To 
thirty grains of bicarbonate of soda, about 
one-fifth more of the above acids. To six 
grains of carbonate of ammonia, two tea- 
spoonfuls of lemon-juice, or about eight 
grains of either citric or tartaric acid. 

So common has the use of effervescing 
draughts become, that the materials, soda 
and tartaric acid, and a measure for the 
purpose, are kept in many houses. The 
practice is not free from danger or injury ; 
the continued use of soda being apt to im- 
poverish the blood. To the weakly it is of 
course more likely to prove hurtful than to 
the strong. 

The mode of mixing effervescing draughts 
which is commonly recommended is a bad 
one. The two powders are generally ordered 
to be quite dissolved in separate portions of 
water before mixing; the consequenee is, 
the gas is extricated all at once ; the vio- 
lence of the effervescence — unless the glass 
is a very large one — is very liable to carry 
up and spill over a portion of the liquid, and 
the action subsides before the person can 
drink. All this may be avoided if the acid 
and alkali, in fine powder, are put dry into 
the glass, and the water poured slowly upon 
them from some little height. In this way 
the gas is more sloAvly extricated ; there is 
no spilling, and, if properly done, full solu- 
tion of the powders ought to be effected. If 
lemon-juice is used, it should be mixed with 
the water, and poured upon the alkali in the 
same way. Of course, when the draught is 



EFF 



223 



E M A 



a very small medicinal one, the same pre- 
cautions are not required. 

Refer to Ammonia — Carbonic Acid — Potas- 
sa — Soda. 

EFFLUVIUM — Is a gaseous emanation or 
exhalation from any body, generally of an 
offensive or noxious character. Effluvia is 
the plural. 

Refer to Contagion — Disinfectant, §c. 

EFFUSION — Is a medical term applied to 
the throwing out of an unnatural amount 
of fluid into cavities, or tissues, which 
ordinarily contain a small quantity only. 
Thus, the watery fluid which is thrown out 
into the chest in consequence of inflamma- 
tion of the pleura or covering membrane of 
the lungs, is named an effusion. There are 
also effusions into the abdomen and in the 
head, also into joints and cellular tissue. 

EGG — Of the domestic fowl, or of birds 
generally, as articles of diet, is one of the 
most nutritious. This is evident, indeed, 
from the fact, that from the contents of the 
egg the entire young bird is formed. As a 
means of nourishment for the sick, espe- 
cially when it is beaten up, and given mixed 
either with hot or cold fluid, the yelk of egg 
is often most valuable. The white of the 
egg is composed of albumen and earthy 
salts ; its yelk, similarly constituted, con- 
tains in addition oily matter and sulphur. 

In the preparation of medicines of an 
oily character, the yelk of egg is often ad- 
vantageously employed, forming with them 
an emulsion which is'miscible with distilled 
or rain-water. Castor-oil and turpentine are 
both advantageously given by this method. 

ELASTICITY— Is the power possessed by 
various bodies of returning quickly to the 
form from which they have been forcibly 
altered. India-rubber, both in its natural and 
in its vulcanized condition, presents one of 
the most familiar and best examples. The 
elastic properties of this most useful pro- 
duct of nature have been abundantly taken 
advantage of in the formation of appliances 
of various kinds for the treatment of disease, 
and for the relief of suffering. — See Caout- 
chouc. The gum-elastic cushions have al- 
ready been adverted to under the above ar- 
ticle. The elastic bandages, stockings, and 
supporters of various kinds are among the 
most valuable additions to the modern prac- 
tice of medicine ; and with them may be 
classed the elastic pads of M. Bourjeaurd, 
which, while they exert a sufficient amount 
of pressure, yield, when, from counter- 
pressure such as that caused by swelling of 
the part to which they are applied, inelastic 
hardness would prove injurious. The author 
makes no excuse for bringing forward these 



improvements : many persons go on suffer- 
ing in consequence of not being aware that 
there are means of relief existing. 

ELATERIUM — Is a medicine possessing 
most powerful drastic cathartic properties. 
It is obtained from the juice of the Momor- 
dica elaterium, or "squirting cucumber." 
The plant. is native to the South of Europe. 
It is a most valuable remedy in proper 
hands, but one much too powerful to be used 
with safety by unprofessional persons. 

ELBOW-JOINT. — See Dislocations — 
Joints, &c. 

ELECTRICITY, or the Electric or Gal- 
vanic Fluid — Is a material agent diffused 
throughout nature, either latent or unmani- 
fested, or active and manifested, according 
to circumstances. Much yet remains to be 
learned respecting the electricity of our own 
bodies, and that of the objects and agents 
with which they are surrounded, and its 
relation with the phenomena of disease. As 
an agent in the treatment of disease, electric 
or galvanic action is now much employed. 
It is a powerful excitant. The shocks from 
an electric machine, or other electrical ap- 
paratus, are not often useful, except in such 
cases as suspended animation from drown- 
ing, &c. when their passage in not too great 
intensity, through the spine, to the pit of the 
stomach, may be of service. A continued 
current of the galvanic fluid is a much bet- 
ter application of the excitant powers of the 
agent ; and various contrivances for its con- 
venient medical employment are sold. 

The latest noticeable application of the 
curative powers of electricity is the electric 
chain or belt of M. Pulvermacher, which 
is made of various sizes and powers. The 
author has not yet tried the large and more 
powerful forms of the apparatus, but he has 
found the application of the smaller chains 
of much service in the cure and alleviation 
of neuralgic disease. 

ELECTUARY. — A medicinal preparation 
made of sugar. — See Confection. 

ELEPHANTIASIS— Is a name applied to 
two very distinct forms of disease. One is 
a cutaneous eruption, the other a thicken- 
ing of the tissues beneath the skin and 
around the muscles. Both are peculiar to 
hot climates. Their discussion could scarcely 
be of service in the present work. 

ELM-BARK, [Slippery El>i]— From the 
well-known tree, has been used as a remedy 
in skin diseases. 

EMACIATION— Is wasting of the tissues 
so that the body becomes thin. The process 
of emaciation, however, is very different 
from simple diminution of bulk : the latter 
may take place while the appearance of 



EMB 



224 



E ME 



health is still retained ; but with true ema- 
ciation, the skin, and aspect generally, pre- 
sent an unhealthy appearance. There are 
few diseases which are not accompanied 
with loss of flesh or emaciation, and it is 
not unfrequently the first observable symp- 
tom. Dr. Watson remarks — " It occurs in 
complaints that are not commonly danger- 
ous — as in dyspepsia, and in hypochondri- 
asis, which is often connected with dyspepsia 
— and when it does occur, it marks the 
reality of the disease. This wasting hap- 
pens in many fatal maladies — in pulmonary 
consumption, for example — and in dropsy, 
although the dropsical enlargement some- 
times masks it. It accompanies many 
acute diseases, and is reckoned an unfa- 
vourable symptom ; for it shows that the 
body is not properly nourished. Sometimes 
the emaciation is so extreme that the inte- 
guments give way — the bones of the patient 
are said to come through his skin. 

Refer to Atrophy. 

EMBROCATION.— A fluid applied, with 
friction to any portion of the body. — See 
Liniment. 

EMETICS — Are substances which excite 
vomiting ; that is, which cause the stomach 
to be forcibly emptied of its contents by 
the mouth, and which do this by a peculiar 
action, exerted either directly upon the 
organ itself, or in consequence of their 
having been taken into the circulation; thus, 
vomiting maybe excited by the injection of 
some emetic substances into the veins. 

Many agents are capable of exciting 
vomiting, which are not classed as emetics, 
such as nauseous tastes or smells, swinging 
motions, such as that which causes sea- 
sickness, mechanical irritation of the throat, 
&c. ; but these causes are very different 
from the specific action of a true emetic, 
which acts independently of taste or smell. 
Emetics constitute a class of our most valu- 
able remedies, although not so indiscrimi- 
nately and extensively used as they were 
formerly. In ancient times, particularly 
among the luxurious Romans, emetics were 
commonly employed for the disgusting pur-, 
pose of enabling them to disgorge one luxu- 
rious meal as soon as swallowed, that they 
might immediately begin with another. 
" Cicero, in describing a visit paid to Csesar 
at a villa near Rome, states that Csesar paid 
him the high compliment of taking an emetic 
before dinner, when he understood that 
Cicero intended to spend the day with him." 

The emetics most generally used, and 
most useful, are — 

Antimony. 

Ipecacuanha. 



Sulphate of zinc, or white vitriol. 

Chamomile. 

[Alum.] 

Mustard. 

Salt is sometimes used as an emetic, and 
the mechanical irritation of the throat is 
often resorted to with benefit for the pur- 
pose of exciting vomiting. The reader 
will find further information respecting 
the above emetics under their individual 
articles. 

When an emetic is given, it should be 
mixed in the first place with a small quantity 
of water. Except in the cases of sulphate 
of zinc (and some other mineral emetics 
not adapted for domestic use) some little 
time will elapse before the effects of the 
emetic are experienced — longer if the sto- 
mach be full of food, and vice versa. The 
first sensation is one of nausea, accompanied 
with a flow of the saliva, slight faintness, and 
cold perspiration. At last the effort of 
vomiting supervenes, and the contents of 
the stomach are ejected. As soon as actual 
vomiting commences, as a general rule, but 
not before, some tepid fluid (water, gruel, 
chamomile-tea, or such like) should be 
given in moderate quantity, not exceeding 
a pint at a time. A slight caution is requi- 
site upon this head, for occasionally indi- 
viduals under the action of an emetic are 
encouraged to drink very freely of fluid and 
to distend the stomach. This is not well, 
for it not only embarrasses the action of the 
organ, but might cause its being lacerated 
or burst. It is also requisite to caution 
against giving the diluent fluid too soon, 
that is, before the specific power of the 
emetic substance has come into action. If 
this is done, the dilution will either delay, 
or altogether prevent the desired effect. 
When there is much debility of stomach, it 
is better to choose for the diluting fluid, 
a bitter, such as chamomile-tea, which has 
the additional advantage of being itself 
emetic. As a general rule, the mineral act 
more quickly and violently than the vege- 
table emetics. For this reason the former 
are generally selected in cases of poisoning, 
such as that by opium, in which there is 
some difficulty in rousing the stomach to 
action at all, and in which it is important 
that it should be relieved of its contents as 
speedily as possible. In such cases medical 
men may give the sulphate of copper ; but 
for the unprofessional, the sulphate of zinc, 
or white vitriol, is the safest, and is a nearly 
equally efficacious remedy. 

When there is much fever, and in some 
forms of inflammation, the salts of anti- 
mony, particularly tartar emetic, are most 



EME 



225 



EMI 



generally used if emetic action is desirable. 
As a simple emetic to relieve the stomach, 
and also in cases of chest affections, ipeca- 
cuanha will be found the best. In diseases 
of depression, mustard is most useful, and 
carbonate of ammonia may also be employed 
alone or combined with ipecacuanha. In 
cases -where the power of swallowing is 
lost, medical men can excite vomiting by 
the injection of emetic substances into the 
veins. This practice, of course, cannot be 
followed by the unprofessional, yet they 
may safely, and with much certainty of suc- 
cess, have recourse to mechanical irritation 
of the back of the throat, either by the fin- 
ger or by a feather. A few individuals 
possess the power of spontaneous vomiting, 
or at least of exciting regurgitation of the 
food from the stomach into the mouth, a 
process somewhat analogous to the rumina- 
tion of animals. Such persons usually suf- 
fer from dyspepsia, and have recourse to 
the operation to free the stomach from food 
it cannot digest. 

The evening is generally the most suitable 
time for administering an ordinary emetic, 
as the stomach has time to recover itself 
duiing the night, and the uncomfortable 
nausea which often follows is less felt. 

Emetics are used to fulfil various indi- 
cations, the most direct and obvious being 
the emptying of the stomach of any nox- 
ious substances, either formed within the 
body, such as bile, or taken in by the 
mouth, as indigestible food or poison. For- 
tunately, these matters often of themselves 
excite vomiting, but in many instances, they 
do not sufficiently empty the stomach, in 
which case the action must be kept up, or 
re-excited, either by a diluent or by some 
emetic medicine. It must be remembered, 
however, that in the case of some poisons 
it is not desirable to dilute largely. In 
addition to their power of emptying the 
stomach, emetics are valuable from the 
mechanical effects, both general and local, 
which they exert upon the body. Formerly, 
the general mechanical effect, or " shock," 
of an emetic, was believed to have the power 
of checking fever and other diseases at their 
outset. It is not now, however, much trusted 
to by medical men, and, if it does not do 
good, is apt to prove injurious, by causing 
an irritable condition of the organ, which 
may continue throughout the disease. In 
many cases of incipient disease, however, 
characterized by depression, coldness of the 
skin, &c. the mechanical action of a smart 
emetic of ipecacuanha, either alone, or with 
five to eight grains of carbonate of am- 
monia, is most beneficial, by rousing the 



system, and removing the tendency to in- 
ternal congestion, or accumulation of blood. 
Another and most beneficial mechanical 
emetic effect is in the case of children 
suffering from affections of the chest, with 
accumulation of mucus, or phlegm. Chil- 
dren cannot expectorate, and are liable to 
be suffocated, if the phlegm is in large quan- 
tity and cannot be removed. Nothing in- 
sures its removal so effectually as an emetic, 
or rather emetics repeated from time to time 
(every few hours) according to circum- 
stances. In cases of jaundice and over- 
loaded liver, the mechanical action of eme- 
tics is often beneficially had recourse to. 
In consumption, the periodical exhibition 
of emetics has been recommended. In 
spasmodic diseases, either general, as hys- 
teria, or local, as in spasm of the stomach, 
emetics are beneficial — in the latter case, 
often, of course, by freeing the stomach 
from the offending cause of the disorder. 
In asthma they often relieve when nothing 
else will. 

Emetics are not always safe remedies. In 
pregnancy, in persons of very full habit, 
particularly if there is determination to the 
head, in rupture, in falling down either of 
the bowel or of the womb, vomiting should, 
if possible, be avoided. The ancients held 
the opinion that emetics strengthened the 
stomach, and they were even used in the 
training of the athlet£e. Modern experi- 
ence certainly does not uphold the fact, for 
the habitual use of these agents assuredly 
injures the tone of the organ and weakens 
its power. 

An error is frequently committed in using 
antimonial, or, as it is called, " antimony 
wine," as an emetic ; it is far too depress- 
ing for general purposes. For these, ipe- 
cacuanha is quite the safest agent of the 
class ; it should be given in powder mixed 
with water, and not in the form of wine, if 
the former is procurable. 

EMIGRATION. — For those who leave 
their native country and go to seek a home 
and fortune in other lands, one thing is es- 
sential to success. Invaluable to all, health 
is necessary to the emigrant. It is to him 
a capital of more value than money ; and 
yet this foundation of future fortune, nay, 
even of existence, is often carelessly and 
ignorantly undermined at the very outset 
of the enterprise. Many are undoubtedly 
too poor and too ignorant to profit by coun- 
sel even when it is given, but thousands 
annually leave the shores of Britain as emi- 
grants, who are capable of acquiring and 
acting upon useful information concerning 
matters of health ; and how few, compara- 



15 



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226 



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tively, have even a slight acquaintance with 
the laws which regulate their being, on 
the observance of which their health and 
usefulness depend ! How few are capable 
of acting intelligently and promptly under 
the occurrence of those accidents and con- 
tingencies which it must often fall to the 
lot of the emigrant to encounter ! Into the 
hands of some who meditate emigration 
these pages may. fall ; to them the author 
more particularly addresses himself. 

The first thing to be considered must be, 
not whether gold is to be extracted from 
the river-sands in one place, or corn is to 
be grown without exertion in another, but 
the question should be, What is my consti- 
tution ? What are its tendencies, hereditary 
or acquired ? To what climate is it most 
adapted ? Will it endure the hot summers 
and severe winters of America, or will these 
probably develop the consumptive tendency 
I inherit ? Is it not more suited for Austra- 
lia or New Zealand ; are not my children 
more likely to be reared in the one climate 
than the other? These and numerous 
other considerations connected with the 
adaptation of constitution to climate and proba- 
ble occupation ought to hold the chief place 
in the decision as to emigration. That 
being decided, the next is the preservation 
of health during the voyage. As far as 
circumstances will permit, a vessel should 
be selected which guaranties sufficient room, 
ventilation, supply of water, and fresh food. 
Of course circumstances must, to a certain 
extent, modify these requirements ; but let 
circumstances be what they may, a man 
had better remain at home, and lay his 
bones with those of his fathers, than take 
ship in some of the floating pest-houses that 
have been permitted to carry across the 
Atlantic their freight of wretched humanity, 
marking their track on the deep with the 
bodies of those poisoned in their iniqui- 
tous holds, and landing the survivors with 
disease or death upon them, or with the 
strong arms that were to win the bread of 
themselves and children weakened and 
unnerved. Space will not permit, in a work 
like the present, the detail of all those 
means and measures which the intending 
emigrant should adopt as regards health. 
Much information on these points he may 
gather from the various Emigrant's Guides, 
particularly those of the Messrs. Chambers; 
and further, he is referred to the various 
articles in this Dictionary which treat of 
matters connected with the preservation 
and regulation of health, more particularly 
Ague, Bed, Climate, Clothing, Consumption, 
Food, Medicines, Ventilation, Water, $c. §c. 



These and others contain many hints which 
will be found valuable, both in the selection 
of the future home and of the mode and 
means of transit. One thing is generally 
agreed upon, that however good an emigrant 
ship's dietary may be, it is always advisable 
for the passengers to add a private one, of 
such preserves and pickles as means will 
allow — common cabbage will do, preserved 
in vinegar — which may afford a supply of 
the vegetable acids, the best counter-agents 
to the effects of the salted provisions which 
necessarily form a large proportion of the 
food on board ship ; a few bottles of lemon- 
juice are always a valuable addition to the 
sea-store. 

As regards clothing, it is unnecessary to 
repeat here what is said in the article on 
that subject ; but it may be mentioned that 
emigrants who probably have to encounter 
exposure on first landing in their adopted 
country, would do well to provide some 
cheap waterproof material to place beneath 
them at night. An attack of rheumatism 
is an unfortunate, and often, when once 
acquired, too constant companion of the 
emigrant, and may cripple him permanently. 
Those who have to undergo the confine- 
ment which a long voyage must entail, most 
especially require to attend to all the laws 
of health, and particularly exercise, which, 
from the small walking-space on board ship, 
is often neglected ; it should be a carefully 
observed rule to walk for a certain time 
daily. 

The amusement of the mind is a matter 
of much importance, even in a health point 
of view, for those exposed to the monotony 
of a long sea-voyage. Happy are those to 
whom books afford their never-ending re- 
source ! and the time might be worse em- 
ployed than in the perusal, or rather study, 
of works like the present. When the new 
scene of labour is reached, the opportunity 
will be past, but the man who has acquired 
for himself information which may enable 
him either personally to avoid, or, in the 
case of others, to counsel the avoidance of 
sources of disease, or to act intelligently 
and promptly in cases of sudden illness or 
accident, may have reason to bless the per- 
haps otherwise wasted time spent in the 
acquisition of the principles of Domestic 
Medicine, or of Household Surgery. 

After landing in his new country, the 
emigrant ought to inform himself as far as 
possible respecting the occurrence and 
causes of illness, either in the one district 
of his residence, or in those he may have to 
pass through. 

As said at the commencement of this 



EMI 



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article, health is, next to trust in God, the 
essential; and it cannot be too jealously 
guarded by the emigrant, to whom its loss 
is ruin and misery. For information re- 
specting medicines, the emigrant reader is 
referred to the article. 

The following extract from an American 
publication will, perhaps, add force to what 
has been said respecting care in selecting a 
vessel, and attention to the means of health 
during the voyage : — 

" The condition of the German and Irish 
emigrants, prior to their embarkation and 
during their transit of the ocean,was, in most 
instances, conspicuously different. While 
the former were generally robust, and well 
provided on the passage with the means of 
subsistence, and observant of cleanliness 
and ventilation, the latter . were, in most 
cases, enfeebled for the want of sustenance, 
and on shipboard destitute of supplies of 
wholesome food, depressed in mind, clothed 
in filthy garments, and crowded and con- 
fined in air rendered pestiferous by the ex- 
crementitious matters eliminated from their 
own bodies. In contrasting the hygienic 
circumstances in which the two classes of 
emigrants were placed, it is easy to account 
for the greater amount of sickness and 
mortality which occurred in one class than 
in the other. It is said that of the admis- 
sions of emigrants into the hospitals and 
almshouses of New York, the Irish exceeded 
the German in proportion of ten to one. 

" The Montreal Immigrant Committee, in 
their report for 1847^-state that that year 
has been unparalleled for the amount of im- 
migration into Canada; near 100,000 souls 
have left the British Isles for these pro- 
vinces during that period ; over 5000 of 
these died on their passage out, 3389 at 
Grosse Isle, 3862 at Montreal, and other 
places in the same fearful proportions. 
Never had Canada presented such fearful 
scenes of destitution and suffering. ' From 
Grosse Isle, the great charnel-house for vic- 
timized humanity, up to Port Sarnia, along 
the borders of our magnificent river, upon 
the shores of Lakes Ontario and Erie, and 
wherever the tide of immigration has ex- 
tended, are to be found the final resting- 
places of the sons and daughters of Erin — 
one unbroken chain of graves, where repose 
fathers and mothers, sisters and brothers, 
in one commingled heap.' 

" The disease of which the emigrant pas- 
sengers, and in many instances the officers 
and crews of ships, perished at sea, and of 
which a great number were ill on their arrival 
in the United States and Canada, was typhus 
[or ship] fever in its genuine form. In some 



ships, dysentery, small-pox, h.nd measles 
swelled the amount of mortality, and added 
to the number of sick that reached the ports 
of destination." 

EMMENAGOGUES— Are medicines which 
exert, or are supposed to exert, their action 
upon the womb, and to promote the men- 
strual discharge. The only well-known 
medicinal agent which exerts an undoubted 
specific action of the kind, is the Secale 
cornulum, or ergot of rye. — See Ergot. Re- 
cently, a Chinese emmenagogue, the Key- 
tse-sing, has been highly spoken of; but 
at present the experience of its powers is 
limited. Some medicines seem to exert their 
influence upon the womb by stimulating 
neighbouring organs : to this class aloes 
belongs ; others, such as valerian and asa- 
foetida, by their action on the nervous sys- 
tem, and another set, such as iron, by their 
tonic influence upon the system at large. 

Refer to Menstruation. 

EMOLLIENTS — Are remedies which pos- 
sess the power of relaxing and softening parts 
to which they are applied. Heat and moist- 
ure, and oil or fatty matters, are the chief 
and best emollient remedies. 

EMPHYSEMA— Is a medical term ap- 
plied to two very different disorders. In 
one case it denotes a state of coalescence, 
and unnatural distension of the air-cells of 
the lungs. — See Lungs. In the other, it is 
applied to the distension or blowing up of 
the cellular or areolar tissue of the body 
by air. This latter form of emphysema 
sometimes follows upon the accident of frac- 
tured rib, when a point of the bone pene- 
trates the lung. In this case, with every 
breath drawn in, air passes from the lung 
into the cavity of the chest, from whence it 
finds its way through the wound made in the 
walls of the cavity, and by this means be- 
comes diffused through the cellular tissue ; 
the features and the whole body become 
greatly swollen, and when the surface is 
indented by the finger, a crackling sensation 
is experienced. The mere distension of the 
cellular tissue is not a circumstance of so 
much importance as the accident which 
gives rise to it, but in those perfectly una- 
ware of the possibility of such an occur- 
rence, the appearance presented by the af- 
fection would cause much alarm : of course 
the broken rib itself should be attended to ; 
the emphysema may be relieved by punc- 
tures made in the skin by a lancet, and by 
the application of bandages. 

Refer to Fractures — Rib, Sfc. 

EMPYEMA— Is a collection of matter in 
the cavity of the chest, between the lung and 
the ribs. _ Refer to Inflammation of Lungs. 



EMP 



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EPI 



EMPYREUMA — Is the peculiar, and 
often offensive smell which many substances 
acquire after exposure to considerable heat 
in close ovens or vessels. The fact of an 
article of diet becoming empyreumatized 
renders it unwholesome and irritating to 
the stomach ; on this account baked meats, 
pastry, &c. are more apt to disagree than 
the same articles roasted or boiled. 

Refer to Baking. 

EMULSION— Is a mixture of oil with 
water by the intervention of a third sub- 
stance. This may be effected by means of 
gum mucilage, syrup, &c. ; but perhaps the 
best agent for forming emulsions is the yelk 
of egg. The oil must first be rubbed up 
with the yelk, and then distilled, rain, or 
perfectly soft water added gradually. Milk, 
which is itself a natural emulsion, is also a 
very good agent for uniting some oily or such 
like matters resembling the oils in composi- 
tion, with water, particularly camphor. — See 
Camphor — Castor-oil — Turpentine. 

ENAMEL.— The outer hard casing of the 
teeth.— See Teeth. 

ENCEPHALON.— A medical term em- 
ployed to designate the parts. generally con- 
tained within the skull. 

Refer to Brain. 

ENDEMIC — Is a term applied to diseases 
which are peculiar to, and persistent in, 
certain districts or countries. Thus, ague 
is endemic in marshy districts; bronchocele 
or goitre where the water is impregnated 
with magnesian limestone ; and cretinism 
in the low dark valleys of Switzerland. 
These, and other endemic affections, are 
undoubtedly due to natural peculiarities of 
soil and climate ; but their power is un- 
questionably much augmented .by the pri- 
vations attendant on poverty, and by the 
depressing influence of dirt and vice ; or, 
as in the case of bronchocele, by laborious 
lives. 

Besides naturally caused endemic dis- 
eases, there are others which may equally 
be called endemic, though arising from the 
artificial circumstances which have hitherto 
been attendant on man when living in com- 
munity ; such are the fevers of our large 
towns, which are so constant in their ope- 
ration in particular localities, as truly to 
merit the name of endemic. 

In many situations, the constitutions of 
the natives of districts in which endemic 
influences prevail, appear to become habi- 
tuated to, or proof against, the morbific 
causes, which are quickly productive of 
disease in strangers. Such is strikingly 
the case in the rivers of the African coast; 
and the Niger expedition afforded melan- 



choly proof of how fatal to Europeans a 
climate may be, in which the natives live 
with comparative impunity. In many cases 
something is due to the adaptation of habits 
and modes of life by the inhabitants, which 
are either unknown to or neglected by 
strangers. 

Refer to Climate — Epidemic, §c. 

ENDERMIC — Is the transmission of medi- 
cinal actions to the constitution through the 
skin. — See Skin. 

ENEMA.— A clyster.— See Clyster. 

ENTERITIS.— Inflammationofthebowels. 
— See Alimentary Canal. 

Refer to Inflammation. 

ENTOZOA — Are parasitic animals which 
are found in a living state within the body. 
The most common entozoa in man are the 
various forms of worms. — See Worms. 

ENURESIS. —Incontinence of urine — 
See Urine. 

EPHEMERA.— A fever which does not 
last more than twenty-four hours. 

EPIGASTRIUM.— The pit of the stomach. 

EPIDEMIC — Is a term applied to a disease 
which attacks a large number of individuals 
simultaneously, or at least in quick succes- 
sion. Perhaps the best instance of an 
epidemic is the well-known influenza, which 
seems more independent of endemic, or 
local, influences, than most others of the 
class. Cholera is an epidemic disease, but 
the liability to its visitation is evidently 
connected with local circumstances, which 
either assist in developing the activity of 
its mysterious germs, or at all events exert 
an attracting influence over them. Scarlet 
fever, measles, small-pox, and other dis- 
eases of the class, most certainly prevail 
epidemically at times ; for though they un- 
doubtedly disseminate themselves by con- 
tagion, observation would show that the 
contagious influences are much more potent 
in different places at different times. The 
reason why this should be so is not always 
traceable ; but as regards the greater and 
more pestilential epidemics, it has been 
observed that they have been preceded or 
accompanied by striking vicissitudes in the 
weather. It is well known that the first 
extensive diffusion of the Asiatic cholera 
dated from a swampy district at the mouth 
of the Ganges, after a very wet season ; and 
it is matter of history that the epidemics of 
plague were associated with unusual modi- 
fications of weather ; the extremes of heat 
or cold, of drought or moisture. Neither 
are the epidemic influences always confined 
to man : the lower animals are also fre- 
quently and fatally subject to them. It is 
remarkable, as indicative of this influence, 



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EPI 



that birds have been observed to forsake 
districts in which an epidemic pestilence 
prevailed. 

Epidemics were much more common and 
fatal in former times than they have been 
within the last hundred years. Such were 
the plague at Athens, 430 years before 
Christ, the black death or plague of the 
fourteenth century, the sweating sickness 
toward the end of the fifteenth, and the great 
plague of London of the seventeenth. At 
the present day, the plague of Eastern coun- 
tries, of Egypt in particular, and the cholera, 
are the modern pestilences. All these, and 
many others, are undoubted epidemics ; 
but equally certain is it that they owed 
and still owe much of their potency for 
evil, to local and endemic causes, and to 
the entire want of attention to sanitary 
arrangements. However deficient these 
may be in this country, even at the present 
day, were it not for such • regulations as 
there are, we know of no reason why the 
plague which still lingers around and some- 
times decimates the neglected oriental city, 
should not again visit our shores. 

Refer to Contagion — Fomites, $c. 

EPIDERMIS.— The outer or scarf skin, 
or cuticle. — See Skin. > 

EPIGLOTTIS— Is a cartilage of an oval or 
heart-shaped figure, situated at the root of 
the tongue, which falls upoa. and covers the 
glottis or opening into the larynx, so as to 
protect it, particularly during the passage 
of food, in the act of swallowing. 

Refer to Larynx — Swallowing, §c. 

EPILEPSY, or Falling Sickness — Is 
one of the very afflicting maladies to which 
man is subject, belonging to the class of 
convulsive diseases. It is also one of the 
most eminently characteristic, and at the 
same time terrible to witness, when it occurs 
in its severer forms. 

The fits, or convulsive seizures of epi- 
lepsy, are most varied as to occurrence. 
Occasionally an individual has suffered from 
one paroxysm, and one only, the disease 
never again returning ; in other cases, years 
have intervened ; frequently the interval is 
one of months, but again, daily fits, or even 
two or three times a day, are the rule in 
the worst cases. The attack of epilepsy is 
for the most part sudden : the individual, in 
the midst of some accustomed occupation, 
or while holding active communion with 
persons around, suddenly utters a loud — a 
fearful — cry, and, if unsupported, falls to 
the ground ; the eyes are staring or rolling ; 
the head, or rather chin, is drawn toward 
one shoulder, the countenance becomes dark 
or livid, the veins of the face and temples 
U 



turgid with blood, and the features are 
thrown into convulsive movement ; there is 
frothing at the mouth, while a kind of choking 
noise is often made in the throat ; the limbs 
are also more or less convulsed, and the 
excretions are often expelled involuntarily. 
The tongue very often suffers from being 
bitten, and the teeth have even been frac- 
tured during the fit. Gradually, these 
convulsive movements diminish, and the 
person awakes to consciousness, with a 
heavy stupid look, or falls into a deep 
lethargic sleep, which continues for some 
hours ; but even when roused from this, 
there often remains slight temporary sus- 
pension of the activity of the mental func- 
tions. Such are the phenomena of a severe 
epileptic paroxysm ; the disease, however, 
occurs in much milder forms, even in those 
who at other times suffer from it in greater 
intensity. A slight temporary unconscious- 
ness may be the only symptom, with or 
without the slightest approach to convulsive 
movement, as evidenced by the twitching of 
a finger, the roll of an eye, or slight spas- 
modic action of the muscles of the face ; 
the patient may fall gently as in a faint, or 
remain standing as it were asleep for a few 
moments. As there is every variety in the 
nature of the attacks, so is there likewise 
in their duration : from a few moments to 
the average period of from five to eight 
minutes, but sometimes much longer. 

The attack in many cases appears to by- 
standers to come on suddenly and without 
warning ; but most epileptic patients are 
sensible for some time previously of the 
approach of the paroxysm, and even for 
twenty-four hours are always aware that a 
fit is at least probable, although its direct 
accession may not be certainly known until 
just previous to its occurrence. It may, 
however, happen that these symptoms will 
pass off without a fit, either independently 
of any effort of the patient to ward off 
the attack, or in consequence of some 
of those measures found to be efficacious, 
and adopted by epileptic patients for the 
purpose. 

The premonitory symptoms vary greatly: 
low spirits, or unusual irritability, some- 
times an increased energy, dizziness, noises 
in the ears, floating specks before the eyes, 
and many other signs connected with dis- 
order of the nervous system, are the pre- 
cursors of the epileptic paroxysm. But the 
most generally marked and remarked 
precedent is the epileptic "aura," a sort 
of creeping sensation, which is described 
by the patient as arising at some par- 
ticular part of the body, such as the ex- 



EPI 



230 



EPI 



tremity of a limb, and gradually ascending 
upward to the trunk or head, till the indi- 
vidual loses his consciousness in the con- 
vulsion. 

Epileptic seizures are very frequent in 
the night- time, just as the person is falling 
asleep ; but they may occur at any period 
of the twenty-four hours, and may be in- 
duced by causes affecting the nervous sys- 
tem; the excitement of joy or passion, or 
the depression of grief, intoxication, and 
sexual excesses, are most frequently not only 
actual exciters, but also predisposers, to the 
attack of epilepsy. 

Epilepsy may be a congenital disease, 
that is, the child is born with the tendency, 
and becomes subject to the fits, either with 
or without apparent cause, early in life. 
Indeed, many of the convulsions of children 
occasioned by teething, &c. are in fact epi- 
lepsy, but as they arise from causes irri- 
tating the brain, and not from affections of 
the organ itself, they are possibly not re- 
peated when the cause of the irritation has 
subsided. If, however, the tendency exists 
strongly in the constitution, and has not 
developed itself before puberty, it is very 
apt to do so at that period, and more espe- 
cially if favoured by circumstances which 
lower the tone of the body generally or of 
the nervous system in particular ; but no 
period of life is exempt from becoming the 
period of epileptic development, even to 
old age. The following observations of 
Dr. Bright upon this point are generally 
instructive, he says — " There are leading 
periods in the evolution of the frame, and 
peculiar circumstances connected with cer- 
tain periods, which may well be considered 
as influential in the production of the dis- 
ease. In infancy, the nervous system is 
delicate, and easily acted upon by various 
causes of irritation. Then follows the try- 
ing period of teething. In a few years the 
second dentition occurs. In a few years 
later, all the great changes connected with 
the age of puberty. To this follow the 
excesses and exposures of manhood; and 
after the lapse of years the vigour of the 
system fails, and many causes act to 
derange the nice balance of the constitu- 
tion : the bowels often become sluggish, &c. 
&c." 

A person may die in an epileptic fit, even 
in the first, but this is seldom the case. 
More generally the disorder does not imme- 
diately threaten life, but the individual goes 
on from year to year, suffering more or less, 
and still lives ; even when the fits occur 
daily, or two or three times a day, this is 
the case. "When death does occur early in 



the disease it is more probably due to suf- 
focation arising from the spasm of the 
muscles of the throat and neck, than to the 
brain affection. But if life is continued to 
the confirmed epileptic, the intellect too often 
becomes affected. This may not be palpable 
after a first seizure, not even after many 
seizures for many years, not throughout a 
tolerably long life, but these are exceptions. 
The generality of epileptics become feebler 
in intellect, the memory fails, the power of 
continuous exertion of the mind is lost, and, 
perhaps, at last the condition ends in mental 
fatuity. 

That epilepsy is due to disease or dis- 
order of the brain and nervous system is 
unquestionable ; the affection either directly 
originating from them, or through them, in 
consequence of irritation in some portion 
of the body. It is well ascertained that 
hereditary predisposition gives greater effect 
to causes which have plainly exerted influ- 
ence in the production of this distressing 
malady. Dating, either directly or indi- 
rectly, from the nervous system, whatever 
weakens that system tends to cause epi- 
lepsy. From this it is evident how well 
founded the observation is, that there is no 
more fertile source of epilepsy than the 
abuse of the sexual organs, particularly in 
the young. The subject is a painful one, 
but the direful consequences of vice, with 
which the merest children become imbued at 
school, is frequently coming before medical 
men. Unaware of the sin and evil conse- 
quences of their acts, they ruin constitu- 
tions at the most critical period of life, and 
lay the foundations of epilepsy and other 
nervous diseases, which are either quickly 
developed, or do not show themselves till 
late in life. The subject is one to which 
parents and tutors cannot be too strongly 
alive. Intoxication is a cause of epilepsy, 
and delirium tremens may be complicated 
with it. Strong and prolonged mental 
exertion may induce epilepsy. Fright is 
another and very frequent exciting cause. 
Worms and irritations in the bowels, in- 
deed whatever can irritate the nervous 
system, may induce the disease in question. 
Imitation, or at least the witnessing an indi- 
vidual in the epileptic paroxysm, has been 
known to give rise to the fits in others ; but 
they were most likely predisposed, or at all 
events of nervous and susceptible tempera- 
ment ; for this reason, such persons, young 
females and children especially, should 
never, if possible, be permitted to witness 
an. epileptic fit. The premonitory cry is so 
terrifying that it has been known to affect 
even the lower animals. 



EPI 



231 



EPI 



Of the predisposing causes there is no 
question that hereditary tendency is a pow- 
erful one, and, especially, if the constitu- 
tion of the family be scrofulous. Epilepsy 
in the offspring has been traceable to no 
other cause than dissipated and, especially, 
drunken habits in the father. It is fre- 
quently observed to be concomitant with 
malformation, or at least mis- shape, of the 
head of the sufferer. From what has now 
been said, it must be evident that epilepsy 
is no disease for domestic management, in 
a curative point of view, but that it affords 
much room for preventive and other means. 

In families in which a tendency to epi- 
lepsy is known to exist, the greatest care 
should be taken to guard the nervous sys- 
tem from all causes either of irritation or 
exhaustion. In infancy, the period of teeth- 
ing and the condition of the bowels will 
require special attention, and the tone of 
the system to be maintained as directed in 
article "Children." The physical strength 
and health are to be cultivated in early 
life, even at some sacrifice of educational 
advancement. At puberty the strictest eye 
must be kept upon the habits and tenden- 
cies, and, while the constitution is develop- 
ing, and growth going on, all exhausting 
exercises prevented. Indeed, during life, 
the suspicion of a tendency to so terrible 
an affliction as epilepsy should be a never- 
forgotten check upon excess in every way 
— a check upon the man who consumes 
his energies in the exertions of business 
or of study, as well" as upon those who 
waste them in the pursuits of vice or sen- 
sualism. In addition to passive preventive 
means, all those measures which are fully 
laid down throughout this work for the 
preservation of health, should be well at- 
tended to, particularly the use of cold water 
to the head, spine, and surface generally, 
if there is sufficient reaction to bear the 
application. 

Care must be taken in the curing or sup- 
pression of accustomed or long-continued 
discharges, such as habitual diarrhoea, 
bleeding from piles, &c. At the same time 
it must be borne in mind that the dis- 
charge, by weakening the system, may be 
itself the cause of the disease ; but this is 
a point which the medical attendant must 
determine. 

Certain precautions are always requisite 
with those who suffer from epilepsy, and, 
as a general rule, it may be laid down that 
they should never, if possible, place them- 
selves or be placed in situations in which a 
sudden seizure will expose them to danger. 
Thus, employments which necessitate riding 



on horseback, ascending heights, &c. ought 
never to be engaged in, neither such as 
those in which even momentary uncon- 
sciousness may involve the lives of others 
in danger. Even the suspicion of epilepsy 
in a railway official ought to be a disquali- 
fying circumstance. Many, it is true, have 
sufficient warning to enable them to pre- 
pare for the attack and to withdraw from 
danger, but this is not always possible ; 
the worst case of burning, or rather roast- 
ing, the author ever witnessed, was in 
consequence of a fall into the fire in an 
epileptic paroxysm. When means will allow 
of it, the epileptic ought to have an attend- 
ant constantly with them. When an indi- 
vidual is seized with a fit of epilepsy, but 
little can be done for its immediate relief; 
the chief thing is to prevent the patient 
inflicting injury upon himself, by striking 
against surrounding objects, and also to 
protect the tongue. Those who are much 
in attendance upon the epileptic ought 
always to have at hand a piece of India- 
rubber, or a thick India-rubber ring — such 
as is used for children teething — to insert 
between the teeth. All fastening about the 
body, such as the neckcloth, &c. ought to be 
loosened, and air freely admitted ; the head 
should be raised, and cold wet cloths may be 
applied to it if there is much heat. It has 
been advised to cram the mouth full of salt 
as soon as the fit comes on. Dr. Watson, 
who had the plan tried in hospital, thought 
it seemed to curtail the duration of the 
convulsion. 

The treatment of an epileptic patient in 
the intervals of the fits must be left to a 
medical man ; it involves too many con- 
siderations to be advantageously managed 
by others. When well treated, there is a 
hope of cure, and this chance should be 
afforded to the patient, which can only be 
certainly done under efficient and educated 
management, for even with all that skill 
and attention can do, the disease often 
proves intractable. The various remedies 
which have been used in epilepsy — and they 
have been very numerous — it would serve 
no good purpose to enumerate here, further 
than to state that much benefit has fre- 
quently resulted from counter-irritation, 
such as the introduction of a seton in the 
neck, or, better still, a full and free erup- 
tion produced over the shaved scalp, by 
tartar emetic and croton-oil ointment, or 
down the spine, should any tenderness be 
detected there. It sometimes happens that 
accidental counter-irritating effects relieve 
epilepsy, at all events for as long as they 
are in action. In one case attended by the 



EP1 



232 



EPS 



author, a man who was suffering from daily- 
attacks of epileptic convulsion fractured his 
leg, and from that time had no attack for 
five or six weeks, during the period the ac- 
cident was being recovered from. 

Further, it is well to draw the attention 
of the reader to the article "Cotyledon." 
Where the plant is within reach, either of 
the patient or of friends, there could be no 
possible objection to its powers being tested, 
and of them the author can speak favourably. 

Epilepsy is often a feigned disease, par- 
ticularly among soldiers and sailors, and 
also by mendicant impostors. The latter 
usually choose public places for the exhibi- 
tion, throw their legs and arms about, foam 
at the mouth with a little soap mixed with 
the saliva, and continue their exertions for 
a much longer time, and with more expen- 
diture of heat, but with less active power 
than the real epileptic. A real epileptic is 
not susceptible to pain or sensation ; where 
suspicion exists, therefore, some test of this 
kind which will not injure may well be tried. 
Snuff may be put up the nostrils, and if it 
produces sneezing there is no epilepsy ; 
sometimes the proposal, within hearing of 
the person, to try some mode of treatment 
which involves considerable suffering is suf- 
ficient to dispel the fit. 

Refer to Ablution — Convulsion — Cotyledon 
— Children, fyc. 

EPIPHYSIS— Is the extremity of a long 
bone, such as of the arm or thigh, which is, 
in the young, connected with the shaft or 
main portion of the bone by means of gristle. 
When such bones are boiled for some time 
the epiphysis separates, as may be seen in 
the case of veal or chickens. In children 
the epiphysis is sometimes separated by ac- 
cident attended with violence. 

Refer to Bone. 

EPISPASTICS— Are substances used me- 
dicinally for producing inflammation of the 
skin, which may be followed either by blis- 
tering or by the formation of matter. Their 
action is in fact that treated of under the 
article "Counter-irritation," which may be 
referred to. — See also Blister, fye. <$fc. 

EPIST AXIS.— Bleeding from the nose.— 
See Hemorrhage, Nose, 8;c. 

EPITHELIUM— Is the external layer of 
a mucous membrane. — See Mucous Mem- 
brane. 

EPSOM SALTS — Are a compound of 
magnesia and sulphuric acid, (sulphate of 
magnesia,) and derive their name from hav- 
ing been first obtained by the evaporation of 
the water of a- spring, situated near Epsom, 
in Surrey, which contains the salt in large 
quantity. They are now prepared largely 



I by manufacturing chemists from magne- 
sian limestone, and also from sea-water. 
They are solid in the form of small pure 
white, needle-like crystals, and from theii 
cheapness are extensively, indeed too much 
so, used among the poor as a general aperi 
ent, and not unfrequently by all classes. 
Epsom salts are tolerably certain in their 
action, do not gripe much, and produce free 
watery evacuations of the bowels ; on these 
accounts the medicine is a most valuable 
one in many diseases, particularly in per- 
sons of a full habit, but, as generally em- 
ployed, it is not suitable for a common or 
frequently repeated aperient. From its 
being in many instances taken in a state of 
too concentrated solution, it induces a dis- 
charge of the watery part of the blood into 
the bowels, and thus seriously debilitates. 
Moreover, after the action of a dose of Ep- 
som salts, the bowels, in those liable to ha- 
bitual constipation, are very apt to be left 
with a greater tendency to inaction than be- 
fore ; nevertheless, in persons of full, strong 
habit, an occasional dose of the medicine 
is, without question, beneficial, but it should 
be taken in smaller quantity and much more 
largely diluted than is usually done. The 
question of dilution is a very important 
one in the administration of this salt, and, 
if attended to, renders it safe and efficient 
even for the comparatively delicate. From 
half a drachm, or even less, to a drachm, 
should be dissolved in at least six ounces or 
half a pint of cold or tepid water, and taken 
on first rising in the morning, when the 
dose should be followed by the fluid break- 
fast. Many persons liable to constipation 
find this method a simple and effectual 
remedy, which may be used for weeks to- 
gether. From five to ten drops of dilute 
[or aromatic] sulphuric acid are often a 
good addition to the dose, and one which at 
the same time corrects in some degree the 
bitterness of the salt. If there is debility, 
either of the stomach or generally, from a 
quarter to half a grain either of quinine or 
of some salt of iron may be added. The 
quinine appears to increase the aperient 
power. The most convenient method of 
taking Epsom salts in this form is to dis- 
solve one ounce in a pint (sixteen ounces) of 
water, adding the acid or other ingredients 
in proper proportion. Of the solution, 
from half to a whole wineglassful may be 
taken the first thing in the morning, diluted 
with the proper quantity of water before 
taking, or, if preferred, by the latter being 
drank immediately after the medicine. 

The following method for the administra- 
tion of Epsom salts has been recommended 



ERG 



233 



ERY 



in France : — -Take of water about sixteen 
ounces, powdered or roasted coffee two and 
a half drachms, Epsom salts one ounce, boil 
well for two minutes, (not in a tinned vessel ;) 
remove from the fire, and let the mixture 
infuse for some minutes, so as to allow time 
for the development of the aroma, then 
filter, or merely strain off. It must be 
sweetened to taste. This fluid does not 
impart the slightest taste of the bitterness 
of the salt. It should be observed that the 
simple infusion of coffee is not capable of 
removing the bitter taste. 

The combination of Epsom salts with in- 
fusion of senna, constituting the common 
black draught, is one of the best forms of 
active occasional purgative in common use. 
It is well to bear in mind that there is con- 
siderable resemblance between oxalic acid, 
in its crystalline commercial form, and Ep- 
som salts, and that, in consequence, fatal mis- 
takes have occurred. The intensely acid taste 
of a single crystal of the former would at 
once clear up any doubt. Perhaps it might 
be well always to use so simple a test. 

Refer to Oxalic Acid — Purgatives — Senna. 

ERGOT OF RYE— Is a peculiar diseased 
or fungoid growth which is developed upon 
the seed of the common rye. The affected 
grain is sometimes called " spurred rye," 
from the peculiar curvature of the growth, 
which varies from half an inch to an inch 
and a half in length, is about a quarter of 
an inch thick, slightly angular in shape, 
and black in colour. As a remedial ad- 
junct in the hands of the accoucheur, ergot 
of rye is most valuable, but is scarce likely 
to form part of the domestic medicine-chest. 
It is more commonly met with on the conti- 
nent, where much rye is grown, than in this 
country ; and when the grain is largely in- 
fected with it, pestilential diseases have 
been ascribed to the use of the flour in 
which it has been mixed. It is certain that 
a peculiar kind of dry mortification of the 
extremities has followed the prolonged use 
of grain containing ergot. 

Ergot of rye has been used in medicine 
in hemorrhagic and other diseases, but 
chiefly on account of its undoubted action 
upon the womb. It can only be safely used 
by medical men. 

ERRHIXES — Are medicinal substances 
used as snuff to excite discharge from the 
lining mucous membrane of the nostrils. 
They are, in fact, means of counter-irrita- 
tion, but are not much employed by medical 
men. In some cases of headache they are 
useful, and common snuff may be used with 
as much effect as any of the class. 

ERUCTATION— Is the rising, either of 
v2 



gas or fluid, into the mouth from the sto- 
mach. It is a constant symptom in dyspepsia. 

Refer to Flatulence. 

ERUPTION. — A diseased appearance on 
the skin. — See Skin. 

ERYSIPELAS, or St. Anthony's Fire, 
or The Rose — Is an inflammatory affection 
of the skin, with or without vesication or 
blistering, sometimes extending to the cel- 
lular tissue beneath. It appears on various 
parts of the body, but most generally on the 
head and neck. Unless the attack is very 
slight indeed, the occurrence of erysipelas 
is generally ushered in by symptoms of fe- 
ver, shivering, and headache, furred tongue, 
perhaps sickness, followed by thirst, hot 
skin, quick pulse, &c. ; at the same time 
the part first affected, such as the nose, 
cheek, or ear, becomes stiff, painful, red and 
swollen, the pain being of a burning cha- 
racter. If unchecked, this inflammation of 
the skin extends with more or less rapidity, 
and so rapid indeed is its progress at times, 
that in a very few hours the whole head 
and face become enormously swollen. As 
the disease progresses, blisters resembling 
those raised by a scald form over the sur- 
face, which is intensely hot and red, or 
purplish ; the pain is severe, fever runs 
high ; sore throat is a very frequent accom- 
paniment, and delirium is common. 

So serious a disease as erysipelas ought 
only to be treated by a medical man ; but 
as it is important, if possible, to check it at 
its first onset, the following measures should 
be adopted if proper assistance cannot 
quickly be procured. A disease present- 
ing the symptoms above detailed must 
generally be recognisable even by unpro- 
fessional persons. There is great diversity 
of opinion respecting bleeding from the arm 
in the first onset of erysipelas, but here, as 
in many other cases, the treatment must 
hinge upon the constitution of the patient, 
and not on the name of the disease. Under 
any circumstances, however, it would not 
be well for an unprofessional person to use 
so active a remedy ; but if the affected in- 
dividual be of very full habit, there is no 
objection to the application of leeches 
around the inflamed patch ; that is, if there 
is no peculiar tendency to irritation of the 
skin after the use of leeches. If the 
tongue is very foul, an emetic may be given, 
and the bowels freely purged with the calo- 
mel and colocynth pill, while eighth of a 
grain doses of tartar emetic may be admi- 
nistered every three or four hours, the diet 
being kept as low as possible. In weakly 
persons, a more negative plan should be 
pursued ; the bowels must be more gently 



EKY 



234 



ERY 



acted upon, as by five grains of gray pow- 
der, followed in a few hours by some gentle 
aperient such as castor-oil ; effervescing 
saline draughts should be given (and, in- 
deed, are useful in the former case also) 
every few hours, while all stimulants and 
animal food are cut off. With respect to 
local applications, the most certain and effi- 
cacious is certainly the nitrate of silver, or 
lunar caustic, which, if carefully used, maybe 
employed beneficially even by the unprofes- 
sional. Indeed it is quite possible to imagine 
a clergyman, for instance, in the country, 
checking effectually a fast-spreading at- 
tack of erysipelas, which would, unattended 
to, gain a dangerous ascendency before the 
services of a medical man could be obtained. 
The lunar caustic is used for two objects, 
one to check the spread of the inflamma- 
tion over the skin, and the other to quell 
the disease; for the first it is best used in 
the solid stick, for the latter purpose in 
strong solution. 

Erysipelatous inflammation tending to 
spread may be stopped by surrounding the 
affected part entirely with a cauterized ring. 
The parts to be touched must in the first 
place be shaved, if covered with hair, and 
the skin must always be thoroughly cleansed 
from its natural oily secretion, by washing 
with soap and water. It must then be moist- 
ened all round, and the stick of caustic 
drawn slowly and gently over it, so as to 
make a line of demarcation at least a quar- 
ter of an inch broad ; but this line must be 
entire throughout — deficiency in one spot 
may permit the inflammation to extend by 
the outlet. It is not asserted that in every 
case this caustic line will inevitably stop the 
disease, but it will do so in the majority, if 
care be taken that it is efficiently done, and 
that it includes, without doubt, every por- 
tion of the affected skin. When the solu- 
tion of caustic is to be used to quell the 
disease, it should be used of the strength 
of forty grains to two drachms of distilled 
or rain water. The inflamed surface must 
be gently cleansed by soap and warm water, 
and the solution applied all over it by 
means of a camel-hair brush or a feather. 
The practice now recommended is perfectly 
safe, is very efficacious, both as a preventive 
against the extension, and as a cure of this 
formidable disease, and might be quite jus- 
tifiably employed by an intelligent person 
in the absence of medical assistance. It 
has, however, the inconvenience of turning 
the skin to which it is applied perfectly 
black for some time afterwards, that is, 
until the outer skin has peeled off, and 
been replaced by a fresh layer. For this 



reason it is better in mild cases to have 
recourse to some of the local remedies yet 
to be mentioned. It is desirable that per- 
sons should be duly impressed with the 
necessity of cutting or shaving off the hair 
whenever erysipelas in a severe form ex- 
tends to parts naturally provided with the 
covering. 

In addition to the local treatment by 
lunar caustic, which the author has always 
found the most to be depended upon, other 
applications are used, and may be used, 
when the other is not procurable, or when 
the cases are so very mild that it is unne- 
cessary to incur the temporary discolora- 
tion of the skin produced by the caustic ap- 
plication. ' . 

Flour [especially that of rye] is a very 
common and often a good and comfortable 
local remedy in erysipelas ; hot fomenta- 
tions, either of simple water or a decoction 
of poppy-heads, applied continuously for many 
hours, by means of flannel, give much relief 
in some cases ; or a lotion composed of 
twenty grains of sugar of lead, a drachm of 
laudanum, and sixteen ounces of distilled or 
rain water, may be used slightly warm, and 
applied by means of linen cloths, with much 
advantage. 

The remedial measures, both local and 
general, which have now been recommended, 
ought and may, under intelligent unprofes- 
sional management, do much to keep this 
formidable disease in check until the medi- 
cal man, whose presence must be necessary, 
can be got. Moreover, there ought not to 
be much doubt as to the nature of the dis- 
ease, if the distinctions pointed out in the 
first part of this article are attended to ; 
and further, many attacks of erysipelas are 
secondary ones, as persons who have once 
suffered are liable to do so again. 

Much confusion of ideas exists on the 
part of the public with regard to erysipelas, 
and many affections of the skin are imagined 
to be this disease, which do not in the least 
resemble it. It should be remembered that 
it is an affection which appears suddenly, 
tends to spread, and is accompanied with 
fever ; that the affected skin is red, hot, ten- 
der, and often blistered. 

The causes of erysipelas are numerous: 
cold and atmospheric vicissitudes, and pecu- 
liar conditions of the atmosphere, are all apt 
to excite an attack, and every thing which 
tends to produce debility predisposes to it. 
Wounds and sores often appear to be the 
first originators of the malady, and, in such 
cases, contagion has much to do with its 
diffusion through a hospital or a town ; even 
the most trifling scratch being sufficient to 



E EY 



235 



EXC 



become the attraction. For this reason, 
erysipelas is the most formidable enemy 
which can gain a footing in a surgical hos- 
pital; and for the same reason, when the 
disease occurs in private houses, caution 
should be observed that persons suffering 
from wounds do not come into close contact 
with the affected ; and, indeed, in any case, 
the same precautions should be adopted in 
erysipelas as in contagious diseases gene- 
rally. This is doubly requisite in a house 
in which a confinement is expected, or has 
recently taken place, for there is an un- 
doubted close connection between erysipelas 
and fatal childbed inflammation. The head 
and neck are the most frequent sites attacked 
by this disease, but any other portion of the 
body may be liable to it ; the throat not un- 
commonly suffers, and is a dangerous com- 
plication, best treated by the free applica- 
tion of the caustic solution to the tonsils, 
&c. It ought to be quickly attended to by 
a medical man, for death sometimes occurs 
most unexpectedly from suffocation, in con- 
sequence of swelling. Hot bran-poultices 
and mustard-plasters externally would per- 
haps relieve the throat in some degree. 

When erysipelatous inflammation extends 
to the tissue beneath the skin, it constitutes 
what medical men call "phlegmon;" puru- 
lent matter forms, and the parts slough or 
mortify. In such cases it is usual for the 
surgeon to cut through the skin to give free 
exit to the matter, &c. ; and by the proceed- 
ing much relief is afforded. This, of course, 
unprofessional persons cannot do, and poul- 
tices and fomentations must be their re- 
source, should it happen (which is not per- 
haps likely) that a case which has reached 
this stage has been unvisited by a medical 
attendant. 

Refer to Silver, Nitrate of — Skin, §c. 

ERYTHEMA — Is a more superficial and 
evanescent inflammation of the skin than 
erysipelas. The most familiar instance of 
it is the inflammation produced by the 
chafing which occurs in stout children, or 
adults, between the folds of the skin, and 
which has a tendency to spread from its 
point of origin. The application of cloths 
dipped in tepid water, or in the sugar of 
lead and laudanum lotion recommended in 
erysipelas, will allay the burning sensation. 
A few grains of gray powder should be given 
at bedtime, followed by castor-oil or senna in 
the morning, and then quinine administered 
in doses suited to the age of the patient. 
Rapidly spreading erythema, even in an in- 
fant, quickly yields to small doses of quinine. 

ESCHAR — Is the portion of "killed" ani- 
mal tissue which separates from the living 



body after the application of a caustic or 
cauterant. 

ESCHAROTICS— Are substances which 
possess the power of destroying chemically 
the living animal tissues to which they are 
applied. — Refer to Caustic, §c. 

ETHER.— See ^Ethers. 

EUSTACHIAN TUBE.— The canal which 
connects the throat with the ear. — See Ear. 

EXANTHEMATA.— The eruptive febrile 
diseases, such as scarlet fever, measles, &c. 

EXCITEMENT— Excitants, or Stimu- 
lants. — To excite, to stimulate, is either to 
originate action where no action previously 
existed, or to give increased energy to 
powers already in active operation. Ex- 
citants or stimulants, therefore, are agents 
which are capable of producing such effects, 
and excitement is the effect produced. Ex- 
citants may be artificially divided into — 

I. Ordinary excitants, the regular un- 
ceasing action of which is necessary for the 
preservation of sound health both of mind 
and body. 

II. Extraordinary or occasional excitants, 
which produce a certain amount of temporary 
exalted action of mind or of body, or of both. 

III. Superfluous excitants, which are gene- 
rally those comprised in the second division 
abused. 

Under the head of ordinary excitants we 
have the following : — 

A. — Physical Excitants. 



I. Heat. 

II. Light. 

III. Electricity, Mag- 
netism. 



IV. Atmospheric air. 
V. Aliment. 
VI. Muscular action 
— Exercise. 



B. — Mental Excitants. 
I. Occupation of the mind with some defi- 
nite object. 
Under the head of extraordinary excitants 
we have — 

A. — Physical Excitants. 
I. Alcoholic excitants. 
II. Excitant ingesta generally : tea, coffee, 

spices, drugs, &c. 
III. Atmospheric changes. 

B.— Mixed Excitants. 

I. Sexual stimuli. 

II. Extra exercises : dancing and athletic 

sports. 
III. Travelling, and exciting or novel scenes. 
Mental Excitants. _ 
I. Hope, Joy, &c. 

II. Love, Anger, &c. 

III. Social intercourse. 

IV. Argument, Politics, &c. 
V. Music. 

VI. Eloquence, written or spoken, Exciting 
literature. 
VII. Religion. 



EXC 



236 



EXE 



For the more particular consideration of 
the above-cited agencies, both as excitants 
and otherwise, the reader is referred to the 
various articles in which they are treated 
of in this work. From these it will be seen 
that certain ordinary physical stimuli, or 
excitants, are necessary for the sustenance 
of human health and life, and that equally 
important for the preservation of vigour, 
not only of mind, but of body, is the stimu- 
lus resulting from the ordinary but regular 
action and reaction of the mind of man, 
originating either in daily intercourse with 
his fellows, or in pursuits which con- 
tinuously engage the mental powers. And 
further, that the mental and bodily func- 
tions are at intervals acted upon by occa- 
sional or extraordinary stimuli, which tem- 
porarily occasion their exalted and increased 
action, not only without actual injury, but 
with positive benefit. And, lastly, that 
these extraordinary stimuli are not liable 
to lose their power of beneficial stimulation, 
unless exerted in a disorderly and unre- 
strained manner. 

EXCORIATION.— See Abrasion. 

EXCRETION.— Any thing, either super- 
fluous or noxious, separated and thrown 
out from the living body. Excretions may 
consist of noxious and superfluous matters 
which have been introduced into the cir- 
culation by the stomach — in the food — or 
through the lungs, or skin ; but the bulk of 
the excretions consist of " effete" matters, 
that is, of substances which, having fulfilled 
their part in the animal economy, could not 
be retained in it without danger to health 
or life, and are therefore cast out by some 
of the outlets specially provided for the 
purpose. The urine is perhaps the best 
specimen of an excretion, and consists of 
water holding in solution mineral salts, 
and the used-up elementary substances in 
various combinations. One of these com- 
pounds — the urea — is a narcotic poison, and 
if, from disease of the kidneys, or other 
cause, it is retained in the blood, it acts as 
such, and kills. The chief constituents of 
excrement from the bowels are matters ex- 
creted by the large bowel, which cannot be 
retained in the body without danger. The 
kidneys, the bowels, including the liver, the 
skin, the lungs, are the excretory outlets of 
the body ; and what has been said of the 
nature of excretions generally must render 
evident the paramount importance of keep- 
ing these outlets in free operation. 

Refer to Alimentary Canal — Bile — Blood — 
Lungs — Skin — Urine, S$c. 

EXERCISE — Spontaneous Muscular 
Movement. — The stimulus imparted to the 



system generally, and to every one of the 
vital processes particularly, by the exci- 
tant power of muscular movement which 
every healthy man is compelled or ought 
to undergo, is a fact generally recognised ; 
it is one of those ordinary excitements the 
agency of which is linked with our happi- 
ness and health, and, it may almost be said, 
with our existence. A man engaged in 
active bodily exercise is undergoing a re- 
gular course of excitement ; his will is 
stimulating the nervous system to rouse 
the muscles to action, and in this process 
both the rouser and the roused are using 
up their own substance ; the acting muscles 
are sending the blood more quickly through 
the capillaries and large vessels, and the 
heart must move more actively to keep 
pace with them, and transmit the quickly 
returned blood, loaded with effete matter, to 
be purified in the lungs. To preserve the 
balance the respirations are increased, and 
the stomach is stimulated to crave for 
nourishing food and unstimulating drink, 
fitted to keep in repair the ever-wearing 
structures of man's body, and to supply 
the fluid waste. Baron Liebig has done 
much to give us clear views respecting the 
changes which take place within the body 
under the influence of muscular movements ; 
and from him we learn that, in the ex- 
penditure of this force, the substance of 
the muscles is used — burnt up by the oxy- 
gen of the arterial blood, and that this 
burning up is requisite that the force may 
be produced. 

Exercise, therefore, is in the first place 
requisite as an ordinary excitant, to be 
brought into daily operation, that the 
vigour of all the functions of the body, 
whether of digestion or of secretion or ex- 
cretion, may be preserved. It is the mer- 
ciful provision by which the decree, that 
man should earn his bread by the "sweat 
of his brow," has been converted into a 
blessing. It is the great compensating ba- 
lance which gives the labourer sound sleep 
and healthy appetite and vigour, instead of 
the wealth which too often seduces to indo- 
lence and palls every enjoyment of life. 

Exercise, again, is requisite as an agent 
with reference to the food consumed. Food 
is taken to supply the waste of the body, 
which must go on more or less as long as 
man lives — more if actual exercise is taken, 
and vice versa,. Man ought not, therefore, 
to expect, if neglecting muscular exercise, 
that is to use up the substance of his body 
in exertion, to have the same appetite for 
and enjoyment of food as if he did; but 
man does expect this in many instances : 



EXH 



237 



EXP 



he indulges in indolence, and then excites 
the appetite and stomach, by artificial means 
and tempting food, to take nourishment 
which is not required, and which must, con- 
sequently, produce disorder somewhere. If 
an individual's employments are of a kind 
which do not require muscular exertion, his 
food should be diminished, either as regards 
quality or quantity, in due proportion. But 
even under this regulation none can be well 
or vigorous who do not take some amount 
of exercise in the open air daily. 

With regard to extra exercises, such as 
dancing, and athletic sports generally, which 
are only engaged in at intervals, it is cer- 
tain that their beneficial effect upon the 
functions and health depends quite as much 
upon the excitement of the mind as upon 
that of the body ; and every one's experi- 
ence must tell him how much his favourite 
exercise owes its renovating influence to the 
mental stimulation which accompanies it. 

Refer to Blood — Excitement — Food, §c. 

EXHALATION— Applied to the body, 
means an excretion in a state of vapour, 
such as that from the lungs. 

EXHAUSTION— Is the diminished or al- 
most extinguished power, either of the body 
generally or of one or more of its organs, 
to continue its natural active operations 
until it has been recruited by a pei'iod of 
repose. Exhaustion may arise from two 
principal causes — failure of the nervous 
power, and deficiency of organized mate- 
rials fitted to support the requirements of 
the living body. 

If every thought, every exertion of the 
will upon the body, occasions the con- 
sumption of nervous matter, exhaustion of 
nervous power must in all probability be 
due to using up of nervous substance. 
Sooner or later, according to circumstances, 
every exertion must come to an end, and 
repose must be taken, that the exhausted 
brain and nerves may be recruited ; and, if 
man acts wisely, he will if possible stop 
exertion either of mind or body at the 
first point of exhaustion. It is true that 
powerful exercise of the will can and does 
compel exertion beyond the point at which 
nature says "stop;" but the effort is not 
made with impunity, and the after exhaus- 
tion is proportionally increased. No per- 
manent injury probably arises from those 
occasional exhaustions, either mental or 
physical, which all have at times to un- 
dergo ; but no man can habitually go on 
exhausting his nervous power, whether in 
the direct service of the mind, in the la- 
bours of the body, or in the less excusable 
requirements of vicious excess, without suf- 



fering eventually. The early paralysis and 
softened brain of the mental, the prema- 
ture old age of the physical labourer, the 
wretched decrepitude of the debauchee, 
are all the results of continued nervous 
exhaustion. It is not, however, simply the 
brain and nervous system which suffer, but 
the other organs of the body, particularly 
those of nutrition, suffer also, if the supply 
of nervous power which ought to sustain 
their healthy action is withdrawn to sup- 
port the exhausting efforts either of mind 
or muscle. Those, therefore, who can, will 
do wisely to avoid the cause of these evils ; 
but all cannot do this : in many situations 
of life, continued exertions, which carry the 
individual to the extreme of exhaustion, be- 
come absolutely necessary. It becomes a 
question, therefore, how the evil effects of 
the necessity may be most efficiently coun- 
teracted. This must be done by the proper 
management of the nourishment. The sto- 
mach in such cases is not receiving its full 
supply of nervous stimulation, and, there- 
fore, its work must be made as light as 
possible, consistent with conveying good 
nourishment into the system. Small quan- 
tities of food should be taken at once, and 
more frequently repeated, rather than any 
thing like a meal made. In the majority 
of instances, the most efficient nourishment 
will be strong, concentrated animal soup, 
either alone or mixed with some farinaceous 
material ; and next in utility will be coffee or 
cocoa, along with bread or biscuit, or with 
the yelk of egg beaten with them. Of course, 
if these are unattainable, the next best 
substitute must be used ; but the principle 
must be to keep the system supported by 
means of repeated small quantities of food, 
of as nourishing a quality and in as digestible 
a form as may be ; the use of alcoholic 
stimulants being avoided as long as pos- 
sible. At length, if the exhausting agencies 
are still in operation, a time comes when 
the stimulation of alcohol is eminently ser- 
viceable, by virtue of its peculiar action 
upon the nervous system, when it does 
that to support the bodily powers which 
nothing else can ; and then the draught of 
porter, or the dose of wine, or of diluted 
spirit, does come like an elixir of life to 
"him who is ready to perish." 

Refer to Alcohol— Blood — Brain — Food, §c. 

EXFOLIATION— Is the separation of a 
scale of dead bone from the living. The 
term is applied either to the process itself 
or to the separated portion of the bone. 

EXPECTORANTS— Are a class of me- 
dicines which assist the separation and 
expulsion of mucus from the air-tubes or 



EXP 



238 



EYE 



bronchi of the lungs. Very many sub- 
stances are employed with this view ; the 
most useful are — 

Acids, which astringe and stimulate. 

Ammonia, which stimulates. 

Ammoniac [Gum], which stimulates. 

Antimonials, which relax. 

Ipecacuanha, which relaxes. 

Squill, which stimulates. 

Stramonium, or Thorn Apple. 

Tolu, which stimulates. 

Tobacco. 

Vapour, either simple or medicated. 

In whatever way these medicinal sub- 
stances exert their action upon the body, 
the most important practical point is the 
division into relaxing and stimulant. In 
the first stages of affection of the bronchi 
with cough, when there is fever (and pro- 
bably inflammation) present, the relaxing 
expectorants only should be used, either 
antimony or ipecacuanha ; the former may 
be given with solution of acetate of am- 
monia, the latter with carbonate of potassa. 
"When there is much debility, ammonia com- 
bined with camphor is generally employed, 
and probably squill added. In chronic 
cough, with difficult expectoration, the same 
combination may be used ; and when there 
is a relaxed state of the system, with co- 
pious expectoration and tendency to per- 
spiration, the acids, either vegetable or 
mineral, alone or combined with squill, are 
most serviceable. 

The combination of opium or some other 
anodyne with expectorants is both a com- 
mon and a useful practice ; it allays the 
irritability of the bronchial membrane and 
the frequency of the cough, and probably 
also relaxes spasm. Opium, hoAvever, tends 
to stop expectoration, and on this account 
ought in almost every case — in which it is 
given to allay cough — to be combined with 
some counteracting expectorant. More mis- 
chief is, perhaps, done with squill than 
with any other of this class of remedies ; 
its syrup is much given domestically, and 
generally too early, whereby both irritation 
and cough are increased. Tolu syrup is a 
good and pleasant addition to cough mix- 
tures. Many expectorants act also as eme- 
tics, and in so doing, especially in children, 
frequently assist most efficaciously their 
expectorant action. Tobacco or thorn-apple 
smoked, or watery vapour inhaled, act di- 
rectly upon the air-tubes. 

Refer to articles on various expectorant 
medicines, to Catarrh — Cough, $c. 

EXPECTORATION— Is the term applied 
either to the act of coughing up matters 
from the lungs, or to the matters so coughed 



up, [but the latter are more correctly desig- 
nated as the " sputa."] These vary greatly 
in consistence and appearance, and, conse- 
quently, are valuable guides in the investi- 
gation of disease affecting the chest ; indeed, 
until the physical examination of the chest 
by the ear was introduced into practice, the 
expectorated matters were the most distinc- 
tive evidences attainable. Expectoration 
may be thin and frothy, as it is when the 
lining membrane of the air-tubes is suffer- 
ing from irritation or inflammation, or thick 
and almost solid, as it becomes in the last 
stages of a cold. It may be ropy, as it often 
is in old people, or viscid, in inflammation 
of the substances of the lungs, when it 
generally becomes of a dull reddish-brown 
or rust colour ; it may consist more or less 
of purulent matter, or be tuberculous and 
semi-solid, as in pulmonary consumption ; 
it may be mixed more or less with blood, 
or pure blood may be expectorated, or it 
may be what is called the prune-juice ex- 
pectoration from its colour, as happens in 
mortification of the lungs. Generally, ex- 
pectoration is inodorous, but sometimes it is 
abominably fetid, the odour being mostly, 
but not invariably, indicative of mortifica- 
tion of the lung itself: other matters, such 
as bile, &c. are occasionally coughed up [or 
follow coughing]. 

EXPIRATION— Is the act of expelling air 
from the chest after it has been inspired. 

EXTRACTS — Are medicinal preparations 
made by separating the active portions of 
various drugs from the inert ones, this being 
effected by dissolving out the former, either 
by water, alcohol, or aether, and evaporating 
the superfluous fluid, until a tolerably firm 
consistent mass of extract is left. Formerly, 
heat was used in the evaporation ; but as 
this destroys in some measure the activity 
of the preparation, the best extracts are 
now all prepared without any heat what- 
ever, and these should always be purchased 
in preference. The extracts of aloes, of 
colocynth, of hemlock, of henbane, of gen- 
tian may be used by unprofessional persons. 
There are many others, but they are either 
dangerous, or the medicine is better used in 
other forms. 

EYE. — The organ of vision, not only in 
man, but in the lower animals, is an instru- 
ment so wonderful, so replete with beautiful 
structures and admirable contrivances, that 
it is always alluded to' as one of the most, 
if not the most splendid instance of the 
power and beneficence of God, as displayed 
in his physical creation. Its importance to 
man as an organ of sense ought to render 
the study of its construction and adapta- 



EYE 



239 



EYE 



tions one of intense interest, and must ever 
render its perfection and preservation an 
object of the greatest solicitude. The space 
which can be spared in a work like the pre- 
sent is too limited to do justice to the subject. 
The whole apparatus of vision naturally 
divides itself into two sections — the globe of 
the eye and the appendages of the globe. 
The conical-shaped sockets, or orbits, in 
which the eye-globes are suspended, have 
projecting edges, especially superiorly, which 
protect the organ from injury. The pent- 
house of the eye-brow slightly shades from 
the light and intercepts perspiration, which 
might trickle down and irritate. The fringed 
curtains of the lids are ever ready to close 
over and instinctively protect their charge, 
and on their internal surface secrete a lu- 
bricating mucus. On their edges a series 
of minute glands (fig. lxv. 2) open, which 




secrete an unctuous matter. In the upper 
and outer angle of the socket lies the lachry- 
mal gland, which furnishes the tears, and 
is always pouring out a watery fluid, which 
is continually passing over and cleansing 
the exposed surface of the eye, being taken 
up at its inner angle at the points (3) and 
conveyed through the lachrymal duct (1) 
into the nose, which it also supplies with 
moisture. Through this duct, also, the mem- 
brane (the conjunctiva) which lines the nose 
is continuous with that which covers the fore- 
part of the eye-globe and lines the lids. 

In the socket, the eye-globe lies embedded 
in fat, but is also, as it were, slung in a kind 
of membrane. It is, further, both fixed and 
moved by means of its six muscles, (fig. lxvi. 
1, 1,) four of which pass forward from the 

Tig. lxvi. 




back or apex of the conical cavity to be at- 
tached to the globe. The optic nerve, fig. lxvi. 
(2,) and other nerves and blood-vessels, are 
also contained within the socket, the whole 
being arranged so as to afford the most facile 
but at the same time steady movement. 

The globe of the eye itself is barely an 
inch in diameter, and measures longest from 
before backward. Its outer coat, called the 
sclerotic, (fig. lxvii. 1,) is very firm, and is 
composed of interlaced fibres. Anteriorly, 
Fig. lxvii. 




a portion of it is, as it were, cut out to per- 
mit the insertion of the cornea, (figs. lxvi. 
3, and lxvii. 3,) or glass of the eye ; poste- 
riorly it gives passage to the optic nerve, 
(figs. lxvi. 2, and lxvii. 6.) Within the outer 
coat is the choroid coat, (4,) of a dark cho- 
colate colour, and within that the retina, or 
nervous coat, (5,) which forms the sensitive 
field of vision. The mass of the globe is 
filled with a remarkably transparent semi- 
fluid substance, the vitreous humour, in the 
forepart of which the crystal lens (7) is 
imbedded. In front of this, and partly sur- 
rounding it, is the iris, (figs, lxvii. 8, and lxv. 
8,) the circular aperture in which (fig. lxv. 9) 
constitutes the pupil. In front of the lens, 
between it and the cornea, is the chamber 
of the aqueous humour, (10,) so called from 
the watery fluid with which it is filled. It 
will be remembered that the entire fore- 
part of the globe, or white of the eye, and 
the clear cornea are covered with the con- 
junctiva, as already mentioned. 

To give the sense of vision, the rays of 
light from surrounding objects penetrate the 
eye, first by the cornea, (3,) pass through 
the aqueous humour, the lens, and the vi- 
treous humour, (10, 7, 11,) and, in doing so, 



EYE 



240 



EYE 



undergo a series of refractions, which bring 
them at last into focus in the retina, (5,) 
where the picture of external objects is 
formed, and where the impression is con- 
veyed to the brain by the optic nerve, (6.) 
The object of the black or chloroid coat (4) 
being to absorb the superfluous rays of light, 
which would otherwise be reflected within 
the eye and confuse vision. 

This rapid and necessarily imperfect 
sketch of the construction and functions of 
the organ of vision will, it is trusted, assist 
the unprofessional reader in gaining some 
rational idea of the dangers and diseases to 
which so important a portion of his frame 
is liable. The membrane, or conjunctiva, 
which covers the inside of the lids and 
white of the eye is, from its exposed situa- 
tion, liable to become inflamed from various 
causes. Minute particles of dust or other 
substances getting into the eye, and becom- 
ing fixed in the lining of the upper eyelid, 
between it and the globe, cause an amount 
of pain and irritation which could scarcely 
be credited from their size, but which is well 
accounted for by the accurate apposition of 
the two surfaces between which they lie. A 
particle so situated may be discovered without 
much difficulty by a second party examin- 
ing the sufferer with the head thrown back, 
while he slightly everts the upper lid with 
the thumb and finger. The slightest speck 
of foreign matter must be removed, and no 
better instrument can be employed for the 
purpose than [a camel's hair pencil] or a piece 
of not over-stiff writing-paper twisted like a 
match. Those who work in metals are apt to 
get minute scales imbedded in the forepart of 
the ball ; they cause much irritation, and are 
often so extremely difficult to remove that a 
surgeon's assistance is required. The effect 
of these mechanical irritations is to cause in- 
flammation of the conjunctiva. (See descrip- 
tion.) This, however, may often arise, and 
frequently does from cold, from disorder of 
the digestive organs, &c. The first symp- 
tom of inflammation is a sensation as if a 
particle of some kind had lodged in the eye, 
and if an examination be made there will be 
seen, not only an enlargement of any small 
blood-vessels that may be generally visible 
on the white of the eye, but a new develop- 
ment of others, the appearance varying 
from the slightest apparent increase of 
vascularity, to the most intensely red in- 
flammation. At the the same time there is 
considerable increase in the mucous secre- 
tion — not in the tears, as is often supposed 
— and in bad cases this becomes purulent or 
mixed with matter. There is, sometimes, 
considerable swelling of the surface, usually 



distinguished as the white of the eye. The 
above is the most superficial form of in- 
flammation to which the eye is subject; if 
neglected, it may extend itself over the 
cornea and produce permanent blindness. 
It is distinguishable from the next form, or 
inflammation of the sclerotic coat, by the 
size and winding character of the small 
blood-vessels, and by their being slightly 
movable along with the conjunctiva itself 
when the lids are drawn down. It is im- 
portant that these distinctive characters 
should be attended to in the first place, 
that no error may be committed between 
this form and a more serious and deep- 
seated inflammation of the eye, but also 
that proper treatment may be used. A 
great error is committed in treating this 
form of inflammation by means of warm fo- 
mentations, &c. applications tending rather 
to keep up than to cure the disease, which 
is generally quickly removed by astringents. 
A drop of laudanum or of Battley's solution 
in the eye, repeated two or three times, will 
often cure the disorder ; or a lotion of sul- 
phate of zinc, from one to three grains to 
the ounce of water, will be found efficient ; 
but the best of all is the solution of nitrate 
of silver, or lunar caustic, of the strength 
of four grains to the ounce of distilled 
water, as recommended by Dr. Mackenzie. 
Of this, a single drop may be introduced 
into the inflamed eye twice or three times in 
the twenty-four hours. The eye, of course, 
should be exercised as little as possible, and 
if the bowels are confined or the stomach 
disordered, a few doses of the blue pill and 
colocynth will be found useful. If the dis- 
ease is obstinate, a blister to the back of the 
neck may be applied with advantage. 

The disease which has just been treated 
of, is a comparatively mild disorder, but 
under certain circumstances it becomes 
much more virulent. The secretion of 
matter is very great, and acquires the power 
of propagating the disease by contagion 
from one person to another. The well- 
known Egyptian ophthalmia is of this nature, 
and is carried from individual to individual 
by the flies, which, according to travellers, 
seem to have acquired an instinctive ten- 
dency to fly toward the eyes in that country. 
Newly-born and young infants frequently 
suffer from a severe form of this ophthal- 
mia, which often shows itself within three 
days after birth. The inflammation is in- 
tense, and the matter often accumulates 
largely between the lids, gushing out when 
they are separated. In scrofulous children 
especially the affection is often obstinate. 
The nitrate of silver in solution is the best 



EYE 



241 



FAI 



application, and small doses of quinine the 
best internal remedy. Syringing between 
the lids with a solution of alum, four grains 
to the ounce of water, six or eight times a 
day, is also recommended. A little lard 
should be used on the edges to prevent 
them sticking together. 

In inflammation of the sclerotic or outer 
coat of the ball itself, there is more actual 
pain, it is more deeply seated, the redness 
seen on the white of the eye is more of a 
pink hue than in the conjunctival affec- 
tion, the vessels appear much smaller and 
straighter, radiate as it were from the cor- 
nea, and are not movable ; the affection is, 
moreover, generally a more serious one 
than the other. The more interior struc- 
tures of the eye may also become inflamed, 
and especially the iris. In all these cases 
of deep inflammation of the eye the consti- 
tution is much affected, there is shivering, 
followed by thirst, fever, &c. ; the pain in 
the organ itself is often most severe, and 
extends to the forehead ; light cannot be 
borne. If the iris is the part affected, its 
colour is changed and often becomes of a 
dirty brick red ; the pupil at the same time 
is irregular. 

In these, and indeed in all affections of 
so precious an organ as the eye, whenever 
proper medical treatment is attainable, it 
should be taken advantage of; if not, sup- 
posing symptoms such as those enumerated 
show themselves, some active treatment is 
requisite ; leeches should be freely applied 
to the temples, or behind the ears, or cup- 
ping on the back of the neck resorted to ; 
the bowels must be freely purged with ca- 
lomel and colocynth, &c. in the first in- 
stance, and then calomel in two-grain doses, 
or some other mercurial, given at intervals 
of six or eight hours. The diet must be 
reduced as low as possible, all stimulants 
avoided, every attempt at exertion even of 
the unaffected eye forbidden, and the person 
confined to a darkened room, the only local 
application being continued hot fomentation 
to the eye and a blister between the shoul- 
ders. By a continuation of the above treat- 
ment, even till the gums get sore with the 
mercury, much may be done, supposing 
circumstances are such that a medical man 
cannot be procured. If the iris is thought 
to be affected, some preparation of bella- 
donna (or, in its absence, of henbane) should 
be employed to keep up dilatation of the 
pupil. For this purpose ten grains of the 
extract should be rubbed up with half an 
ounce of water, and a few drops introduced 
into the eye. For information respecting 
the more chronic affections of the eye, the 
V 16 



reader is referred to the articles Amaurosis, 
Cataract, &c. In some eye affections the lids 
are apt to become glued together during sleep 
by the secretion. This is best prevented by 
smearing the edges with some simple oil or 
ointment. The edges of the lids, likewise, 
are apt to become affected with a succession 
of small pustules, or abscesses, which often 
continue to form in spite of treatment, de- 
pending probably on some disorder of the 
digestive organs, which should be attended 
to. Local treatment seems to do but little 
for their amendment. 

The lachrymal sac, or some of its ducts 
(fig. lxv. 2) are apt to become the seat of in- 
flammation and to be blocked up in conse- 
quence ; the tears, not escaping by their 
natural outlet, run over the cheek, causing 
painful excoriation, and the corresponding 
nostril is dry. The disorder is not only 
troublesome to bear, but often to manage, 
and should be seen by a surgeon. 

A stye in the eye, or rather eyelid, is a 
small abscess, and often gives great pain. 
It is best treated by fomentations. 

Blows on the eye frequently give rise to 
effusion of blood beneath the conjunctiva, 
which occasions the white of the eye to 
become of a deep, almost black, red colour, 
and to present a very alarming appearance. 
The state of matters may be distinguished 
from inflammation by the uniformity of the 
redness, and by the absence of those charac- 
teristic symptoms enumerated above. The 
eyes frequently assume an "injected" or 
bloodshot appearance in affections of the 
brain. 

Disordered vision may be the result of 
causes, such as cataract, &c. which inter- 
fere with the transmission of the rays of 
light ; it may also arise from disorder of the 
digestive organs, and not unfrequently from 
incipient disease of the brain. Persons 
who become suddenly and unaccountably 
affected with disordered vision, should ma- 
nage themselves as directed in article Amau- 
rosis, and get medical advice as speedily as 
possible. 

Refer to Amaurosis — Cataract, $c. 

FACE. — See Countenance, Complexion, 
&c. 

FACE-ACHE.— See Neuralgia. 

FJECES. — The excrement from the bowels. 

Refer to Alimentary Canal — Digestion, fyc. 

FAHRENHEIT.— The German inventor of 
the thermometer which bears his name. — 
See Thermometer. 

FAINTING, on Syncope— Is a state of 
partial, or of total unconsciousness, in con- 
sequence of diminished circulation of blood 
through the brain, the result of depression 



FAI 



242 



FAR 



of the heart's action. Some persons are 
much more liable to become faint than 
others, and there is often a good deal of pe- 
culiarity with respect to the acting cause. 
Certain objects of sight will cause some 
persons to become faint immediately. The 
most general, probably, being accidents, or 
their consequences, which injure the human 
body, and cause effusion of blood ; certain 
smells affect others, and cause immediate 
faintness ; even the smell of a rose has 
been known to have this effect. Affections 
of the mind, and sudden emotions, debility, 
habitual or temporary, weakness of the 
heart itself, loss of blood, or, in fact, what- 
ever depresses the acting power of the 
central organ of circulation is apt to pro- 
duce faintness. 

A person about to faint becomes affected 
with ringing in the ears, the sight fails, the 
ideas are confused, and the mind incapa- 
ble of exertion, the countenance becomes 
deadly pale, cold sweat breaks out over the 
forehead, the power over the limbs either 
becomes very unsteady or fails altogether, 
and if actual fainting happens, the indi- 
vidual sinks down, and is really in a condi- 
tion which much resembles death, and might 
pass into death. 

As said above, the direct cause of fainting 
is diminished circulation of blood through 
the brain. It must be obvious, that in the 
endeavours to restore a person who has 
fainted, this condition must be altered as 
quickly as possible ; and for this purpose, 
the individual should be laid quite flat 
down, the head on a level with the body, 
so that the feebly-acting heart may not 
have to propel the blood upward, but hori- 
zontally. The neck and chest should be 
exposed, fresh air admitted freely, a little 
water sprinkled on the face, and stimulant 
vapours, such as ammonia, held to the 
nostrils at intervals. Sal-volatile, or a little 
spirit, or wine and water, may be given at 
the same time. 

It must be remembered that the first pe- 
riod of some apoplectic or paralytic seiz- 
ures is one of faintness ; and also, that 
where the affection is the consequence of 
loss of blood, its continuance to some ex- 
tent may be the safety of the patient. In 
either case the use of stimulants must be a 
very cautious one. 

Refer to Apoplexy — Hemorrhage, fyc. 

FAITH — In medicine is one of those 
strong emotions of the mind, which, like 
hope and despondency, exerts much influ- 
ence upon the progress of a case of illness, 
whether it attaches itself to the medical 
attendant, or to the system of treatment 



pursued by him. The history of popular 
delusions connected with the treatment of 
diseases is rich in illustration of how far 
simple faith in some method of treatment 
which has acquired reputation will add to 
the apparent curative powers of that 
method, in consequence of results which 
are due to that tendency to cure — vis medi- 
catrix naturce — which has no more powerful 
assistant than the hopeful and trusting, even 
if mistaken, mind. It sometimes becomes 
a nice question in medical ethics how far 
medical men are justified in using this 
agent in the treatment of their patients. 
With the intelligent and unprejudiced, a 
true faith in curative means, grounded in 
clear understanding of the nature of their 
case, and the requisite treatment, is always 
to be preferred to a blind and unreasoning 
trust, however implicitly given ; but amid 
the ignorant, if they will employ a foment- 
ation more assiduously because it has a 
few chamomile flowers in it, or such-like ; 
and if it will insure their greater faith in 
the treatment generally, it is a concession 
to prejudice at least, which ought to be 
made. Many persons err in placing too 
great reliance — faith — in mere medicines 
and drugging alone, to the neglect of the 
equally important general aids in the treat- 
ment of disease, so often alluded to in this 
work. Such persons are not content, and do 
not think themselves properly ("actively") 
treated, if they are not constantly swallow- 
ing physic. 

Refer to Advice, Medical, §c. 

FALLING SICKNESS, or EriLErsY.— 
See Epilepsy. 

FAMINE. — See Starvation. 

FARCY. — See Glanders. 

FARINA— Derived from " Far," corn- 
means literally the meal or flour formed 
from grain, when ground, and consists, 
therefore, of starch, gluten, &c. [Farina 
forms an excellent article for the diet of 
invalids. — See Diet.'] The word, however, 
is sometimes applied to the farinaceous 
matter contained in other vegetable pro- 
ducts, such as the potato, when it consists 
almost entirely of starch or fecula ; also in 
beans, peas, &c. The farinaceous matters, 
or particles, are contained in a network of 
cells. — See Fecula. 

FARINACEA.— Articles of food generally 
which contain farina. 

FARINACEOUS FOOD — Is an article 
of diet prepared from one or other of the 
grains, professedly, in such a manner as to 
make it easy of digestion. The varieties of 
the preparation are very numerous ; most 
of them consist of wheat flour baked, with 



FAS 



243 



FAS 



or without the addition of sugar ; others I 
contain rice-flour, potato-flour, &c. Semo- 
lina and semola belong to the class of fari- 
naceous foods, and contain more of the 
gluten of the grain. In consequence of the 
greater or less removal of the starchy com- ; 
ponents, they are more powerfully nutritious 
than those articles which have the full pro- 
portion of starch. Unquestionably, baking 
the flour must make it a more wholesome | 
article of diet for the infant; but there is 
no reason why persons should not do this 
for themselves, and thus avoid the chance of 
getting an article mixed with other things. 
Moreover, the sugar is not in all cases a 
desirable addition. 

Refer to Food — Gluten — Grains, $c. 

FASTING.— The remaining without food 
for a longer period than usual, may some- 
times be a useful proceeding, as a kind of 
negative remedy, for those who have been 
living too freely ; but even then abstemi- 
ousness, that is, the partaking of a reduced 
quantity of very plain food, is better than 
complete denial of aliment. Fasting, as a 
term, is more properly applicable to a con- 
dition in which the desire for food exists. 
When the appetite fails, as it does in dis- 
ease — and its failure is a natural indication 
that the system is not in a fit condition to 
receive nourishment — it can scarce be said 
that a person fasts. The power of fasting 
depends greatly upon habit, constitution, 
climate, and other contingent circumstances. 
It has been, and still is, the custom of many 
nations to take but one meal in the twenty- 
four hours, but if into that meal must be 
crowded the entire nutriment required for 
the body during that space of time, it is need- 
less to remark that for some time after, the 
individual can be fit for little beyond digest- 
ing his food, and that such a division of 
duties would but ill suit the arrangements 
of civilized life, even if it could be followed 
without serious detriment to health. As a 
general rule, it may be said that it requires 
more than an average of constitutional 
vigour to enable an individual in this 
country and climate to do with but two 
meals a day, that is, to fast twelve hours at 
a time. 

The consequence of too long fasting is 
physical exhaustion of the body generally, 
in which the stomach is involved; conse- 
quently, when a person has gone longer 
than usual without food, especially if under- 
going fatigue at the same time, although 
at the conclusion the system at large re- 
quires nourishment, the stomach is so weak- 
ened that it cannot digest a full meal. The 
inability to fast with impunity is increased 



the more rapid the changes going on in the 
system ; thus, children and young people 
tolerate fasting worse than others ; and for 
the same reason physical exercise or fa- 
tigue, which quickens all the usual func- 
tions within the body, also renders undue 
fasting less easily borne, and more inju- 
rious. External circumstances, again, such 
as shelter, clothing, climate, all exert much 
influence as regards the toleration of fast- 
ing. It has been shown in more than one 
article in this work, that a certain propor- 
tion of the nutriment taken is required as 
fuel, that is, as a physical agent, to assist in 
sustaining the bodily temperature ; and it 
is evident that the less abstraction there is 
in animal heat — in other words, the better 
either man or animals are protected from 
the cold — the less occasion have they for 
food within a certain limit ; and as a neces- 
sary inference, fasting may be practised 
with less inj ury in a warm than in a cold 
climate, and such is found to be the case 
among civilized people. Barbarians, or 
uncivilized tribes, such as the Esquimaux, 
who feed to a repletion which would kill 
other persons — and thus lay in a store of 
nutriment — are of course exceptional. Per- 
haps the best instances of the power — not 
exactly of fasting, but of extreme abstinence, 
is in the runners of Northern Africa, who 
are said to travel immense distances and at 
a very rapid rate, with only the sustenance 
of a limited portion of gum during the 
journey. The Arab horses, too, have often 
excited the wonder of travellers from their 
powers of endurance on extremely small 
supplies of nourishment, when compared, 
at least, with what is required by the same 
animal in this country. Hereditary con- 
stitution and habit, however, undoubtedly 
assist the influence of climate. 

As a general rule, it may be taken that 
entire abstinence from food by persons in 
health in this country for more than six or 
eight hours, must, if habitual, be injurious, 
and the more so the younger and more 
delicate the constitution. Very many cases 
of stomach disease date from the practice. 

The marvellous cases of long fasting 
which have from time to time been brought 
before the public have turned out on strict 
investigation, to be impositions, although 
they have served to exemplify the power 
of sustaining life on extremely small quan- 
tities of nutriment. The power of fasting, 
without injury, seems to be considerably 
increased in cases of insanity ; and if it is so 
in one form of nervous excitement, it may 
be so in other excited conditions of mind. 

The subject of fasting has been treated 



FAT 



244 



FAT 



in this article in an every-day life point of 
view, as it applies to society generally, 
more especially at the present day in this 
country, and without any reference to 
scriptural history, or to those miraculous 
powers which are recorded, either in the 
case of our Lord himself, or of holy men 
of old, when for his good purposes they 
were imparted. The remarks are made to 
impress the fact that absolute fasting is 
injurious to the majority — the more so if 
habitual — and may lay the foundation of 
disease. [Delicate persons should therefore 
never fast, even as a religious observance, 
without consulting a medical man.] 

Refer to Animal Heat — Blood — Digestion — 
Food, $c. 

FAT — Is a compound of three principles, 
stearine, margarine, and oleine, which at 
the temperature of the living animal body 
are fluid; but when, as after death, the 
temperature falls, the two former become 
solid. The fluid fat is contained in simple 
cells of a spherical form, which prevent its 
being diffused, or falling to the most de- 
pendent portions of the body. The uses 
of fat are, evidently, partly to form a soft 
pad or cushion for various parts ; but there 
can be no question that it also constitutes 
a store of fuel, or combustible material, for 
aiding the purposes of animal heat. This 
is palpable in the case of hybernating ani- 
mals, which are usually very fat before 
taking to their winter sleep, but the reverse 
on waking from it. A certain amount of 
fat, as a constituent element of the body, 
is requisite for health, and desirable for 
appearance ; but its accumulation may be- 
come so great as to amount to disease, and 
may become an impediment to the per- 
formance of the duties of life, as well as 
a cause of its shortened duration. The 
following remarks from the high authority 
of Dr. Chambers ought to be universally 
diffused. After adverting to a species of 
"monstrous" obesity, or fatness, which 
dates from birth, and is generally asso- 
ciated with intellectual deficiency, and 
fortunately proves fatal before the age of 
puberty, he remarks — " When the dis- 
ease" — that is obesity — "begins in child- 
hood, or about the time of puberty, we 
must not be deterred by the circumstance 
of its being hereditary from attempting to 
remedy the inconvenience arising from it. 
We cannot truly reduce our patients en- 
tirely to the average size and weight ; but 
we may enable them to pass life with com- 
fort and usefulness. The later the disease 
commences, the more controllable it is by 
management, until the middle period of life 



is passed, and then old age impedes in some 
degree the benefit which we may confer ; 
not by rendering our measures inert, but 
by preventing our employing them quite so 
actively as we should have done earlier. 

" The first thing indicated, in all cases, 
is to cut off as far as possible the supply of 
material. Fat, oil, butter should be rigor- 
ously interdicted in the diet-table. But all 
eatables contain some portion of oleaginous 
matter, and especially those most conve- 
nient to advise the use of for a lengthened 
period ; and almost all are capable of a 
transformation into fat, when a small quan- 
tity of this substance is previously present. 
It is desirable, therefore, that the mass of 
food should lie in the stomach as short a 
time as possible, in order that at least a fatty 
fermentation may not be set up in it. Very 
light meals should be taken at times most 
favourable to rapid digestion, and should 
consist of substances easy of solution and 
assimilation. To this end, the time of the * 
meals should be fixed for an early hour in 
the day, before exertion has rendered the 
power of the organs of nutrition languid and 
weak. Breakfast should consist of dry toast, 
or what is still better, sea-biscuit, and, if 
much active exercise is intended, a small 
piece of lean meat. Dinner at one o'clock, 
on meat with the fat cut off, stale bread or 
biscuit, and some plain-boiled maccaroni, or 
biscuit pudding, by way of second course. 
Liquids should be taken, not at the meal, 
but half an hour after, so as not to impede 
the action of the gastric juice upon the 
mass, and here should end the solid feeding 
for the day. No second dinner or supper 
should follow, nor, indeed, any more meals 
be taken sitting down. A piece of biscuit 
and a glass of water can be taken standing 
up, if faintness is experienced ; or a cup 
of gruel, or a roast apple, before going to 
bed. 

"The smallest amount of nutriment con- 
sistent with the health of the individual 
can be found by experiment only ; but we 
need not fear that ten ounces of solid food 
a day is too little. It may be remarked, by 
the way, that it is often advisable to add a 
small allowance of malt liquor at dinner, 
as otherwise the craving of the appetite 
is less easily appeased. The beers to be 
avoided are of course the thick, sweet kinds ; 
but that which is thoroughly fermented, at 
a low temperature, in the Bavarian way, 
seems to contain very little injurious matter. 
I do not know that any advice concerning 
sleep is peculiarly applicable to obese per- 
sons, beyond what we should recommend 
to all classes of men. They are usually 



FAT 



245 



FEC 



uneasy sleepers, and, though lethargic, by 
no means averse to early rising. 

"In cases where the fat is largely accu- 
mulated in the abdomen, it is very conve- 
nient for the patient to wear a band round 
the cavity, which may be tightened gradu- 
ally. The support thus given to the abdo- 
minal muscles relieves the dragging sen- 
sations in the loins, which many persons, 
whose viscera are heavy in proportion to 
their strength, expei'ience. It enables ex- 
ercise to be taken with more facility ; and 
appears also, by pressure, to afford some 
assistance to the absorption of fat. The 
above remarks will apply equally to all 
forms of obesity ; the abstinence recom- 
mended can be borne even by the aged, and 
only comfort be experienced. 

"As respects exercise, however, a dis- 
tinction requires to be made. The young 
and vigorous, whose obesity does not pre- 
vent the use of their legs, cannot employ 
them more usefully than in walking as long 
as they are able. The greater number of 
hours per day that can be devoted to this 
exercise, the quicker will 'be the diminu- 
tion of bulk. But as riding, by the gentle 
shaking of the abdomen, excites the secre- 
tions of the digestive organs more, it should, 
where practicable, be employed in addition. 
Where freedom of motion has once been 
gained, rowing, shooting — any, or all, of 
the forms of British gymnastics, should be 
adopted as regular habits. * * .' * 

"Purgatives I have generally found not 
needed in the pletheric form ; the bowels 
usually act once or twice in the day. But 
in the asthenic obesity of old people, where 
the abdominal walls are weakened by long 
pressure of an unnatural weight, it is neces- 
sary to employ them. 

"But there is one class of medicines so 
universally applicable to all cases of obesity 
that I think a trial should never be omitted. 
The chemical affinity of alkalies for fat point 
them out as appropriate alteratives in this 
complaint, and experience proves that they 
are suitable to the state of the digestive 
organs. The most eligible one is liquor po- 
tassse, and it may be administered in much 
larger quantities than any other. If given 
in milk and watei', we may safely commence 
with half a drachm, and raise the dose to a 
drachm and a drachm and a half, three times 
a day. The milk covers the taste of the 
potash better than any other vehicle. It 
has, truly, the advantage of saponifying a 
portion of the remedy, but there is no evi- 
dence to prove that its efficacy is thereby 
endangered ; indeed, soap itself has been 
strongly recommended." 
v2 



Vinegar, which is sometimes foolishly 
taken largely, with a view to reduce fat, can 
only do so by disordering the digestive organs. 

Food of a fatty nature is generally diffi- 
cult of digestion. As a remedy in the cure 
of disease, the fats of various animals, deer, 
vipers, &c. were formerly used in medicine. 
In some cases of irritability or low inflamma- 
tion of the lining membrane of the stomach, 
fatty food seems to be serviceable. 

Refer to Axunge — Bacon — Digestion — 
Food, §c. 

FATUITY.— Mental imbecility. 

FAVUS. — A peculiar skin disease, gene- 
rally developed on the head, but occasion- 
ally elsewhere, and remarkable from the 
yellow cupped scabs being the site of de- 
velopment of a minute fungus. 

FAUCES.— The Gorge [or orifice of the 
oesophagus]. — The space and its sides be- 
tween the back part of the tongue and upper 
part of the gullet. 

FEAR — The exact opposite to faith, is one 
of those depressing agents which always 
acts unfavourably in cases of confirmed dis- 
ease, and lays the person open to the attacks 
especially of contagious or epidemic mala- 
dies. Sudden fear has sometimes acted bene- 
ficially, and paralytics have been known to 
recover the use of their limbs in their efforts 
under a paroxysm of terror ; more gene- 
rally, however, its operation is the reverse, 
and many cases of epilepsy, mania, heart- 
disease, &c. date from fright. In children, 
particularly of a nervous temperament, the 
influence of fear, either in jest or earnest, 
is most sedulously to be avoided. Above 
all things, care should be taken that cir- 
cumstances in which children may be placed 
accidentally, or individuals with whom they 
may necessarily have to come in contact, 
are not made sources of terror. This is too 
often practised, and threats of what the 
" doctor will do" so terrify a child that, 
when visited in illness, fright quickens the 
pulse, the tongue will not be shown, and 
the sounds of the chest are so obscured by 
sobs, that it is next to impossible to arrive 
at an accurate judgment of the case. Fur- 
ther, if a child has been systematically 
frightened about the dark, &c. it may, if 
accidentally placed \n it, suffer serious in- 
jury from fright. 

FEBRICULA.— A slight fever. 

FEBRIFUGE. — Any medicinal agent 
which has the power of subduing fever. 
The term was much more used in former 
times than it is now. 

FECULA, or Starch — Is a principle uni- 
versally diffused throughout the vegetable 
kingdom, nearly approaching gum in compo- 



FEC 



246 



FEE 



sition ; it is found in various parts of plants, 
where it is evidently destined to be a store 
of nutriment for their young or newly-de- 
veloped parts ; thus, in seeds it nourishes 
the young plant ; in tubers, such as the 
potato, the bud shoots ; in the sago palm, 
the young leaves. Before, however, it can 
afford suitable nourishment, it must be con- 
verted into sugar, and this is done by the 
influence of " diastase," a substance already 
treated of. It need scarcely be said that 
while starch fulfils its peculiar office as re- 
gards the vegetable, it is a no less important 
provision for animal wants ; it is, in short, 
one of the chief elements of nourishment 
derived from the vegetable kingdom for the 
support of animal life. Amid other exam- 
ples, arrow-root is nearly pure starch. 
Starch occurs in the form of granules, 
which vary considerably in size and shape, 
according to the tribe of plants from which 
they are obtained. These granules are com- 
posed of concentric layers, the outer of 
which, when exposed to a temperature of 
160° in water, burst, and allow the inner 
layers to be dissolved ; consequently starch 
of any kind, after exposure to the above 
heat, can never be restored to its original 
condition. It is scarcely requisite to re- 
mark, that starch is insoluble in cold water, 
differing in this respect from gum. 

The composition of starch is simple, that 
is to say, it is made up of carbon and water, 
or carbon and the components of water, 
oxygen and hydrogen, but it contains no 
nitrogen, no earthy matters. From this it 
is evident that the nourishing power of 
starch, and of starchy articles of food gene- 
rally, is limited, that is to say, they cannot 
yield what they do not possess, nitrogen 
and earthy salts ; but as these are requi- 
site for the full nourishment of every por- 
tion of the frame, starchy food, either alone 
or in too great preponderance, cannot suffi- 
ciently nourish the body, particularly during 
the period of growth. This will bear out 
remarks made under articles " Arrow-root," 
" Bread," &c, which show that animals may 
be starved to death if fed on starch alone, 
or articles principally composed of starch, 
and that through ignorance of these facts 
infants and children 'have been seriously 
injured by the improper regulation of their 
food. But though starch, and such-like 
compounds, such as sugar, gum, &c, cannot 
build up bone and muscle, they can protect 
them, they can furnish respiratory aliment, 
or fuel, and also, when not thus required, 
assist largely in the formation of fat. 

Befer to Animal Food — Blood — Digestion, 



FEMORAL ARTERY.— The great arterj 
of the thigh. — See Artery. 

FEMUR.— The thigh-bone.— See Thigh- 
bone. 

FERMENTATION— Is a process of de- 
composition, or of change, in the relations 
of the various elements of fermentable 
bodies. For the action of this process of 
decomposition or of fermentation, it is in- 
dispensable that certain " azotized" sub- 
stances, named ferments, should be present. 
These substances all belong to the albumi- 
nous principles — bodies which in a moist 
condition putrefy and decompose sponta- 
neously. Thus, a solution of pure sugar 
will not ferment, however long it may be 
kept; but if a decomposing — putrefying — 
azotized ferment, either animal matter or 
vegetable albumen, or gluten, or yeast be 
added to the solution, the change quickly 
commences, and goes on until fermentation 
is complete. Vegetable juices, such as that 
of the grape and others, and even a solution 
of brown sugar, take on the process of 
fermentation spontaneously, because they 
contain sufficient azotized principles — ap- 
proaching the putrescible albuminous ani- 
mal matter in composition — to act as fer- 
ments. Milk also takes on a spontaneous 
process of fermentation for the same reason, 
but it is not the alcoholic ; no gas is evoked, 
and instead of spirit, a peculiar acid, the 
" lactic," is generated. Temperature, more- 
ever, exerts much influence upon the pro- 
cess of fermentation, and some juices yield 
either alcohol or lactic acid, according as 
the process is carried on under a low or 
high temperature. The acetous fermenta- 
tion, or that which results in the production 
of acetic acid, or vinegar, is carried on in a 
temperature of from 70° to 85° Fahr., and 
of course likewise requires the presence of a 
ferment. A certain amount of moisture and 
elevation of temperature are essential to the 
process of fermentation; dryness and cold 
alike stop the action. 

" The identity of composition of the chief 
constituents of blood, and of the nitrogenized 
constituents of vegetable food, has certainly 
furnished, in an unexpected manner, an ex- 
planation of the fact, that putrefying blood, 
white of egg, flesh, and cheese, produce the 
same effect in a solution of sugar as yeast or 
ferment." 

The explanation is simply this, that fer- 
ment or yeast is nothing but a vegetable 
principle, resembling these animal ones, 
in a state of decomposition. As it is only 
that modification of sugar, named grape- 
sugar, which is capable of being converted 
into alcohol, all fermentable substances, 



FER 



247 



FET 



■whether containing cane-sugar, or starch, 
must be, and are, converted into grape- 
sugar, as the first step of the process. Anti- 
septics stop the process of fermentation. 

" The maturation, as it is called, or sweet- 
ening of winter fruits, when stored up for 
their preservation in straw, is the result of 
a true fermentation. Unripe apples and 
pears contain a considerable amount of 
starch, which becomes converted into sugar 
by the nitrogenous constituent of the juice 
passing into a state of decomposition, and 
transmitting its own mutations to the parti- 
cles of starch in contact with it."* 

Refer to Alcohol — Antiseptic — Vinegar — 

jiCClSt JxC 

FERMENTED LIQUORS— That is, beve- 
rages which have undergone the process 
of alcoholic fermentation, may almost be 
considered a natural product of warm cli- 
mates, from the readiness with which vege- 
table juices take on the process in these 
situations. The pure juice of the grape, 
if left to itself in a suitable tempera- 
ture, will ferment in a few hours ; and the 
palm-juice of Africa and other tropical 
countries, and the " pulque" of Mexico, are 
instances of the same thing. Ancient re- 
cords, including those of Scripture, all tend 
to show that fermented liquors have been 
known and used from the earliest periods. 
In the present day, the principal fer- 
mented liquors in use are — 1. Grape wines ; 
2. Domestic or home-made wines, which 
are for the most part rendered fermentable 
by the addition of sugar ; 3. Liquors made 
from the fermented juice of the apple or 
pear ; 4. Malt liquors, from various grains, 
principally barley. For further information 
the reader is referred to the individual ar- 
ticles on the above subjects; also to Drinks, 
Food, $c. 

FERN, or Male Fern — Or, as it is called 
in botanical language, the " Aspidium filix 
mas," is a common native plant, noted 
principally as a remedy in tape-worm, but 
until lately too much neglected. It is pro- 
bable, that if given with the same care and 
precaution, it might not be found inferior 
to the now celebrated Eousso. The male fern 
(fig. lxviii.) grows chiefly on strong ground, 
in slightly-shaded situations ; no descrip- 
tion could guide an unprofessional and un- 
botanical person to gather it with certainty 
if it cannot be recognised from the figure, 
(lxviii ;) but perhaps the safest plan for any 
one wishing to use it, would be to have the 
plant either collected for him, or both it 
and its distinctive characters pointed out 



Liebig's Letters on Chemistry. 



Fig. lxviii. 




by some competent person. Dr. Christison 
gives the following directions: — '''The root, 
which is the part of the plant used, should 
be collected between the end of May and 
the middle of September. It should be 
cleared of foreign matters, root-fibres, and 
old or decayed tufts, but without being 
washed. It should then be dried quickly 
and thoroughly in the open air without 
heat, and in the shade ; these tufts, as well 
as the parts of the root-stock which are 
greenish internally, should alone be de- 
tached, and immediately reduced to pow- 
der ; and the powder must be kept in well- 
closed bottles." It should not be relied 
on when above one year old. The usual 
dose of the powdered root is from one 
to three drachms; but the' oil extracted by 
means of ether is the best preparation, the 
dose being eighteen drops given at night, 
either in pill, emulsion, or mixed with castor- 
oil, and repeated again in the morning. 
It is better to avoid much food just before 
taking the dose of either powder or oil, or 
during their operation ; and it is always 
requisite to follow the last dose taken with 
some aperient — castor-oil is perhaps the 
best — two or three hours afterward. The 
worms are discharged dead.f 

Eefer to Kousso — Worms, fyc. 

FERRUGINOUS.— Connected with iron. 

FETOR— Is a bad odour of any kind. In 
many cases it is the result of the process of 
putrefactive decomposition or fermentation, 
and may be developed either on the external 
or in the internal parts of the body. The use 
of chlorine or of chloric ether in various 
ways [or of the essential oil of camphor] 



f A case of tape-worm successfully treated by male 
fern is recorded hi the Lancet, for March 6th, 1S52. 



FE V 



248 



FEY 



is the best corrective. The mercurial fetor 
is a peculiar odour always acquired by the 
breath when the constitution is sensibly 
affected with mercury. 

Refer to Chlorine, Mercury, Sfc. 

FEVER — Is that condition of the body in 
which the pulse is quickened, the skin hotter 
than natural, thirst present, and the func- 
tions generally disordered. This feverish 
state of the system may arise from and be 
the concomitant of various local and other 
affections, but it may also constitute a dis- 
ease in itself, and it is to it in this light 
that the present article applies. 

Fever, properly so called, naturally di- 
vides itself into intermittent fever or ague, 
eruptive fever, such as small-pox or measles, 
hectic fever, remittent and common con- 
tinued fever. It is with the two last that 
we have to do at present ; the others will be 
considered under their own heads. 

Remittent fever may be regarded as an 
aggravated form of intermittent fever or 
ague, (see Ague) ; it has the regular succes- 
sion of hot, cold, and sweating stage, but 
the interval between the paroxysms is not 
characterized by the return to comparative 
health, as it is in the latter. Through most 
tropical countries, the principal type of 
fever is the remittent; but the complica- 
tions of the fever, and consequently its 
management, vary according to locality. 
Under these circumstances, it would answer 
no good end to devote more space to the 
subject at present, than to advise all who 
are about to reside in hot climates, to in- 
form themselves thoroughly on this as well 
as other matters connected with the pre- 
servation of health, and also on the nature 
and management of the diseases in and con- 
nected with their future home. 

Common continued fever is an affection 
of the whole system ; as described by a 
medical author of eminence, "it affects 
the head, the trunk of the body, and the 
extremities ; it affects the circulation, the 
absorption, and the nervous system ; it 
affects the skin, the muscular fibres, and 
the membranes ; it affects the body, and 
likewise the mind." By medical men this 
serious disease is subdivided into different 
varieties and types ; but it would serve no 
good purpose to enter into these here. The 
management of a disease so gravely im- 
portant as fever can never be legitimately 
undertaken by unprofessional persons, if 
medical assistance is procurable ; but as a 
provision for circumstances when this is 
absent, the less complicated the account 
both of the disease and its treatment, the 
more likely is it to be managed with ad- 



I vantage domestically. The first symptoms 
of incipient fever are usually displayed 
through the nervous system. The indi- 
vidual feels an unaccountable languor, and 
complains of headache and shivering, can- 
not exert his powers either in the duties or 
pleasures of life, is easily tired, sleep is dis- 
turbed, the appetite is impaired, the skin 
looks dusky and the eyes heavy, the pulse 
quickens, and at length the feeling of gene- 
ral illness drives the patient to bed. The 
attack, however, may commence much more 
suddenly — a shivering, or, as the people in 
many places call it, an "ague fit," may be the 
first symptom ; or severe headache, or vomit- 
ing, or fainting, or even convulsion may be 
the first symptom of the impending malady. 
When fever is fairly established, the pulse 
ranges above 100, the tongue is furred, 
probably brownish and dry, sleep is dis- 
turbed or supplanted by delirium, the mus- 
cular power is diminished and diminishing, 
and the mind indifferent to passing circum- 
stances ; dark incrustations collect about 
the teeth, the patient sinks down in bed, and 
perhaps passes the natural evacuations un- 
consciously, thus displaying the most evident 
signs of debility. This condition may in- 
crease till it terminates in death, or tends 
toward recovery, either by some marked 
crisis, such as profuse perspiration, or by an 
almost imperceptible amendment. Tranquil 
sleep, improved aspect of the countenance, 
the skin cooler and with more tendency to 
moisture, the tongue cleaning at the edges, 
and a natural desire for food, all give sign 
that the disease is passing away ; on the 
other hand, if a fatal issue is approaching, 
the general weakness increases, the patient 
slips down in the bed in consequence, and 
lies in a state of dreamy muttering; there is 
convulsive starting of the fingers or other 
parts of the body, picking at the bed- 
clothes, the insensibility to externaL impres- 
sions increases, and probably stupor closes 
life. 

Such are the general features of fever, 
whether simply continued, or when it runs 
on to the more serious forms of typhoid, or 
low, or nervous, or malignant fever. There 
are many other indications which occur, but 
which it would serve no good purpose to 
detail here ; all that is required is that the 
disease should be recognisable, so that its 
general management may be properly and 
intelligently conducted when it falls to the 
lot of an unprofessional person to have the 
direction. 

In the first place it must be remembered, 
that for continued fever we have no cure, 
that is, we have no medicine which we can 



FE V 



249 



FE V 



give with the tolerable certainty of remov- 
ing the disease, as quinine removes ague : 
it must be vanquished by the powers of 
the constitution, by the tendency to health, 
and our endeavour must be to place these 
powers in the most favourable condition 
possible for the struggle, and, where they 
appear to be insufficient, assist. Sometimes 
the constitutional power will throw off 
fever at the very onset. Probably few 
medical men have not experienced in their 
own persons, when attending fever patients, 
that they had contracted the disease, and 
that after all its symptoms had been in 
course of development for four- and- twenty, 
or even eight-and forty hours, it has been 
cast off, probably, by perspiration or diar- 
rhoea, and health restored. From this 
almost ephemeral attack, to the week after 
week of continued fever, the disease may be 
thrown off at any period of its course. A 
person attacked with fever ought to be 
placed in as roomy and well-aired a situa- 
tion as possible — better even in a barn than 
in a close or crowded room; the greatest 
cleanliness as regards every thing around 
must be observed, and perfect quietude ; 
if thirst is present, it should be liberally 
indulged with simple diluents ; if nourish- 
ment is taken, it should be given in mode- 
rate quantities, and consist principally of 
milk and farinaceous preparations ; grapes, 
oranges, and ripe fruits, if they do not 
create flatulence or diarrhoea, are allowable. 
If the skin is hot and dry, it should be 
sponged daily, or oftener, with water, and, 
indeed, this practice is beneficial, more or 
less, in most cases. By these simple means 
of management, almost without medicine, 
beyond some gentle aperient at intervals 
to keep the bowels perfectly free of their 
necessarily depraved contents, many a case 
of fever may be well conducted to a favour- 
able issue, with much more certainty than 
under a more meddlesome treatment — care 
being taken when signs of amendment show 
themselves, that there is not too great hurry 
in giving or permitting strong nourishment. 
In more serious forms of fever, the same 
principle of treatment must be kept in view, 
but more urgent symptoms may call for 
more active interference ; violent delirium 
may require the treatment pointed out 
under the article devoted to the subject; 
difficulty of breathing and cough may ren- 
der a blister on the chest desirable, or 
tenderness of the bowels on pressure, par- 
ticularly in the right iliac region, (see Ab- 
domen,) may call for the application of half 
a dozen leeches. Diarrhoea may require to 
be checked, (see Diarrhoea,) or constipa- 



tion removed by gentle aperients; eastor-oil 
or rhubarb or senna will generally be found 
safest and best, or by clysters. Sleepless- 
ness at night, with convulsive starting of the 
fingers, may require opium, (see Delirium ;) 
or the general sinking of the powers, the 
pulse becoming feeble and easily extin- 
guished, may call for the careful and 
measured administration of wine or brandy, 
or of camphor in milk, (see Camphor,) with 
strong meat-broth, or gravy, in frequently 
repeated small quantities. At this time 
care must be taken to observe whether urine 
is passed ; if there seems to be difficulty, a 
bag of hot bran on the lower part of the 
body will possibly make it easier ; if it 
dribbles away, means should be taken to 
protect the back and hips of the patient 
from being wetted with it. This may be 
done in various ways, either by waterproof 
material, or by constant renewal of dry 
cloths ; it is much better effected, however, 
by bags of bran, so placed as to absorb the 
urine as it comes away. If with every 
quart of bran, four ounces of the diluted 
sulphuric acid be mixed, it will neutralize 
the ammoniacal emanations which so quickly 
arise wherever urine collects. Very re- 
cently, bags filled with the powder of peat 
charcoal have been recommended for the 
same purpose ; and where this article can 
be procured, it will probably be superior to 
any other. 

All patients who lie long in fever become 
liable to bed-sores, or ulcerations on the 
prominent parts of the body which are 
subject to pressure as they lie; these are, 
especially, the back and hips, points of the 
shoulder-blades, back of the head, tips of 
the ears, &c. When these ulcerations form, 
they not only add materially to the suffer- 
ing of the patient, but may become the 
cause of a fatal termination to a case that 
might otherwise have recovered. They 
should, if possible, be prevented. The parts 
named above should be frequently examined, 
and on the slightest appearance of redness, 
the skin at the spot should be rubbed -with 
spirit — brandy — or a solution of camphor in 
spirit. When the skin has actually broken, 
it may be dressed with simple spermaceti 
ointment spread on linen; lead plaster 
spread on soft leather is often useful, or the 
white of egg beat up with alum. — See Alum. 
Both as a preventive and as a remedy after 
the sores have formed, the parts should be 
relieved from pressure as much as possible 
by various arrangements of cushions, &c. 
the elastic ones made for the purpose being 
the most suitable. — See Caoutchouc, Elas 
tic, §c. 



FIB 



250 



FIL 



Such are the general principles on which a 
case of fever is to be managed ; by attention to 
them an unprofessional person will be much more 
likely to do good than by meddlesome interfe- 
rence. Attention to the ventilation of the 
room, to the perfect cleanliness of the pa- 
tient and of every thing around — a free 
supply of diluent drinks, and care that the 
bowels are duly, but not forcibly relieved 
of their always depraved contents, ought to 
constitute the chief resources of the do- 
mestic management of fever. 

Again it is repeated, fever is not a disease 
to be cured, but to be guided to a safe ter- 
mination. If many of the symptoms which 
arise, or may arise, in fever, or if minutiae 
of treatment are here omitted, it is because 
either their enumeration would have been 
useless, or that a judicious reference to va- 
rious parts of this work will furnish ade- 
quate guidance. As regards the causes of 
fever, the first, " Contagion," has been fully 
treated of in its special article, and the rest 
are so fully pointed out in the various sani- 
tary articles, such as "Air" and "Atmo- 
sphere," "Bedroom," "Chlorine," "Disin- 
fectant," "Drainage," &c. &c. that it would 
involve needless repetition to go over them 
here. They may be summed up : Predispos- 
ing — whatever lowers, either temporarily 
or permanently, the standard of the gene- 
ral health ; and Direct — contagion and the 
products of animal or vegetable decompo- 
sition. 

Fever in children in this country [England] 
is more generally of a remittent character 
than it is in adults. 

This article cannot be closed without re- 
ference to the employment of fresh yeast in 
cases of fever, particularly of a low, malig- 
nant, or putrid tendency, in which it is most 
useful. It is given in tablespoonful doses, 
repeated every three or four hours. 

Refer to Ague — Bedroom — Contagion — Dis- 
infectant — Disease — Debility, §c. 

FIBRIN — Is that constituent of the blood 
which — along with the entangled globules — 
forms the clot. It also constitutes the fibre 
of flesh or muscle. It is identical in com- 
position with albumen, to which state it 
must be reduced in the process of digestion 
in the stomach, for the purposes of nutri- 
tion; but it is in a much more "vitalized* 
condition than the former substances ; in 
other words, is much more fit to become 
incorporated with the tissues of the living 
body. 

Refer to Albumen — Blood — Digestion — 
Food, §c. 

FIBULA.— The small bone of the leg. 

FIGS — The well-known fruit, contain a 



wholesome and somewhat aperient pulp, but 
the thick tough rind is indigestible, and 
should not be eaten. 

FILBERTS— Are liable to the objection 
to nuts generally, and are diflicult of di- 
gestion. 

FILTER — Is an agent for separating solid 
impurities from fluids. Filtering papers 
made for the purpose, or white blotting 
paper, are most usually used as medical 
filters, being supported by the well-known 
funnel or tundish, which ought to be of 
glass or porcelain, and ribbed inside, (fig. 
lxix.) To make a paper filter, the paper 
Fig. lxix. 




used must be square, (fig. lxx.) By the 
first fold the corners (1,1) are put together, 
at the next (2, 2) are put together, thus 
forming a triangle, (1, 3, 2;) 1 and 2 are 
next put together, making a triangle, (4, 3,2;) 
and one more fold (5, 3, 2) completes. The 

Fig. lxx. 
1 



4 ..-•* 




top being squared off, the filter is made, and 
may be opened out and placed inside the 
supporting tundish. In filtering through 
paper, it is always desirable to pass the first 
few ounces of the fluid through a second 
time, as a small amount of impurity gene- 
rally escapes at first. When the solids to 
be separated by filtration are not in very 
fine powder, the operation is more quickly 
done through linen or flannel. Of the va- 
rious filters sold for the purifaction of 
water, it is unnecessary here to speak. But 
as the purity of that element is one of the 
essentials for health, and as, in those situ- 



FIN 



251 



FIT 



ations and circumstances in which it is used 
in its greatest impurity, almost any kind of 
bought filter is unattainable, the following 
suggestion from the Proceedings of the British 
Association is most valuable : — Any common 
vessel with a hole below, such as a flower- 
pot, may be used. Its lower portion is to be 
filled with coarse pebbles, over which should 
be placed a layer of finer ones, and on these 
a layer of clean coarse sand ; on the top of 
this, a piece of burnt clay, perforated with 
small holes, should be put, and on this a 
stratum, three or four inches thick, of well- 
burnt pounded charcoal. A filter thus formed 
will last a long time, and not only separates 
solid impurities, but purifies the water, by 
means of the charcoal, from the putrescent 
and other noxious substances held in solu- 
tion, which cannot be separated by ordinary 
filtration. 

Refer to Water. 

FINGERS — From their constant exposure, 
are liable to many accidents and diseases — 
fractures, dislocations, whitlow, separation 
of the nail — all which are treated of under 
their respective articles. There is, however, 
one mishap which does not fall under any 
particular head. 

A ring which cannot be removed. — When 
this occurs, the use of cold to the finger 
and hand, the hand and arm being elevated 
at the same time, may cause sufficient 
shrinking to permit the removal. If this 
does not succeed, the following may : — A 
piece of fine pack-thread, or linen thread, is 
to be wrapped evenly and firmly round the 
finger, from the tip as far as the ring, 
through which its end is to be inserted, 
which being done, the packthread must be 
gradually unwound by means of the end 
thus placed. If this process does not suc- 
ceed, the ring should be filed off. It cannot 
remain without risk. 

FIRE.— See Heat. 

FISH — As an article of diet, is generally 
wholesome. It is neither so nutritive nor so 
heating as animal food, and on these ac- 
counts is often to be permitted when the 
latter is not. 

Fish are classed as fresh-water, salt- 
water, and shell-fish. Dr. Paris remarks, 
" Turbot, cod, whiting, haddock, flounder, 
and sole are the least heating of the more 
nutritive species ; and the flakiness of the 
fish, and its opaque appearance after being 
cooked, may be considered as true indica- 
tions of its goodness ; for when the muscles 
remain semi-transparent and bluish, after 
sufficient boiling, we may reject it as infe- 
rior in value, and not in season. When fish 
is in high perfection, there is also a layer 



of white curdy matter, resembling coagu- 
lated albumen, interposed between its flakes. 
The whiting ("the chicken of the sea") is 
well adapted for weak stomachs, on account 
of the little viscidity which it possesses. 
It is at the same time tender, white, and 
delicate, and conveys sufficient nutriment, 
with but little stimulus, to the system. The 
haddock is firmer in texture. Cod is not 
quite so digestible as the two former, but it 
is nutritious. Turbot is wholesome, without 
lobster sauce. Sole is tender, and yet suf- 
ficiently firm ; it is, therefore, easy of di- 
gestion, and affords proper nutriment to 
delicate stomachs. Salmon is very nutri- 
tious, but, being one of the oily fishes, is 
less digestible than many others — vinegar 
in some degree corrects the fault. Eels are 
always indigestible." From these observa- 
tions the value of fish may be appreciated, 
and the qualities which entitle them to 
election easily understood. [In the United 
States the rock-fish is most esteemed, but the 
shad, cat-fish, sun-fish, perch, pike, trout, and 
herring are also excellent articles of food.] 
Firmness of texture, whiteness of muscle, 
and the absence of oiliness and viscidity, 
are the circumstances which render them 
acceptable to weak stomachs. The flesh of 
fish contains kreatine. — See Kreatine. Shell- 
fish may, without exception, be considered 
as indigestible. Oysters eaten raw are un- 
doubtedly nutritive, but by some they are 
not easily digested. Many persons are lia- 
ble to cutaneous eruptions after the use of 
some descriptions of shell-fish, and some 
suffer from diarrhoea. 

In such places, as the coast of Norway 
and Sweden, where a diet of fish alone is 
habitual, the people are very liable to chro- 
nic cutaneous diseases. 

The most wholesome method of cooking 
fish is by boiling ; frying is not suitable for 
the invalid. It is well known that certain 
species of fish are poison at all times ; others 
appear to be so only occasionally, and 
under peculiar circumstances. Of these, 
the common mussel has proved more inju- 
rious than any others. The oily fishes also, 
such as salmon, herring, &c. when too long 
kept, have also given rise to symptoms of 
irritant poisoning. 

Refer to Mussels, §c. 

FISTULA — Is a canal or passage formed 
by disease, and healing with difficulty, which 
opens from the surface of the body. The 
word fistula, alone, is generally used popu- 
larly with reference to the disease when 
situated at the fundament. — See Rectum. 

FITS. — The term is applied popularly to 
any form of convulsion or spasm of the 



FIX 



252 



FOM 



voluntary muscles, such as Epilepsy, Hys- 
teria, and Convulsions generally, either in 
adults or children. To these heads the 
reader is referred. 

FIXED AIR. — The name given by Dr. 
Black to carbonic acid gas. 

FLANNEL — A woollen texture, is an ar- 
ticle of clothing which should be worn next 
the skin by every man, woman, and child 
in every country, notwithstanding its pro- 
hibition (!) by Preissnitz, amid other hy- 
dropathic regulations. Under the head 
of flannel is included, of course, woollen 
clothing generally. Wool being a bad con- 
ductor of heat, is, in consequence, the best 
protection against sudden vicissitudes of 
temperature, such as occur in most climates, 
and especially against chills, which may su- 
pervene upon the profuse perspiration in a 
warm one. Of course, the thickness of the 
woollen material worn next the skin may 
and ought to be varied, but wool it ought to 
be, if of no stronger texture than gauze. The 
experience of our military and naval sur- 
geons all tends to prove that there is no 
greater preservative from the dysenteric and 
febrile affections of hot climates than wool- 
len clothing next the skin, and every medi- 
cal man's experience in this country con- 
firms the fact of its protective power. Not- 
withstanding, it is astonishing how many 
carelessly neglect this indispensable article 
of clothing. Some few persons with extreme- 
ly irritable skin cannot wear flannel next 
it. In such cases, a dress of thin cotton 
[or silk] should be worn, with flannel over it. 
Flannel should be worn in summer, but of a 
thin texture. 

FLATULENCE— Or the collection of gas 
in the stomach and bowels, is very commonly 
the result of indigestion ; but it is often 
also the effect of nervous disorder. In the 
former case, it is probably chiefly due to 
the extrication of gas from the badly-di- 
gested food mass in a state of partial fer- 
mentation. In the latter, it is only possible 
to account for the enormous quantities of 
" wind" which are discharged by its forma- 
tion ("secretion") in the bowels. Toward 
the termination of fever, and other acute 
diseases, flatulent distention of the bowels, 
or " tympanitis," as it is called, is always 
an unfavourable symptom. 

Persons who suffer from flatulence require 
sedulously to avoid most kinds of vegetable 
food and fruits. Individual experience, how- 
ever, is the best guide on this head. When 
a severe attack of flatulence comes on, car- 
minative (see Carminatives) and stimulating 
remedies are generally resorted to, and 
often prove useful. But in many cases, 



particularly in nervous individuals, with 
pale tongue, the mineral acids will often 
be of more service — either twenty to thirty 
drops of dilute nitric acid in a wineglassful 
of infusion of orange-peel, or some other 
warm bitter ; or, better still, aromatic sul- 
phuric acid, in ten drop doses, in a wine- 
glassful of water. In general flatulence 
of the bowels, with difficulty of expulsion, 
the clysters of assafoetida or rue are most 
useful. 

Refer to Children — Clysters — Indigestion. 

FLESH. — The muscular substance of ani- 
mal bodies composed of fibrin. It is a po- 
pular error to suppose that flesh is merely 
present in the body "as flesh," and it is not 
understood that every particle of the sub- 
stance is muscle, and employed as such in 
the movements of the living body. 

Refer to Beef — Fibrin — Mutton, §c. 

FLESH-BRUSH.— A brush for brushing 
the skin. — See Skin. 

FLOODING. — Hemorrhage from the 
womb. — See Abortion — Childbed — Menstrua- 
tion, Sfc. 

FLOUR.— See Grains— Farina. 

FLOWERS op SULPHUR. — Sublimed 
sulphur. — See Sulphur. 

FLUCTUATION— In medical language, is 
the movement given to fluids in cavities 
(either natural or diseased) by the fingers 
of the medical man, while at the same time 
he endeavours to make himself acquainted 
with the various peculiarities which charac- 
terize the collection. 

Refer to Abscess. 

FLUOR ALBUS, [The Whites.]— See 
Menstruation. 

FLUX. -A An increased discharge from 
any of the passages of the body, such as 
the bowels, lined by a mucous membrane. 
The term has gone out of use. 

FOETUS.— The term is applied to the in- 
fant from the fifth month till the period of 
birth. 

FOMENTATION— Is a method of apply- 
ing heat and misture to any portion of the 
body. It is a most useful remedy, if well 
done, but is so often badly performed as to 
do more harm than good ; for this reason a 
bran-bag poultice, properly made (see Bran) 
is in most cases preferable. When fomenta- 
tion is to be performed, the bed or clothes 
should be guarded by some waterproof ma- 
terial if possible. Two good-sized pieces 
of coarse flannel are to be employed, one 
being in preparation while the other is in 
use. The flannel being wrung out of hot 
water, should be shaken up loosely, and laid 
upon the part under treatment. The size 
of the flannel must, of course, be propor^ 



FO M 



253 



FOO 



tioned to the case, but it should be ample. 
Simple warm water is generally sufficient 
for fomentation, but in some cases the de- 
coction of poppy capsules may be more 
soothing. Other additions are of no service 
beyond insuring the greater attention and 
confidence of many ignorant persons, who 
will not use, either with care or confidence, 
so simple an application as water. 

Refer to Bran — Heat — Poultice, §c. 

FOMITES.— See Contagion. 

FOOD— That by which the living body is 
nourished, in its widest sense, comprehends 
both liquid and solid aliment. In the fol- 
lowing article, the subject will be consider- 
ed chiefly with reference to the principles 
which regulate, or ought to regulate, the 
food of man, and on which, as far as ascer- 
tained, the nutriment of his material frame 
is conducted. Much special information 
connected with the subject is scattered 
through this work in the papers which treat 
of the individual articles used as nourish- 
ment ; and such papers as "Alimentary 
Canal," " Digestion," &c. bear directly up- 
on it. 

Water is not only the medium by means 
of which most of the operations which go 
on in living bodies are conducted, but it 
also enters so largely into the composition 
of these bodies, that it must be regarded as 
one of the alimentary principles, a due sup- 
ply of which is necessary, not only for 
health, but for life ; and this supply must 
be constant, in order to compensate for the 
loss of moisture which is continually going 
on from the surfaces, exterior and interior, 
of the living body. 

The food taken by man and animals has, 
or ought to have reference in its composi- 
tion to two distinct ends, the nourishment 
of the bodily tissues, and the maintenance 
of animal temperature. Milk is the only 
single article of diet which in itself con- 
tains this essential combination in properly 
balanced proportion. We know that it is 
capable, not only of sustaining, but of 
nourishing in growth the body of the 
young animal ; and thus we have plainly 
set before us, what He who made and sus- 
tains all things has provided as necessary 
for the sustenance of the creature, when 
that creature is confined to one means of 
nourishment solely. In addition to water 
and saline ingredients, milk contains three 
distinct sets of principles : the albuminous, 
represented by the curd; the saccharine, (in 
which is included the farinaceous,) repre- 
sented by the sugar, and the oleaginous, 
or fatty, by the cream. Of these, the albu- 
minous principles and salts are requisite for 
W 



the building up of the frame ; the saccha* 
rine and oleaginous for, so to speak, sup- 
plying it with fuel ; they are what has been 
called "respiratory food," because they 
chiefly furnish materials, carbon and hy- 
drogen, which may combine with the oxy- 
gen taken in from the air by the lungs, and 
burn, as it were, within the body by a slow 
and gentle process. It must not, however, 
be imagined that the saccharine and oleagi- 
nous principles are solely devoted to pur- 
poses of fuel, they also serve important 
ends in the nutrition of the body ; but as 
they contain no azote or nitrogen, it is evi- 
dent they cannot afford proper nutriment 
to tissues of which this element forms an 
essential component. They cannot, there- 
fore, form muscle ; but they can form fat, 
which contains no nitrogen, and requires 
none. In truth, the sugar, starch, and 
probably the fibre and gum of vegetables, 
must constitute the chief sources for the 
formation of fat in graminivorous or vege- 
table-feeding animals. The albuminous, 
the saccharine, and the oleaginous princi- 
ples must each be taken as the representa- 
tives of a peculiar class of substances. 
Under the head of albuminous principles 
falls the caseine, or curd of milk ; albumen, 
as we see it in the egg ; and fibrin, as it 
coagulates from blood, or forms part of 
animal muscle. These are principles all 
identical, or nearly so, in composition, but 
in different states of vital organization. 
They are composed of carbon, hydrogen, ni- 
trogen, and contain phosphorus and sulphur 
in small proportions. They are, therefore, 
adapted to afford due nourishment to such 
portions of the living animal body' as are 
similarly constituted. The milk curd is the 
only substance contained in that fluid from 
which the young animal can form its blood 
and its muscle. From the albumen of the 
egg alone all the tissues of the chick are 
constructed, and the carnivorous animal 
subsists upon the muscle (flesh) of its vic- 
tims. These principles are, therefore, in 
themselves capable of sustaining life. Not 
so the oleaginous and the saccharine, which 
represent, the one the fats and oils, and the 
other the starch or fecula, the sugar, and 
the gum. These being deficient in nitrogen, 
in sulphur, and phosphorus, cannot yield 
them, and, therefore, an animal fed upon 
them alone, will die of starvation, as regards 
certain essential components of its body 
at least. It was, for a long time, a paradox, 
how animals which lived on vegetable food, 
formed from it the albuminous principles 
contained within their bodies, because it 
was thought that in the vegetable kingdom 



FOO 



254 



FOO 



these azotized compounds did not exist. 
Chemistry of late years has solved the dif- 
ficulty, by proving that vegetables do contain 
albuminous principles answering to those 
found in animal substances ; not, it is true, 
in the same large proportion, but quite suf- 
ficient to afford all necessary nourishment, 
even to the muscular bull or the gigantic 
elephant. These principles, and indeed 
their own entire structure, plants elaborate 
" from carbonic acid, water, and ammonia ; 
that is, from the constituents of the atmo- 
sphere, with the addition of sulphur, and 
of certain constituents of the crust of the 
earth." Plants, therefore, may truly be said 
to produce the blood of animals. Certainly, 
animals which live upon vegetables have to 
consume a very much larger bulk of mate- 
rial than animals which live upon flesh ; but 
for this, their habits and the nature of their 
digestive organs have been arranged by the 
Creator. Vegetables, therefore, are the ori- 
ginal formers of these albuminous princi- 
ples, which they present ready prepared to 
the digestive organs of the vegetable-eating 
animal ; the latter have simply the task of 
fitting them for intermixture with the blood, 
previous to their becoming component con- 
stituents of the animal body. In the ani- 
mal, however, it must be evident that they 
exist in a much more compact condition 
than in vegetable substances, and that the 
flesh-eating animal will require to consume 
a much smaller proportion of its natural 
food than the vegetable feeder. Both 
classes of animals, however, breathe, that is, 
take in oxygen by the lungs, which, in main- 
taining their animal temperature, must com- 
bine with the respiratory elements, (carbon 
and hydrogen.) These the vegetable feeder 
receives in abundance, in the starch, the 
saccharine ingredients, the woody fibre, 
&c. which make up the mass of vegetable 
substance ; sources evidently not open to 
the animal living on flesh alone. This, it 
is true, will receive some amount of respira- 
tory food in the fat of its prey ; but it will 
also require to make more violent muscular 
exertion than the vegetable feeder, so that 
using up its muscle in so doing, it may 
obtain the carbon and hydrogen (which are 
contained in muscular substances as well as 
in other albuminous principles) for the pur- 
poses of animal fuel. In accordance with 
this, we find that the carnivorous animals 
expend much more muscular force in ob- 
taining their sustenance, (in hunting,) than 
the graminivorous animal. 

What is applicable to the food of animals 
is also true in that of man, as regards the 
nutrient principles ; the bodies of both stand 



upon the same level, but man has the will 
and the power to consume both vegetable 
and animal food, either mixed or singly, 
as may suit his habits. Existence upon 
animal flesh alone is not common, but it is 
practicable and practised by the Indians of 
the South American pampas, and by many 
people who live by hunting ; but all these, 
like the carnivorous animal, make long-con- 
tinued muscular exertion, without which, 
indeed, under the peculiar diet, they could 
not preserve health or life. Sir Francis 
Head relates, in his Journey over the Pampas, 
that while making immense exertions, he 
lived for months together exclusively on 
beef and water, this being the diet of the 
roamers over these immense plains, who 
spend most of their time in active exercise 
on horseback. 

Existence upon vegetable food alone is 
much more common than that upon ani- 
mal food alone ; and, indeed, is the rule 
with many nations and people, who un- 
questionably maintain high strength and 
vigour upon it. It is, in fact, only requisite 
to look at the grass-eating bull to feel con- 
vinced of the possibility of the fact, and 
did space permit, it would be easy to ci^e 
abundant confirmatory examples ; but if 
man lives on vegetables he must, like the 
vegetable-eating animal, consume a com- 
paratively large bulk to obtain sufficient 
nutriment; and so it is the Irishman and 
the Hindoo must eat seven or eight pounds 
of potatoes, or of rice, at a meal. These, 
however, are extreme instances, for potatoes 
and rice are comparatively non-nutritious, 
containing much starch and — especially the 
latter, when cooked — much water ; the cereal 
grains and pulses, on the other hand, pos- 
sess albuminous principles largely — the glu- 
ten of the former corresponding to the 
animal fibrin, and the caseine of the latter 
to the curd of milk. Those persons, there- 
fore, whose vegetable food is composed 
chiefly of the above, require, of course, to con- 
sume less, and there cannot be the slightest 
doubt that man may lead a most active and 
healthy life upon a grain diet alone, and 
especially if it be combined with milk. But 
what is possible may not always be expe- 
dient, nor suited to man's circumstances, 
and on this hinges the argument respecting 
the nature of food on which man ought to 
live. No physiologist would dispute, with 
those who maintain that man ought to live 
on vegetables alone, the possibility of his 
doing so, or that many might not be as 
well or better under such a system than any 
other ; but no physician acquainted with 
the requirements and constitutions of men 



FOO 



255 



FOO 



generally, who live according to the usages 
(certainly it may be allowed too artificial) 
— of this and other civilized countries, will 
allow that a vegetable diet could become the 
rule to the majority without serious injury. 
The healthy, active countryman, constantly 
exercised in the open air, will do well on a 
vegetable diet, under which the city artisan 
or man of business, the delicate female, the 
pale, perhaps scrofulous child, would be- 
come" diseased, or sink and die. Their 
organs of digestion and assimilation cannot 
extract from the vegetable mass sufficient 
blood-nourishment, neither do they receive 
sufficient stimulation from it. It may be 
contended that the evil is an artificial one, 
engendered by artificial life. That may or 
may not be the case, but so the question 
stands at present ; and, as man generally is 
circumstanced at the present day, he will 
best consult his own comfort, convenience, 
and usefulness, by using a mixed diet, the 
power to use which has been bestowed upon 
him by his Creator. He will, if possible, 
consume albuminous material, (animal food,) 
in quantity sufficient to supply the waste 
of his bodily, especially muscular, tissues ; 
but will mingle it with such respiratory 
food, that is, saccharine, or starchy, and 
oleaginous substances, as will supply the 
carbon and hydrogen requisite for animal 
temperature, without his being compelled to 
undergo the muscular exertion of the half 
savage hunter. 

In the consideration of the principles 
which ought to regulate man's food, and 
which do regulate the nourishment of his 
material animal body, there has been omit- 
ted — for the sake of avoiding confusion — 
all notice of an important and generally 
distributed component of the animal frame, 
the gelatinous, or jelly, principle. This, 
which enters mainly into the composition 
of the skin and tendons, and which forms 
the animal constituent of the bones, belongs 
to none of the principles already enume- 
rated, although it contains nitrogen, and is 
much simpler in composition than albumen. 
In the form of isinglass, gelatine, or glue, 
it is familiar to all. As gelatine enters 
largely into the constitution of the animal 
body, it must, of course, be a valuable, if it 
is not an essential, addition to its means of 
nutriment, when taken in the food, and 
especially as a substitute for albuminous 
nourishment, which must, in its absence, 
be used up in supplying nutriment to the 
azotized gelatinous tissues. The only other 
constituents of food it remains to notice are 
the mineral elements — salts of iron, potash, 
soda, lime, magnesia, &c, and with them 



sulphur and phosphorus ; these must be, 
and they generally are, afforded to the sys- 
tem, along with nutriment generally. 

To review the principles which regulate 
food and nourishment : — We have vegetables 
as the first agents for taking up the ele- 
mentary forms of matter, and combining and 
transforming them into such components as 
are suited to the digestive organs of the 
vegetable-subsisting animal which consumes 
them, and in which they are built up into 
the blood-filled animal frame, of muscle, 
nerve, and bone, ready for the consumption 
of the carnivora, or flesh-eaters, and to 
yield sustenance suited to the wants of 
man. We have these nutrient principles, 
consisting of albuminous compounds, fitted 
to nourish albuminous tissues, gelatinous 
to nourish gelatinous, and saccharine and 
farinaceous to supply the matter of fuel, 
and to take part in all the other operations 
of the system, or to be stored up as fat. 
Lastly, we have water, the aqueous prin- 
ciple, as the necessary medium without 
which these varied operations could not be 
carried out. 

To apply these principles to man, we find 
him so constituted as to be able to maintain 
health and life on animal food alone, or on 
vegetable food alone ; but we also find him 
fitted by organization to subsist on a mixed 
diet, such as is most in accordance with the 
habits and usages of all civilized communi- 
ties. 

In the selection of food, however, it is 
not sufficient that it contains the principles 
necessary for the nutriment of the body, 
but these principles must be reducible by 
the digestive powers. It matters not that 
wood fibre nearly approaches starch or gum 
in composition, or that horn contains albu- 
men largely, if the firm texture is not solu- 
ble in the stomach; and the same argument 
modified, applies to food generally — forms, 
indeed, that consideration with respect 
to it which comes under the designation 
Diet — that is, the facility or the reverse 
with which certain articles used as food are 
digested. To the strong and healthy, this 
is within certain limits a matter of com- 
parative indifference ; to those who suffer 
from weakened digestion — and they are 
very many — it becomes a matter of para- 
mount importance, as one on which com- 
fort and even life depends. The subject 
has engaged a large share of the attention 
of medical men, and is too extensive to be 
fully treated here. The aim of the author, 
therefore, is rather to point out the princi- 
ples on which diet should be regulated, than 
to descend to special minutise, and these he 



FOR 



256 



FRA 



is more willing to omit, from the fact that 
these minutise are greatly matters of indi- 
vidual peculiarity, which vary in each one ; 
and which must and ought to be matters of 
well-ascertained personal experience. 

Thus, we find that some stomachs are 
perfectly unable to cope with fatty matters, 
but do well with the acid or saccharine ; a 
certain class again seem quite at ease with 
milk, which throws others into a ferment ; 
even mutton, the most digestible of all 
meats, has, in a case within the author's 
knowledge, invariably produced vomiting 
when eaten, however disguised. 

It might be expected that something 
would be said as to the digestibility of 
various articles ; but this is sufficiently 
treated of under their individual heads, 
and the tables on the subject which have 
been drawn up are not to be depended upon. 
As a general rule, food is digested with 
more difficulty in proportion to the tena- 
ciousness of its structure, whether owing to 
natural conformation, or insufficient masti- 
cation, or faulty preparation or cooking. — 
See Boiling, Roasting, Sfc. Vegetables re- 
quire more digesting than animal substances, 
but they remain a shorter time in the stomach 
itself, undergoing a great portion of the pro- 
cess after they have passed from that organ, 
whereas animal food leaves it perfectly 
digested. This is partly the reason why a 
meal of animal food satisfies hunger longer 
than one composed of vegetables, but some- 
thing is also due to the position which the 
stomach holds with respect to the system 
generally. If the desire for food is sympa- 
thetic with the wants of the body at large, 
the animal food, which better supplies those 
wants, must do so for a longer period than 
the other. 

Variety in diet is requisite for health. A 
single article of nutriment, even though 
it contain all the requisite elements, can 
scarcely be long used exclusively as food, 
without injury to the digestive organs, or 
even danger to life. Brown bread with 
water is perhaps an exception. For further 
information upon food, the reader is re- 
ferred to the various articles in this work 
connected with the subject, the substance of 
which could not have been introduced here 
without needless repetition and occupation 
of space which cannot be spared. 

FOOT-BATH.— See Bath. 

FORCEPS — Are instruments used in ob- 
stetrical and surgical practice as substitutes 
for the hands or fingers, not only for the 
sake of cleanliness, but as being capable of 
introduction into positions where the hands 
or fingers cannot go. A pair of the com- 



mon dressing forceps (see fig. lxii., arti- 
cle Dressing) would be found useful for 
many purposes in domestic management, if 
for nothing else than taking off plasters, 
and it would be well if responsible persons 
generally, who reside at a distance from 
medical assistance, were provided with a 
pair of artery spring forceps. This instru- 
ment, which somewhat resembles the other 
in shape, is provided with a spring catch 
which keeps its points perfectly closed 
when required. In many cases of wounds 
involving the severance of an artery, an 
unprofessional person could not perhaps 
employ any means for stopping the bleeding 
with such probable certainty and ease. 

Refer to Hemorrhage — Artery. 

FORE-ARM.— The lower arm, between 
the elbow and the hand. It contains two 
bones, the radius (fig. lxxi., 1) and the 

Fig. lxxi. 




ulna, (2.) These are articulated or jointed 
at their upper extremity (3) to the single 
bone of the arm ; and at their lower extremi- 
ties to the small bones of the wrist. The 
bones of the fore-arm are very often broken, 
and in children are often bent by accident, 
without fracture. 

Refer to Fracture. 

FOWL.— See Poultry. 

FOX-GLOVE.— See Digitalis. 

FRACTURES op the Bones— Are acci- 
dents which, from their nature, can only be 
treated with certain efficiency and success 
by the educated surgeon; but on the other 
hand, from their frequent occurrence, par- 
ticularly in situations where no surgical 
assistance can be readily procured, it is 
highly desirable that unprofessional persona 



FR A 



257 



FR A 



should be able to manage them in some- 
thing like an intelligent manner. 

The existence of a fracture is, in some si- 
tuations, made out with difficulty, even by 
the skilful. This is particularly the case in 
the vicinity of joints, such as the ankle, 
hip, shoulder, &c; but in others, as in the 
middle of the long bones, such as those 
of the leg, thigh, forearm or arm, the fact 
is often too obvious to be overlooked by 
the most careless. The general symptoms 
of a fracture having occurred, are pain and 
loss of power over the injured limb, which 
is altered in shape or crooked, and probably 
swollen and shortened. Its lower ex- 
tremity hangs loosely, and is more mov- 
able than it ought to be; motion being 
generally accompanied with a sensation of 
grating, perceptible both to the sufferer and 
to the person handling the limb. The 
broken ends — generally the upper one — 
probably project against the skin, or, it 
may be, protrude entirely through it, con- 
stituting a compound fracture. Much of 
the displacement of the fractured ends of 
a bone is due to the contraction of some 
of the muscles of the limb, which are, from 
the nature of the injury, freed from the 
controlling counter-action of other muscles. 
This fact it is important to remember in the 
treatment, during which, when it can be 
done without sacrificing to too great an ex- 
tent other essential points, the injured limb 
should be placed in a position which allows 
the muscles generally %p be in a relaxed con- 
dition. In addition to these local signs, a 
person who has suffered from severe frac- 
ture is generally faint and depressed for 
some time after. 

In many cases of fractured bones, how- 
ever, the symptoms are far from being so 
plainly marked as described above. 

The fracture of a bone is, of course, in 
itself, a severe injury; but it is rendered 
infinitely more so, by the wounding and 
tearing of the soft parts of the limb by the 
generally ragged ends of the bone. This, 
therefore, it is desirable to prevent, as much 
as possible, both in removing the sufferer 
and afterward. 

It being ascertained that a fracture has 
occurred, if surgical assistance is not im- 
mediately at hand, the removal of the 
sufferer will probably be requisite. If the 
upper extremity be the part involved, it 
should in the mean time be well supported 
by a sling, and the sufferer will find walk- 
ing a much easier and less painful mode of 
locomotion than any other. Much injury 
and suffering are often inflicted upon 
persons who have fractured a lower ex- 
w2 17 



tremity, by hasty and injudicious manage- 
ment in the removal ; the lower end of the 
limb being left entirely unsupported, or at 
best carried by some of those around, thus 
causing great pain, increasing the wound- 
ing of the soft parts within, or, it may 
be, occasioning the protrusion of the bone 
through the skin ; and thus, especially if the 
last should occur, diminishing greatly the 
chances of a good recovery. A person who 
has fractured the leg, if he be not already 
lying on the ground, should be placed 
there till a shutter, a door, or flat board of 
some kind can be procured ; this should be 
placed alongside, covered of course with 
coats or the like, and the sufferer gently 
slid, rather than lifted, upon it. On this he 
is to be hand-carried, even if the distance is 
considerable, as preferable either to cart or 
carriage conveyance. Before lifting him, 
however, the fractured limb should be 
secured from motion as much as possible, 
either by tying it to the sound one by 
means of handkerchiefs, or by straw or 
other material placed about it. In the ' 
mean while, a firm bed should be prepared 
for the patient ; a mattrass is most suitable, 
if procurable — if not, a board of sufficient 
length, passed under the ordinary bed, will 
do : the object of this is to prevent the 
sinking which inevitably occurs from a 
person lying long in one place in bed, a 
circumstance which interferes much both 
with comfort and treatment. 

The object in view in the treatment of a 
fractured bone is to preserve the broken 
ends in contact, in their proper relative po- 
sitions, as steadily and as exactly as possible, 
so that the curative and consolidating pro- 
cess may proceed without disturbance; and 
that when this is complete, the symmetry of 
the limb may be unaltered. In giving direc- 
tions as to the management of fractured 
bones by unprofessional persons, the author 
feels how difficult the task of conveying 
the information is to himself, and how much 
more difficult it must be to those unaccus- 
tomed to deal with such matters, to treat 
them at all satisfactorily from a written de- ' 
scription. At the same time cases do occur, 
in which the choice lies only between perfect 
ignorance and some amount of information of 
the methods to be adopted. For such cases 
this article is written; for certainly no 
sufferer from fracture, in his senses, would 
submit to, nor any unprofessional person 
undertake the treatment, if skilled assist- 
ance was in any way procurable. In ad- 
dition, the author would strongly advise 
any who are likely, in their course through 
life, to be thrown much in out-of-the-way 



Fit A 



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FEA 



circumstances, and who would wish to be 
useful, to see for themselves in some hospi- 
tal the mode of putting up fractured bones. 
A few hours, even, of observation, would 
teach them more than all written descrip- 
tions, though these might afterward refresh 
the memory. 

Either after or before the patient is 
placed in bed, the clothes must be removed, 
cut off the injured limb; of course by the 
seams if possible. The proper applications 
must meanwhile be got ready as quickly as 
may be. These are splints, such as are 
recommended in each particular form of 
accident, with their cushions and bandages. 
— See Bandage. Some surgeons delay the 
application of the splints for some days, till 
the swelling, which always occurs more or 
less after fracture, has subsided, and some 
cases may occur in which this is desirable ; 
but the majority of practitioners put the 
splints on as soon as possible after the acci- 
dent, and this is certainly the preferable 
practice. There almost always exists a 
tendency to spasmodic starting of a limb 
which has been fractured, for some time 
after the accident, and this constantly tends 
to displace the bones, and to increase the 
laceration and swelling of the soft parts ; 
this may in great measure be prevented by 
the early steadying of the whole limb by 
the splint, which, however, need not be 
bound tightly, and may be so applied as to 
be loosened at once if requisite.* 

A splint is simply an agent which can be 
bound to a fractured limb, and which will 
keep it in the straight position ; it may, 
therefore, be made of wood, iron, leather, 
or even straw. The variety of splints is 
very great, but as this article is written for 
use in situations where only the simplest 
means are supposed to be at hand, the sim- 
plest modes of management only will be ad- 
verted to. Moreover, fractures may be 
treated without splints, properly so called, 
as by starch bandages or the like, or by po- 
sition simply. As the continued contact of 
hard splints would occasion pain, they are 
usually cushioned or padded. This may be 
effected by any soft material, care being 
taken that the padding projects everywhere 
beyond the edges of the splint, to which it 
may, if convenient, be attached by tapes, 
(fig. lxxiii.) 

Lastly, all things being arranged, the 
setting of the fracture remains to be ef- 
fected. This, which is always painful, con- 



* The elastic split cushions of M. Bourjeaurd en- 
tirely obviate this objection. These are made of vul- 
canized India rubber, and are inflated with air, which 
can be increased or diminished, as required. 




sists in bringing the broken ends into con- 
tact, as much as possible in their proper re- 
lative position. In some few cases, as in 
the leg, it may happen that although there 
is fracture, there is no displacement ; but 
in the majority of instances the broken ends 
overlap one another, being drawn by the 
action of the muscles ; the main requisite, 
therefore, in the reduction of a fracture, is, 
by gentle but steady drawing down of the 
lower extremity of the limb — while the 
upper is fixed — to bring the ends to a level, 
and, if possible, place them one against the 
other. In the drawing down, however, the 
hand should not grasp the extremity of the 
fractured bone, but should be applied below 
the joint. Thus, in setting a fractured 
thigh, the surgeon grasps the leg, not the 
lower part of the thigh, &c. After a frac- 
ture has once been set, it should never, if 
possible, be disturbed again. This does 
not mean that the appliances are not to be 
removed, and the progress of the case in- 
spected ; for if this be not done, and if by 
any chance the proper position should have 
been disturbed, the bones may become so- 
lidly fixed in an improper manner, and 
deformity result, or the skin may become 
ulcerated. But the appliances should not 
be removed, if possible, before the end of 
the first week, and if all seems going on 
well, not moved again for ten days at least, 
unless for some special purpose. If a frac- 
ture is often disturbed or pulled about 
during the process of consolidation, it may 
chance that this will only be effected im- 
perfectly, and what is called a false joint 
formed ; that is, the broken part, instead of 
being firm, moves like a joint, and the limb 
is useless. It had better be crooked or 
shortened. 

Lastly, much care is always required 
that a limb which has been fractured is not 
used too soon after the accident ; otherwise 
it may be either snapped again, or it may 
be bent. The first advance toward the 
cure of a broken bone is the throwing out 
of a jelly-like matter around the ends; this 



FR A 



259 



PEA 



gradually becomes more solid, and, at last, 
is converted into a thick ring of bone ; but 
for this latter change the lapse of some 
months is requisite. Although, therefore, 
the uniting material, or "callus," as it is 
called, may be strong enough for ordinary 
purposes a considerable time before ossifi- 
cation has been effected, it will not bear 
extraordinary efforts. 

With respect to the general treatment of 
a person who has suffered from fracture, it 
is always advisable that for some little 
time after the accident the diet should be 
lowered, but that when the inflammatory 
stage is passed, the individual should return 
as much as possible to his ordinary food. 
Care must be taken, if the person has been 
accustomed to much alcoholic stimulant, 
that it is not unduly abstracted, otherwise 
the powers of the constitution will be so 
reduced that the reparative process can- 
not take place, and the fracture will re- 
main ununited. In fractures of the lower 
limbs, the use of a bed-pan and. urinal of 
some kind will be required, and attention 
must be given to the back, that it does not 
get sore. An elastic horse-shoe cushion (see 
Elastic) will be a great comfort in such 
cases. 

Fractures of the skull have been already 
alluded to under the article Brain. 

Fracture of the lower jaw is generally to- 
lerably evident. The simplest treatment is 
that recommended by Professor Fergusson. 
Two narrow wedges of cork, about an inch 
and a half long, a quarter thick at the base, 
and sloping away to a point, are placed be- 
tween the teeth, one on each side ; a piece 
of pasteboard softened in waimi water, or of 
gutta-percha, is then to be moulded round the 
jaw, and fixed, either by a bandage or hand- 
kerchief going over the crown of the head. 
By this method, space is left between the 
front teeth for the administration of liquid 
nourishment. The sufferer should rinse the 
mouth frequently with tincture of myrrh 
and water. 

Fracture of the bones of the spine is a rare 
accident. It may be suspected, when, after 
injury to the spine, loss of sensation in, or 
of power over the part, ensues below the 
site of the accident. In such a case, nothing 
could be done by unprofessional persons be- 
yond placing the sufferer in as easy a po- 
sition as possible. 

Fracture of the ribs is known by the pain 
which is felt at the injured spot in every 
motion of the body, even by breathing. 
The sufferer feels a grating sensation, which 
may be felt by another person laying the 
hand on the place. The chief risk involved 



in fractured ribs is from injury to the lungs 
by the sharp ends of the bone ; and when 
this occurs, it is apt to give rise to inflam- 
mation, which will require the usual treat- 
ment of this affection, from whatever cause 
arising. On this account, an individual 
who has suffered from fractured ribs should 
be especially careful, and for some little 
time after the accident should reduce his 
usual diet considerably. The application 
of the hot bran bag for some days after the 
accident will afford much relief, and it may 
be used over the usual bandage. When ribs 
on both sides of the chest are injured, this, 
with leeches if requisite, should be the sole 
application ; the patient being confined to 
bed for at least a fortnight or three weeks, 
in the posture found to be the easiest, which 
will probably be a half-sitting oue, sup- 
ported by pillows, or some other means. 
— See Bed. When the ribs on one side 
only are injured, less confinement is re- 
quired, but the chest should be encircled, 
as firmly as can be borne comfortably, with 
a band of stout calico, from eight to ten 
inches wide, and double; this should go 
once and a half round, and be sewed. A 
month will probably be required for the 
cure. 

Fracture of the collar-bone is a frequent 
accident, usually from falls on the shoulder. 
It is generally easily detected. As the use 
of the collar-bone is to keep the shoulder 
back, — the shoulder of the injured side falls 
forward when it is broken, pushing the 
broken ends over one another. The object 
of treatment, therefore, must be to keep 
back the shoulder by artificial means, until 
the bone has recovered its solidity. This 
might be done by keeping a person confined 
to bed, and in such a position that the 
weight of the shoulder falling backward 
would pull the bone into position without 
any other means being used ; few persons, 
however, will submit to the confinement 
necessary, and other methods are resorted 
to ; they are varied, but that recommended 
by the late Mr. Liston will most easily, and 
with best prospects of success, be adopted 
by the unprofessional. A wedge-shaped 
pad, of any firm material — (a pair of stock- 
ings folded will do) — is to be enveloped in 
the middle of a soft shawl or handkerchief 
of suitable size. The pad is then to be 
placed in the arm-pit of the injured side, 
(fig. lxxiii. 1 ;) the ends of the shawl must 
next be crossed over the opposite shoulder, 
(2,) and tied in the arm-pit, as represented, 
a folded cloth of some kind being interposed 
to prevent the chafing of the skin. Another 
handkerchief or band of some kind is next 




260 



to be applied (3) so as to bind the arm 
down to the side in such a manner that the 
pad in the arm-pit acts as a fulcrum, or 
gives such a "purchase" as allows the outer 
end of the broken collar-bone to be pulled 
outward, as the arm is bound to the side ; 
a sling enveloping the whole forearm is 
next to be applied, and completes the appa- 
ratus, which should be worn for a month at 
least. If carefully attended to, this appa- 
ratus will prove very effectual, and the 
means for it can always be procured. It 
should be understood that the principle of 
the treatment is extending the broken bone 
by means of the pad in the arm-pit. It is 
sometimes requisite to apply a bandage 
from the fingers upward to prevent swelling. 

Fractures and other injuries about the 
shoulder-joint are often so obscure that no 
uneducated person could distinguish them. 
The best management until surgical assist- 
ance can be procured, if it is far distant, 
will be perfect rest. Probably much com- 
fort may be derived from the use of the pad 
in the arm-pit, as recommended for broken 
collar-bone, and also of a sling supporting 
the forearm, wholly or only at the wrist, as 
may be most easy to the patient. The con- 
fining band (fig. lxxiii. 3) must not, how- 
ever, be used. 

In fracture of the shaft of the arm-bone it 
is better to put the whole limb in a sling 
at once, and if the person has to go to the 
surgeon, he will find it easier to walk than 
to ride in any conveyance. Confinement to 
bed will be requisite for some days at least 
after the accident. The injured limb being 
laid in an easy position on a pillow, if there 
is much swelling, it must be lightly band- 
aged from the fingers to the shoulder, and 
a couple of splints of wood or other firm 
material, two and a half inches wide, ap- 
plied one on each side of the limb (fig. 
lxxiv. 1) and secured with just sufficient 
firmness to prevent movement, by means of 
two or three looped bandages. This band- 




age (fig. Ixxv.) is made by taking a doubled 
length, sufficient for the purpose required, 
of the common roller bandage ; one end, or 
" tail," of the bandage (1) is passed through 



Fig. Ixxv. 




the looped extremity, (2,) and may then be 
tied to the other tail, (3.) This form of 
bandage has the great advantage of being 
easily loosened, if requisite, on account of 
swelling. After the first few days, when the 
swelling has subsided, the fracture of the 
arm may be put up more firmly and perma- 
nently. After bandaging the limb tole- 
rably firm, a splint of pasteboard or of 
gutta-percha, or leather, or indeed of any 
firm material, is to be put on each side of the 
limb, (fig. lxxiv.) These ought, however, to 
be shaped as represented by the dotted line 
2, to come a little way along the fore- 
arm, and, having been previously shaped on 
the sound arm, instead of the looped band- 
age, should be well fixed by means of the 
common roller, which may be kept from 
slipping by the addition of starch or paste 
as it is put on. Instead of the splints, how- 
ever, the starch bandage alone, if the indi- 
vidual is not very muscular, may be used. 
But in this case, both the inner and outer 
bandage must be well saturated with strong 
starch, flour paste, or gum, or white of egg, 
and it is well to make the addition of strips 
of stout paper, pasted down over the inner 
bandage, and covered by the outer one, to 
give additional firmness. In this case, it 



FK A 



261 



FR A 



will be requisite to keep the arm very quiet 
till the paste has dried, or a wooden splint 
may be tied outside the bandages till this 
has taken place. A sling will be requisite 
to support the hand and wrist, but not the 
elbow, which should be allowed to hang, the 
weight tending to keep the bones straight. 

Fracture of the forearm is a very com- 
mon accident. In children the bones are 
most frequently partly broken and partly 
bent. In adults both bones or one only may 
be broken ; in the latter case, the sound 
bone acts as a splint to hold the other in 
place, and, should the accident be detected, 
a perfectly straight splint of light wood, 
applied to the inside of the arm, and ex- 
tending from the elbow to the tips of the 
fingers, fixed by a common roller, or by 
some looped bandages, is all that is re- 
quired; and, indeed, when both bones are 
broken, the same treatment will be suf- 
ficient, though some apply a splint on each 
side. After the lapse of a fortnight, in 
adults, the splints may be taken off, and a 
starch bandage used ; but in children who 
are liable to falls it is better to give them 
the protection of the wood for some time 
longer. In fracture of the forearm, the 
sling ought to give support from the elbow 
to the ends of the fingers, and the limb 
must, of course, be kept bent at the elbow 
during the period of cure. 

Fracture of the fingers is treated by a 
narrow, straight wood-splint, or by the 
starch bandage. 

Treatment of a fracture of the lower ex- 
tremity by an unprofessional person must 
be a most unfortunate contingency ; but the 
simpler the means used, the more likely 
will its management be conducted with some 
efiiciency. 

In a case of fracture of the thigh, the re- 
moval and preparation of the sufferer having 
been effected as already pointed out, the fol- 
lowing apparatus is such as an unprofes- 
sional person might, with a little care, ma- 
nage efficiently ; and the materials for its 
construction can scarcely ever fail to be pro- 
curable. Three pieces of wood, about three- 
eighths of an inch in thickness, will be 
required, the measurement as to length 
being made on the sound extremity. One 
of the pieces must be sufficiently broad to 
extend completely under the limb, and 
sufficiently long to extend from just above 
the middle of the thigh (fig. lxxvi., lxxvii., 
1, 1) below the calf of the leg, being edged 
off at either end. The next piece, (2, 2,) to 
be fixed on the outer side of the under one, 
should extend from just above the hip to a 
little beyond the foot, and must be pierced 



Fig. lxxvi. 




Fig. lxxvii. 



with two holes at the upper end. The re- 
maining piece (fig. lxxvi. 3) should extend 
from about two-thirds up the thigh to a little 
beyond the foot, being fixed to the inner 
side of the under piece, and connected with 
the outer piece at the lower end (fig. lxxvi. 
4). A slanting support for the sole of the 
foot, and about the same width, should also be 
fitted in, so that it will admit of the limb being 
extended to quite its full length, this being 
ascertained by measurement of the sound 
leg. The middle of the apparatus forms a 
kind of box. A soft handkerchief padded 
must now be placed between the thighs, (fig. 
lxxvii. 6, 6.) At this stage the limb must 
be set. One person should hold the body of 
the sufferer firmly at the hips, while another, 
grasping the leg just above the ankle, by a 
gentle and steady pull, straightens the in- 
jured limb to the same length as the sound 
one ; the broken ends of the bone being 
by this means brought into contact. The 
apparatus having been previously well 
padded with any soft material, (even chaff 
or dried leaves will do,) the broken limb, 
still kept on the stretch, should be gently 
placed in it. The foot must then be secured 
to the padded foot-board by means of a 
bandage or handkerchief, (fig. lxxvii. 7,) the 
heel being also well supported by the same 
or some similar application. The heel may 
be still further supported by means of a 
double tape sewed to the toe of a sock, pre- 
viously put upon the foot ; the tape being 
carried over the top of the foot-board, and 
tied to a nail or peg fixed to the back. 
The ends of the band (6, 6) passed be- 
tween the thighs are to be passed through 
the holes in the upper part of piece No. 2, 
and tied with sufficient firmness to keep 
the limb on the stretch. This is the essen- 
tial part of the treatment — the foot bound to 
the foot-board, and the band tied through 
the holes in the upper part of piece 2, act 
against one another, and keep the limb ex- 
tended. The upper end of 2 must next 
be secured by a band (8) passed round the 



FRA 



262 



FR A 



body, and the fixing of the apparatus is 
complete. It will be well, however, to fill up 
all the interstices between it and the limb, 
by means of some soft material stuffed in, 
and when this is done, as a further means 
of security, to fix one or two bandages or 
handkerchiefs (10, 10) round both the ap- 
paratus and limb. 

The above contrivance is a modification 
of the one most used by surgeons for the 
treatment of fractured thigh, but requires 
much less bandaging, and is, for this reason, 
preferable. In the usual form of long thigh 
splints, the entire efficiency of the arrange- 
ments depends upon the application of the 
bandage, and no unprofessional person is 
likely to put it on properly. The apparatus 
may be used for fractures of the upper part 
of the leg, as well as for the thigh. Another 
simple mode of treating fractures of the 
lower part of the thigh, or upper part of 
the leg, is by means of two pieces of wood 
similar 'to No. 2, fig. lxxvi., but shorter, 
and a large cloth, such as a table-cloth, in 
each side of which one of the pieces is to be 
folded up, until there is just space left to 
contain the limb, which being set, and 
placed in the space so left, the boards are 
to be tied up to it on each side by means of 
handkerchiefs, or stout tapes. Again, the 
sound limb may be made to act as a splint 
to the broken one. Pads of some soft ma- 
terial should be placed between the most 
prominent points of each, such as the knees, 
ankles, great toes, &c. ; and padded bands, 
two or three yards long, are to be wound 
round the legs as they are placed together, 
just above the ankle, and just below the 
knees. Or the broken thigh may be laid on 
a pillow, on its outer side, in the easiest po- 
sition for the patient. 

Under the former of the two last-men- 
tioned modes of treatment, a short splint, 
extending the length of the thigh, of wood, 
tree-bark, or any other firm material, may 
be applied on the outer side, and will give 
additional support. Under the last-men- 
tioned, such a short splint may be used on 
each side. 

In fractures of the leg, particularly of 
the lower portion of it, a different apparatus 
must be used, although in many respects 
the mode of management as regards pad- 
ding, &c. &c. is the same. In setting the 
limb, however, the -thigh must be grasped 
by one person, and the foot by the other. 
The easiest position for the limb will be 
with the knee bent, (figs, lxxviii. lxxix.,) and 
either of the contrivances figured may be 
easily constructed of any common wood. 
The upper one (lxxviii.) is merely a board 



Fig. lxxviii. 




Fig. lxxix. 

adapted to the size of the limb, with side- 
pieces (1) and foot-board (2) fastened to it, 
and slung by ropes from the corners, so that 
it can be suspended, as represented, from a 
rafter or any other convenient support. This 
is a very easy kind of apparatus, especially 
on board ship. The other apparatus (lxxix.) 
is also to be constructed from boards, as 
represented, with side-board and foot-board, 
(1 and 2.) In both these, it will be an ad- 
vantage to scoop out a hollow for the heel, 
and pad it as well as the whole con- 
trivance, with soft materials. Reference to 
the foregoing portions of this article, es- 
pecially that on fractured thigh, will suf- 
ficiently explain the general management 
of these cases. 

To recapitulate : the first removal of a 
patient who has suffered a fracture should 
always be conducted with the care enjoined 
in the first part of this article. The bed for 
a patient suffering from fracture must al- 
ways be a firm one. The adjustment and 
"putting up" of a fracture should be ef- 
fected as quickly after the accident as may 
be, allowance being made for swelling — and 
if this becomes extreme, loosening of the 
apparatus resorted to. In setting, the bones 
above and below the injured one, not the in- 
jured one itself, are to be grasped ; parts, 
such as the heel, &c. are to be relieved as 
much as possible from the effects of the con- 
tinued pressure which they must necessarily 
undergo during the treatment. It must 
always be borne in mind, that whatever ap- 
pliances are used in the treatment of frac- 
tures, they are all but different means to the 
one end — that of keeping the broken ex- 
tremities of the bone in continued steady 
contact, with as much ease to the patient as 
possible ; that when this has been done for 
three or four weeks, lighter applications 



PRE 



263 



FUR 



than those used at first may be employed, 
such as the starch bandage, &c. 

In conclusion, the foregoing article "will 
be of small benefit to those dwelling in the 
midst of civilization ; but its hints (and 
our space admits of but little more) may 
prove invaluable to those dwelling, or -who 
may be destined to dwell, in a thinly -peo- 
pled country, or in such situations as on 
board ship, in which fractures are far 
from being uncommon accidents. Even if 
proper assistance be ultimately procurable, 
the intelligent management of a case for 
the first few days may be of the highest 
importance ; and if it should happen, that 
throughout, it has been left to unprofes- 
sional management alone, even should a 
limb somewhat deficient in symmetry be the 
result, its cure is not likely to be more 
tardy or less painful, because those around 
are not in total ignorance of how it ought 
to be conducted. 

Compound fractures are those in which 
there is a wound through the skin, per- 
mitting access of the external air to the 
seat of the fracture. The contingency is a 
truly serious one to be without the assist- 
ance of a surgeon. Sometimes the bone 
protrudes considerably through the skin, 
and its end requires to be sawn off before 
it can be returned to its proper position. 
The great object is to heal the external 
wound as quickly as possible ; and probably 
as good a plaster as any will be a piece of 
linen soaked in the blood, [or in white of 
egg] and when this is separated by the dis- 
charge, the simple water dressing. 

FRECKLES — The well-known brown 
spots on the skin, are most frequent upon 
those parts exposed to the influence of 
light, such as the face, neck, hands, &c. r 
and in persons of fair complexion, espe- 
cially with red hair. Water, weakly acidi- 
fied with lemon-juice, is sometimes useful 
as a wash. Mr. Erasmus Wilson recom- 
mends the liniment of lime-water and oil, 
with the addition of a little ammonia. 

FRICTION— Or rubbing a portion of the 
body, either with the hand or with some 
interposed material, is of much importance 
as a curative agent. Applied to the skin 
by means of rough towels, hair-gloves, &c. 
it excites its nervous sensibility, and the 
circulation of blood through its capillary 
vessels. Friction with the hand in thicken- 
ings and congestion of parts beneath the 
skin is often of much service, and in none 
is its beneficial effect more obvious than 
where the breasts are painfully distended 
with milk after childbirth. The various 
oils, &c. used along with friction are gene- 



rally secondary in their effects to the me- 
chanical effect, and are chiefly serviceable 
in facilitating the movement of the hand : 
some, however, are really beneficial — the 
stimulant applications by exciting, and the 
anodyne by soothing. Moreover, some, such 
as codliver-oil, turpentine, &c. appear to ex- 
ert a specific effect. — Refer to Liniment, Sfc. 

FRIGHT.— See Fear. 

FROST.— See Cold. 

FRUITS. — See the individual articles up- 
on the various fruits. 

FRYING — Is a mode of cookery very ill- 
adapted for persons of weak digestion. 

FUMIGATION.— See Contagion, Disin- 
fectants, &c. 

FUNCTIONAL DISORDER.— See Dis- 
ease. 

FUNGI. — See Mushrooms. 

FUNIS.— The navel-cord. 

FUR — As an article of dress, maybe either 
extremely beneficial or the reverse, accord- 
ing to the manner in which it is used. 
When worn over other clothing in the open 
air, or as a regular fixed article of clothing 
in itself, the bad conducting power of fur 
renders it one of the most efficient pro- 
tectors against cold, or rather preservers 
of heat, we possess ; but when it is used as 
an occasional article of dress, it is a danger- 
ous one, and has proved so in the various 
forms in which it has been worn by females. 
When kept close to the skin — as of the 
neck or throat — for any length of time, it 
produces excited action and perspiration, 
which is liable to be suddenly checked 
the moment the boa or victorine is thrown 
back, and cold and sore-throat are the con- 
sequences. Very many cases of this kind 
occur ; and, the cause being unsuspected, is 
repeated again and again with the same 
effect, laying the foundation perhaps of 
serious disease by the improper use of the 
very means employed to guard against it. 
Many females liable to cold and sore-throat 
have been surprised to find how that liability 
has vanished with the laying aside of the use 
of fur round the throat. The change must, 
however, be made at first with caution. It 
is not, however, the fur which is at fault, 
but the uncertain mode of using it. More- 
over, its power of exciting the skin renders 
it a valuable agent when worn permanently 
next it, particularly upon the chest in win- 
ter, by persons with delicate lungs. It not 
only protects from cold but keeps up mild 
counter-irritation. A prepared hare or 
rabbit-skin, lined, makes as good a fur 
chest-protector as any other. 

Refer to Clothing, #c. 

FURUNCLE.— A boil— See Boil. 



GAL 



264 



GAL 



GALBANUM — One of the gum resins, is 
procured from an umbelliferous plant, and 
is brought chiefly from Persia and India. 
It is stimulant and carminative, but is not 
much employed in medicine at present. Its 
best preparations are the plaster, which is 
stimulating, and the compound galbanum- 
pill — dose, ten grains twice a day in nervous 
affections, flatulence, &c. 

GALL.— The bile. 

GALL-BLADDER— The receptacle for the 
bile, is situated beneath the right lobe of 
the liver, almost exactly at the boundary 
line between the epigastric and right hypo- 
chondriac region. — See Abdomen. It is pear- 
shaped, (fig. lxxx. 1;) from its smaller end 

Fig. lxxx. 




proceeds a duct, (2,) which shortly joins a 
similar duct from the liver, (3,) the two to- 
gether forming the common bile duct, (7,) 
which enters the duodenum (4) in its de- 
scending portion; [5 and 6 are arteries.] 
During its retention in the gall-bladder, the 
bile becomes thicker from the absorption of 
part of its water. 

GALL-STONES— Are concretions formed 
from the peculiar crystalline ingredient of 



the bile — the cholesterine. The concretions 
are of every variety in point of size, up to 
that of a walnut ; when small, the number, 
either passed by the patient or found in the 
gall-bladder after death, is often very great. 
These concretions may, and often do, exist 
in the gall-bladder, without giving rise to 
any unpleasant symptoms, their presence 
only being discovered on examination after 
death. But should one of them, from any 
cause, pass into the duct, it gives rise to 
most violent spasmodic pain, which con- 
tinues with little intermission until the 
stone has descended into the bowel through 
the ducts. 

The ordinary calibre of the gall-duct is 
about that of a goose-quill, and the stone is 
generally of much larger size ; the opera- 
tion, therefore, is often a protracted one. 

Symptoms of gall-stone often supervene 
suddenly. The person is seized with the 
most agonizing pain in the region of the 
gall-gladder ; probably, there is severe shi- 
vering and vomiting, and these do not dis- 
appear until the stone has passed. There 
may or may not be jaundice — probably not, 
as long as the obstruction does not pass into 
the common duct (2) and so stop the flow of 
bile from the liver. If jaundice comes on, 
the evacuations from the bowels become 
white and chalky in appearance. The fact 
of there being no fever present, and that 
the pain caused by a passing gall-stone is 
relieved, instead of aggravated, by pressure, 
is sufficiently indicative of the absence of 
inflammation. After the occurrence of the 
above symptoms, it is always proper to 
examine the evacuations from the bowels, 
to verify the disease by finding the cause. 
Gall-stones are easily detected in the eva- 
cuations, as they float upon water. 

When an individual is suddenly seized 
with symptoms of gall-stone, no time should 
be lost before making hot applications over 
the seat of the pain, or getting the sufferer 
into a warm bath. Opium ought to be given 
at once ; the first preparation at hand — 
probably laudanum — in full and repeated 
doses. If laudanum is used, thirty drops 
may be given immediately, and the dose 
repeated, by twenty drops at a time, every 
half-hour, or oftener, till the unbearable 
pain is subdued. As the retching is often 
severe, and liquids of every kind are vomit- 
ed as soon as taken, pills of solid opium — 
one grain each — are more likely to be re- 
tained, and are, therefore, preferable ; they 
may not, however, be at hand in an unex- 
pected attack. Persons who are liable to 
repeated attacks of gall-stone should keep 
these pills beside them. There is generally 



GAL 



265 



GAR 



much distressing acidity of stomach while 
a gall-stone is passing, and Dr. Prout's 
plan of giving full and frequently-repeated 
draughts of hot water, containing in each 
pint a full teaspoonful of carbonate of soda, 
affords much relief, whether vomited or not. 
Of course laudanum may be added to the 
soda solution if requisite. If the stomach will 
not retain the remedies, the opium must be 
administered by a clyster : as a pint or more 
of gruel, with forty drops of laudanum, re- 
peated if requisite. Mustard-plasters over 
the seat of the pain may be useful, but are 
much inferior as an application to the hot 
bran-poultice, on the surface of which lau- 
danum may be sprinkled. 

The suddenness of an attack of gall- 
stone and the agony of the pain, render it 
one of the diseases in which unprofessional 
persons may afford most valuable assistance 
by judicious management ; and, by follow- 
ing the above directions, they will certainly 
give relief, perhaps from many hours of 
suffering, if medical assistance is distant. 
A person who has once suffered from gall- 
stone, ought, of course, to be examined 
medically. 

Refer to Bile, §c. 

GALLS, or Gall-nuts — Are excrescences 
produced upon the twigs of a species of 
shrubby oak, by the prick of an insect for 
the purpose of depositing its eggs. They 
are brought from the shores of the Levant 
and from Asia. Galls are powerfully astrin- 
gent, owing to the tannin or astringent 
principle they contain, which, in its sepa- 
rated form, is now largely used in medical 
practice. Gall-ointment is a useful appli- 
cation in piles, in persons of relaxed or 
enfeebled constitution, but is quite the re- 
verse in those of full habit, in whom the 
piles are in a state of active inflammation. 
The best form of ointment is : Galls, in 
very fine powder, two drachms ; Opium, in 
powder, one drachm ; Lard, one ounce ; well 
rubbed up together. The infusion of galls is 
the best antidote to poisoning by tartrate 
of antimony. 

GALVANISM.— See Electricity. 

GAMBOGE.— See Camboge. 

GAME. — "Wild animals used as food, the 
flesh of which is for the most part easily 
digestible, and suited to many persons on 
account of the less proportion of fatty or 
oily substance which it contains. Of course, 
game, like other articles of food, may be 
rendered hurtful by sauces and modes of 
dressing. 

GANGLION — In anatomy, means an ag- 
gregation of nerve substance. In surgery, 
it is applied to the elastic swellings which 
X 



appear upon the. wrist or top of the foot, 
generally about the size of a hazel-nut. 
These may often be removed by bursting 
the small bag or cyst of which they con- 
sist, and thus effusing the contents — which 
resemble the white of egg — into the sur- 
rounding parts, a bandage being applied 
afterward. The case is best submitted to 
the surgeon. 

GANGRENE.— See Mortification. 

GAPING, or Yawning — Is a nervous af- 
fection, indicative of nervous exhaustion and 
depression of the circulation. Persons in 
health are, as is well known, liable to gape 
when tired ; like other nervous affections, it 
is apt to give rise to imitation in others. 

Gaping is, however, a not unfrequent 
symptom of disease — functional or organic 
— particularly of the chest. Attacks of 
hysteria accompanied with fainting, or of 
spasmodic asthma with depression of the 
action of the heart, are often ushered in by 
gaping. Persons who suffer from disease of 
the heart are also liable to "fits of gaping." 

GARGLES — Are liquid applications to the 
throat and upper part of the gullet, &c. used 
in affections of these parts. Gargles are 
too often used as astringents, particularly 
in the first stage of inflammation of the 
tonsils, &c. or sore-throat. In these cases, 
the warm water or gruel gargle is a much 
better remedy, with the addition of a small 
quantity of vinegar. The common domestic 
gargle *of "sage-tea and vinegar" answers 
very well. As a general rule, in the first 
stages of "sore-throat," it is better to use 
the simple soothing gargles, nearly as warm 
as can be borne ; in the latter stages, when 
there is often much stringy phlegm about 
the throat, the more stimulating and astiun- 
gent gargles will be useful. For the latter, 
from four to five drops of muriatic acid in 
the ounce of water is as good a form as 
any ; or the infusion of roses, with ten to 
fifteen drops of dilute sulphuric acid to the 
ounce. Another very useful gargle, in 
cases of relaxed sore-throat, is made with a 
drachm of alum, half an ounce of tincture 
of myrrh, and water sufficient to make up 
the pint. Cayenne-pepper infusion is also 
used as a gargle. — See Capsicum. In cases 
of chronic weakness of the throat, with 
tendency to frequent swelling and inflam- 
mation, a gargle of oak-bark decoction or 
of salt-water is of much service, used every 
morning for some time. Gargling is ef- 
fected by throwing the head back, and, con- 
sequently, the fluid back in the throat, and 
expelling the air through it from the lungs ; 
it is thus worked as it were into every part 
of the throat. 



GAR 



266 



GID 



GARLIC— See Onion. 

GAS — Is an elastic fluid, -which is per- 
manently aeriform in all ordinary tempera- 
tures, being distinguished from vapours, 
which are only temporarily elastic and 
aeriform. The gases alluded to in the 
course of this work are — 
Ammonia. 
Azote, or Nitrogen. 
Carbonic Acid, and 
Carburetted Hydrogen. 
Chlorine. 
Hydrogen, and 
Sulphuretted Hydrogen. 
Oxygen. 

Refer to separate articles. 

GASTRIC JUICE — Is the acid viscid 
fluid secreted in the stomach when that 
organ is excited by the presence of food ; 
the office of this peculiar secretion being 
the solution of the nutriment, or rather the 
reduction of its albuminous and gelatinous 
portions to a state in which they are fit for 
absorption into the system. 

Refer to Digestion — Food — Indigestion. 

GASTRITIS.— See Stomach, Inflamma- 
tion or. 

GELATINE, or Glue — Is an azotized 
component of animal bodies, of simpler 
constitution than the azotized albuminous 
compounds. — See Food. It may be ex- 
tracted from tendons, shin, &c. by long 
boiling, and from bones by dissolving out 
their earthy matter by acids: it occurs pure 
in many fishes, the air bladders of which 
are formed of gelatine ; isinglass, so well 
known as a jelly-making compound, being 
the prepared swimming or air bladders of the 
sturgeon, cod, ling, &c. The gelatine sold as 
such is generally prepared from bones. 
Many persons have a prejudice against this 
gelatine, and imagine it not so good as that 
which they extract from calves' feet, &c. 
As regards the amount of nutriment, it 
must be precisely the same, and as there is 
no reason to believe that the manufacture 
is otherwise than properly conducted, it is 
a pity that many should deprive themselves 
and others of so convenient an addition to 
sick cookery. — See Cookery, Food, §c. 

GENERAL HEALTH.— By this term is 
meant the state of the body and its functions 
collectively, in contradistinction to the con- 
dition of any special portion of the frame. 
The state of the general health is always 
an important consideration, with respect to 
local maladies, both as regards their treat- 
ment and ultimate prospects. The latter 
must always be more serious when the 
general health begins to suffer. 

GENTIAN ROOT— Is obtained from the 



Gentiana lutea, or yellow gentian, which 
is a native of the more elevated ranges of 
the Alps, Pyrenees, &c. The root is brown 
externally, irregular, knotty, ringed, and 
from half an inch to an inch in diameter ; it 
is yellow within. Like the gentians gene- 
rally, it is extremely bitter, and on account 
of this property it constitutes one of our 
most extensively used and most serviceable 
tonics and stomachics. The most useful 
medicinal preparations of gentian are the 
extract, the infusion, and the compound 
tincture. The extract is chiefly used in 
from five to ten grain (or more) doses, as 
an ingredient in tonic or aperient pills. 
The compound tincture may be taken in 
one or two teaspoonful closes, in water. 
The best preparation, however, for general 
use, is the infusion prepared in a concen- 
trated form, according to the following 
process: — To every ounce of sliced gentian- 
root add a quarter of an ounce of dried 
orange-peel, and infuse these (not boil) 
with successive quantities of boiling water 
poured over them, until their strength is en- 
tirely exhausted. The whole of the infu- 
sion thus made, being separated from the 
root and peel, must next be concentrated 
by boiling in a well-tinned or porcelain- 
lined saucepan, until the quantity is so far 
reduced that there is left half a pint of 
the concentrated infusion for every ounce 
of gentian used. To each half-pint of this 
concentrated infusion half an ounce of al- 
cohol is to be added. The effect of this 
addition of spirit is to coagulate a quantity 
of jelly-looking substance, which must be 
separated by straining through flannel. 
The infusion will thus be got clear, and will 
keep for a great length of time, the dose 
being one teaspoonful in an ounce of water. 
When the fresh infusion is required for im- 
mediate use, a quarter of an ounce of 
gentian-root sliced, with the addition of a 
little orange-peel, to the pint of water, will 
be a proper strength, if infused for an hour 
or two. 

GESTATION.— See Pregnancy. 

GIDDINESS — Dizziness — In medical 
language "vertigo," is a sensation of con- 
fusion, and loss of the power of balancing 
the body, which is frequently momentarily 
experienced even by persons in good general 
health, and is unquestionably often attribut- 
able to stomach derangement solely. Dis- 
order of the circulation of the blood in the 
head is a probable direct cause of giddiness, 
and this is most palpable after persons have 
been confined to bed or to the horizontal 
position for a short time : on first assuming 
the erect posture, giddiness is generally 



GIN 



267 



GOD 



experienced. Intoxication is an example ! 
to a certain extent of the same tiling. A 
mere passing giddiness is probably owing 
to some cause which a little attention to 
the state of the stomach will correct ; but 
repeated attacks, especially if accompanied 
with palpitation of the heart, or pain and 
heat about the head, require medical ex- 
amination without delay. 

GIN — The well-known liquor, also known 
as Geneva, or Hollands, contains oil of juni- 
per, and when first introduced was used 
simply as a diuretic medicine ; it ultimately, 
however, became an object of trade, and 
of general — too general — use. It certainly 
often increases the flow of urine in a marked 
degree. 

GINGER — This well-known spice, is the 
creeping root of a tropical plant. That used 
in Britain is chiefly brought from the East 
and West Indies. Two kinds of ginger are 
met with, the dark-coated and the pale- 
peeled ginger; the latter is the best. "The 
rhizomes, or root-pieces, of ginger of good 
quality, have no epidermis, or outer skin 
— are plump, of a whitish or faint straw 
color, soft and mealy in texture, with a 
short fracture, exhibiting a reddish resinous 
zone round the circumference : the taste 
should be hot and biting, but aromatic. The 
rhizomes of ginger of inferior quality are 
frequently coated with epidermis, are less 
full and plump, often contracted and shri- 
velled ; of darker colour, being of a brownish 
yellow ; of harder texture, termed flinty ; 
and more fibrous, while the taste is inferior 
and less aromatic." Ginger-root is chiefly 
adulterated by means of processes used to 
give the inferior quality the appearance of 
the best; for this purpose, whitewash, chlo- 
ride of lime, sulphur-fumes, &c. are used. 

As an aromatic, especially when added 
to medicines to correct their griping pro- 
perties, ginger is peculiarly useful. For 
persons of relaxed habit it is well suited as 
a spice, but by those of full habit, especially 
with tendency to the head, it should be 
sparingly used in diet. 

GLANDERS— The malignant disease to 
which the horse, the ass, and the mule are 
subject, is also capable of being communi- 
cated to man, certainly by inoculation, per- 
haps by simple contact with the skin. In 
the above animals, the disease is manifested 
by a yellowish, bloody, fetid, adhesive dis- 
charge from the nostrils, the lining mem- 
brane of which is ulcerated. Should any 
of this discharge come in contact with an 
abrasion of the skin, or even get lodged on 
the sound skin, as of the hands, or be snorted 
upon the nostrils or eyes of man, it is ca- 



pable of originating this horrible disease. 
In from two days to a week after inocula- 
tion, the attack is ushered in with fever 
symptoms, or by vomiting and diarrhoea ; 
small tumours which ulcerate and discharge 
form under the skin in various situations, 
and there is yellow viscid discharge from 
the nostrils, &c. Almost every case of this 
fearful disease has proved fatal. The object 
of mentioning it here is to impress caution 
upon ail who may be exposed to the con- 
tingency. The immediate destruction of 
an affected animal should, of course, be ef- 
fected, and its entire body at once buried. 

GLANDS — Are bodies situated in various 
parts of the animal frame, their office being 
either the alteration of some fluid or the 
separation of some secretion from the blood. 
Of the former, the mesenteric glands (see 
Absorbents, Digestion, Sfc.) are examples; of 
the latter, the liver, salivary glands, &c. 

GLAUBER SALTS, or Sulphate of Soda 
— See Soda. 

GLOBUS HYSTERICUS.— See Hysteria. 

GLOTTIS.— The superior opening of the 
larynx. — See Larynx. 

GLUTEN — Is an azotized principle which 
exists in the grains, and corresponds to the 
fibrin of animal bodies ; it is therefore highly 
nutritious. — See Fermentation, Food, §c. 

GLYCERIN— Is a product from fatty 
matter, and is obtained in the manufacture 
of lead-plaster. It is a fluid of thin syrupy 
consistence, very sweet taste, faint mawkish 
smell, and should be like pale sherry in 
colour, or even lighter. It is now a good 
deal used in medical practice on account 
of its powerful retention of moisture, either 
alone or mixed with other substances. In 
diseases of the skin, accompanied with 
harshness and dryness, a lotion composed 
of one part of glycerin to fifteen of water 
is very serviceable. The following lotion, 
as recommended by Mr. Startin, will be 
found very serviceable in chapped hands, 
&c. : — Take of pure glycerin half an ounce, 
borax two scruples, distilled water or rose 
water enough to make up half a pint. In 
deafness and affections of the ear it is also 
used. 

Refer to Cerumen — Ear, §c. 

GODFREY'S CORDIAL— Is one of the 
dangerous quack carminatives frequently 
given to children. It contains opium, and 
fatal consequences are often the result of 
its administration. In February of the pre- 
sent year (1852) one fatal case, at least, of 
poisoning by this compound was reported, 
and it was stated at the inquest that one 
teaspoonful of that used would contain five 
drops of laudanum. The remarks made 



GOI 



268 



GOU 



upon "Dalby's Carminative" apply equally 
to this legalized but dangerous compound. 

GOITRE.— See Bronchocele. 

GOOSE.— See Poultry. 

GOOSEBERRY.— One of our most whole- 
some fruits. It is aperient, and the seeds 
of ripe gooseberries add to this property, 
by their mechanical action upon the bowels. 

GOULARD'S EXTRACT— Is a saturated 
solution of sugar of lead, which, when di- 
luted, forms goulard-water. 

Refer to Lead. 

GOUT— Is a disease of the blood. Its 
exact nature is disputed, but it has been 
positively proved by Br. Garrod that the 
blood of a gouty patient contains an undue 
quantity of a peculiar acid named uric acid. 
This acid is contained in small proportion 
in healthy blood, but, in the disease in 
question, that proportion is found to be 
considerably increased. By some, the ex- 
cess of this uric acid is thought to be the 
effect, by others the cause, of the malady ; 
however that may be, the fact of its pre- 
sence is undoubted. Moreover, the proper 
outlet for this acid is by the kidneys, in the 
urine, which, as a rule, contains it in cer- 
tain proportions, but in greatly increased 
proportion in some peculiar conditions of 
the constitution, when it constitutes one 
form of gravel. It is even a matter of po- 
pular observation that gravel and gout are 
nearly connected. They often alternate with 
one another in the same person, and in the 
same family are found affecting the various 
individuals of it — the gout the males, the 
gravel the females. There is no disease, 
perhaps, the hereditary tendency of which 
is more thoroughly established than gout. 
Generally it occurs in persons of full habit, 
especially if they consume much stimulating 
food and drink, and take little exercise ; but 
it also shows itself in the weak and debi- 
litated. The attack is generally preceded 
by symptoms indicative of derangement of 
the general health, and particularly of the 
digestive organs. Br. Gairdner — one of the 
best authorities on the subject — enumerates 
dull pain in the side, headache, confined 
bowels, high-coloured urine, and scaly erup- 
tions on the skin, as among the most fre- 
quent warning symptoms. The attack itself 
generally comes on in the night, and the 
sufferer is awakened by the pain in the 
foot, having, perhaps, previous to awaking, 
passed through a night-mare, or "sugges- 
tive" dream, (see Dreams,) in which the 
scenes are connected with the uneasiness 
experienced. The ball of the great toe is 
the part most generally attacked, though 
not invariably ; the pain is very severe. A 



French author, in describing it, says — 
" Place your joint in a vice, and screw the 
vice up until you can endure it no longer ; 
that may represent rheumatism : then give 
the instrument another twist, and you will 
obtain a notion of the gout."* The part 
attacked by the gout becomes swollen, hot, 
red or bluish-red, and shining ; these symp- 
toms continue with more or less intensity 
for some days, and then subside. Along 
with the local symptoms there occurs more 
or less feverishness and disorder of the 
bowels and urine ; but when the attack has 
passed away, the individual is left in a 
better state of health than before. This 
fact has given rise to many erroneous ideas, 
and much erroneous practice in connection 
with gout, and by those subject to it*, re- 
garding it as a salutary affection, they have 
rather encouraged it than otherwise — the 
more so that the encouragement involves 
indulgence rather than self-denial — forget- 
ful that, although the outward manifesta- 
tion of a fit of gout may end in a salutary 
effect, from its being the disturbance occa- 
sioned by the constitution endeavouring to 
free itself from morbid matter, it must be 
far better if no such disturbing effort is re- 
quired at all ; and, further, it is certain 
that no constitution can be the subject of these 
repeated, violent perturbations, without its be- 
coming permanently weakened or wholly broken 
up. Let none, therefore, who have a gouty 
tendency, and are periodically renovated, 
as it were, lull themselves into security by 
the idea that they suffer no injury ; for the 
constitution cannot fail to be impaired by 
the repeated trials. Their only security 
rests with themselves, in avoiding those 
habits and modes of life which engender 
that state of system and blood that winds 
up with a fit of the gout. Moreover, al- 
though these fits may at first be more pain- 
ful than dangerous, this is far from being 
the case as life advances, and the constitu- 
tion suffers ; then gout may, and often does, 
attack some more important part than the 
great toe ; and the stomach, the heart, or 
brain are apt to become its seat, with fatal 
consequences. 

The most undoubted predisposing cause 
of gout is hereditary tendency, and it is one 
very widely distributed, though not always 
actively developed. The other causes are 
luxurious habits, the habitual consumption 
of a larger quantity of food — especially of 
animal food — than is required by the sys- 
tem, and undue consumption of wine and 
malt liquor, especially the former. These 



* Watson's Lectures. 



00 u 



269 



GOU 



of themselves will develop gout in the 
predisposed: but if their use is coupled 
with deficient exercise in the open air, the 
exciting power becomes much increased. 
Moreover, the same acting causes give rise 
to attacks of red or uric acid gravel, that 
is, to the excretion of this from the blood, 
by the kidneys, in the urine, Hard malt 
liquor has a peculiar tendency to produce 
in those consuming it, this uric acid, even 
in spite of regular exertion in labour ; and 
the author has found brewery labourers, 
who often consume a considerable amount 
of hard ale, suffering from alternate attacks 
of gout and red gravel. In the country, gout 
is not a common disease, for the population 
generally, while they do not consume ex- 
cessive quantities of meat and malt liquor, 
have also the constant counteraction of 
plenty of fresh air and exercise. When gout 
is met with in the countiy, it is generally 
in those connected with inns and public- 
houses, who consume malt liquor largely, 
and take little exercise. 

From the above, it is evident how much 
any one with a liability to gout has it in his 
own power to prevent its occurrence. Malt 
liquor he should never touch, wine very 
sparingly, or if he must have some stimu- 
lant, though he is much better as a general 
rule without any, a little gin or brandy and 
water. Meat should be eaten sparingly, and 
only once a day ; never at night. Bread 
made with the bran in it, vegetables gene- 
rally, cooling fruits, and milk preparations, 
are the safest articles of diet for those predis- 
posed to gout ; but tea, and especially coffee, 
should not be taken strong. Further, early 
rising, attention to the condition of the 
skin by frequent washing, and regular daily 
exercise are the best adjuncts to temperate 
diet. It is, perhaps, not saying too much 
to affirm that persons predisposed to gout 
may almost wholly escape its attacks by 
attention to the above rules of health. In 
advising exercise, however, the caution must 
be given, that it is not violent and fitful ex- 
ertion which is recommended — this being, 
in fact, more likely to develop the disease 
than to prevent it. The regularity of a 
sufficient amount of daily exercise is the 
essential; indeed, not only does violent phy- 
sical exertion, especially of an unusual kind, 
tend to excite a fit of gout, but even strong 
mental emotion or violent passion has been 
known to do the same. 

Regarding the best treatment of gout 
during the existence of the attack, there is 
considerable diversity of opinion. Little is 
to be done to the inflamed part ; certainly 
cold applications, which have been recom- 
x2 



mended and used, are dangerous ; but a 
piece of flannel, wrung out of warm water, 
laid lightly over the joint, and covered lightly 
with a piece of oiled-silk, will give relief ; or 
the lotion of sugar of lead and laudanum 
may be used warm : perfect rest it is almost 
superfluous to enjoin, as the pain makes 
that compulsory. As regards constitutional 
treatment, where the powers of the consti- 
tution are vigorous, a perfectly low diet 
should be observed. In some cases an ac- 
tive purgative answers well ; in others, but 
chiefly old standing cases, it so certainly 
aggravates the attack, that patients from 
their own experience will not resort to the 
remedy. Ten to fifteen grain doses of car- 
bonate of potash may be given three times 
a day, dissolved in half a tumblerful of 
water, either simply or made to effervesce 
by the addition of lemon-juice. The re- 
medy, however, for gout is colchicum. A 
medical man may, of course, give it more 
boldly than an unprofessional person; but 
still, should it so happen that the person 
suffering from gout is not under medical 
treatment, ten drops of colchicum-wine may 
be given safely three times in the twenty- 
four hours. The power of colchicum in 
subduing both the pain of gout and the 
disease itself is often most striking. The 
I following instance will exemplify it: — A 
I lady suffered from repeated attacks of se- 
j vere shooting pain through the region of 
I the heart, and was treated without relief; 
! at length one of the joints of the forefinger 
; became suddenly affected with gouty in- 
| flammation ; this gave an immediate clue ; 
! colchicum-wine was prescribed in ten-drop 
! doses twice a day, and before six doses 
were taken, both the pain at the heart and 
the inflamed joint were cured; the same 
thing has occurred repeatedly since in the 
same patient. 

It is undoubtedly better, safer, quicker, 
even in mild attacks of gout, for the case to 
be treated by a medical man ; but patients 
who know what the disease is will not 
always have recourse to his aid : in such 
cases, the perfect rest both of body and 
mind, the warm moist flannel, low diet, 
gentle regulation of the bowels, the cooling 
saline, and the small doses of colchicum 
will be the safest measures ; but safer still 
will be attention to those preventive mea- 
sures already pointed out, which any may 
follow by the aid of their own common 
sense — a faculty which ought to show the 
reason for and the reasonableness of such 
a course. Many persons who have suffered 
from repeated attacks of gout become af- 
fected with chalk-stones, (see Chalk-stones,) 



GE A 



270 



G KA 



which impede greatly the usefulness of the 
hands ; the constitution too gives way. In 
these cases, medical assistance ought never 
to be dispensed with, and there are few old 
sufferers from gout in whose power it is not 
to procure it of the best. A much less reduc- 
tion in diet will be required than in more 
recent cases and stronger subjects ; the medi- 
cines must be of a warmer character. Fifteen 
grains of calcined magnesia, ten of rhubarb, 
and forty drops of sal-volatile, in a wine- 
glassful of water, will form a draught which 
may be repeated twice a day. It may also 
be given with advantage with double the 
quantity of sal-volatile, and twenty or thirty 
drops of laudanum, iu the event of gout 
receding to the stomach, as evidenced by 
pain and other signs of disorder of the 
organ, and by the sympathetic faintness 
accompanying the attack. A glass of brandy 
may be substituted for the above with good 
effect; these stimulants, however, being 
given under the caution that no extreme 
tenderness, indicative of inflammation, ex- 
ists at the pit of the stomach. In addi- 
tion, in an attack of " retrocedent" gout, 
either to the stomach, or elsewhere, the 
feet should be immersed in hot water, with 
mustard, or a mustard-plaster should be 
applied to them, with a view of attracting 
the disease to its more usual site. These 
attacks of gout shifting to internal organs 
are often so quick in their seizure, and so 
rapid in their progress, that it is highly 
desirable that such measures should not 
only be understood, but thoroughly carried 
out. The aged and debilitated sufferer from 
gout must not at any time reduce much his 
usual mode of living. Gout has been, and 
is, confounded with rheumatism. The gene- 
ral distinctions are the occurrence of gout 
most frequently after the thirty-sixth year ; 
most often in males, especially those who 
live highly, affecting the small joints — 
generally but one at a time. 

Refer to Colchicum — Gravel — Rheumatism 
— Urine, fyc. 

GRAINS — Or, as they are sometimes 
called, the "cereals," are the seeds of 
plants which belong to the order of the 
grasses. They constitute a large proportion 
of the food consumed by the human race, 
and likewise form no inconsiderable amount 
of the nutriment of vegetable-feeding ani- 
mals generally. They are, perhaps, in one 
sense, the most direct link between the ani- 
mal and mineral kingdoms, for in them the 
nutrient compounds prepared by the vege- 
table from the mineral elements of the soil, 
and from the gaseous constituents of the 
atmosphere, are of such a nature, and are 



so compacted, that they are presented to the 
digestive organs and assimilating powers of 
animals in forms more fitted for affording 
direct nourishment to their tissues, and 
more direct support for their bodily func- 
tions, than any other kind of vegetable nu- 
triment, with the exception of that yielded 
by the pulses — beans, peas, &c. — which are 
not, however, so universally employed as 
food. 

The grains chiefly used by man are wheat, 
oats, barley, rye, millet, maize or Indian 
corn, and rice : the nutritive power of these, 
however, differs greatly. The nourishment 
afforded by the grains to animal bodies may 
be classed under three distinct heads — the 
azotized nourishment, represented by the 
gluten, which is adapted to build up and sup- 
ply the waste of the muscular, or fibrinous 
and albuminous tissues ; the non-azotized 
nourishment, represented by the starch, 
which goes to supply respiratory food, forms 
fat, &c. ; and the nourishment, principally 
phosphates of the alkalies and earths, which 
supplies the mineral elements to the bones, 
the nerves, and to the tissues generally. 
Upon the proportions, therefore, in which 
these different kinds of nourishment are 
contained in the grain, depends its nourish- 
ing power. Wheat, of all the grains, con- 
tains gluten most largely in proportion to its 
other constituents. Oats are next to wheat 
in this respect. Barley and rye are inferior 
to both wheat and oats, and maize and rice 
are very far below any of the above ; the 
former of the two not containing above 5 per 
cent, of azotized matter; the latter not above 
3 or 4 per cent. Vice versa to the above, the 
starch constituents are in much larger pro- 
portion in rice and maize, than in wheat and 
oats. The mineral constituents of the grains 
vary considerably as regards proportional 
amount, but they consist chiefly of phos- 
phates, with oxide of iron. They are con- 
tained most largely in the seeds of the 
cereals and of the pulses, and appear to be 
no less necessary to the perfect formation 
of the seed, than they are to the blood of 
animals, which cannot be properly nou- 
rished, unless the food from which it is 
formed contains these mineral constituents 
in certain proportion — a beautiful instance 
of the harmony and universal adaptation 
of all things which prevails throughout the 
works of the Creator. 

The grains also contain a certain propor- 
tion of fatty or oily matter. Maize does so 
largely, and oats in very considerable pro- 
portion. 

The grains, therefore, from their consti- 
tution, are capable of supporting, with the 



GRA 



271 



GR A 



addition of water, the animal frame and 
functions. It is evident, however, from 
science, and experience confirms the fact, 
that a larger proportion of barley, and still 
more so of rice or maize, is required to 
sustain the muscular development, than of 
either wheat or oats, which contain a greater 
amount of the gluten, or nitrogenized, or 
plastic element of nutrition. For further 
information on these points refer to Blood, 
Digestion, Farina, Fecula, Food, Gluten, §c. 

The flour, or meal, prepared from grain, 
partakes of course of the characters of that 
from which it is formed, and is also modi- 
fied by the mode of preparation, whether 
ground fine or coarse, whether entirely de- 
prived of bran or not. — See Bran, Bread, 
Farina, $c. Under the microscope, the 
various kinds of flour, particularly their 
starch granules, present very different ap- 
pearances ; this agent therefore has become 
valuable as a means of detecting adulte- 
ration, which could not otherwise have 
been discovered with certainty. At pre- 
sent, owing to the abundance and cheap- 
ness of wheat and wheat flour, there is no 
temptation to its adulteration. — See Bread. 
May that temptation never be again in ac- 
tion ! Besides being ground into flour, some 
of the grains are otherwise prepared artifi- 
cially for food, as in the case of pearl-barley 
and groats formed from the oat. 

See Barley — Oat, $c. 

GRANULATIONS— Are the small red 
rounded points which-cover the surface of 
a healing sore. They are very vascular, 
and bleed easily. When the granulations 
are deficient, the sore is depressed, smooth, 
and glazed-looking, and is not healing well. 
When the granulations are excessive, they 
constitute what is called "proud flesh." 
In this state they are paler than they should 
be, and require depressing or astringing by 
some caustic or astringent agent, such as 
Lunar caustic, blue vitriol, &c. 

See Caustics, Ulcers, fyc. 

GRAPE.— The fruit of the vine, one of, 
if not the most wholesome of fruits. When 
ripe it contains sugar abundantly, vegetable 
jelly and mucilage, and the characteristic 
tartaric acid in combination with potassa ; 
also an azotized albuminous constituent, or 
gluten, on which depends its property of 
ready fermentation, in which respect the 
juice of the grape excels all other vegetable 
juices ; undergoing spontaneously the neces- 
sary change, and becoming converted into 
true wine by its own inherent power of fer- 
mentation. The juice, if kept a few hours, 
will spontaneously ferment. As a cooling 
article of diet, ripe grapes are most whole- 



some, and invaluable in many cases of ill- 
ness ; but must be forbid when their ape- 
rient properties may prove injurious. Of 
late years, what is called the "grape-cure" 
has been introduced into Germany ; the per- 
sons undergoing it living chiefly on grapes 
— of which they have to consume many 
pounds' weight per day — and bread. It is 
probable that in some states of constitution 
this cooling system of diet may be useful ; 
it has, however, at least one serious draw- 
back : the continued application of the acid 
of the fruit to the teeth completely dissolves 
off the enamel. 

Refer to Fermentation — Raisins — Wine, §c. 

GRAVEL.— See Urine. 

GRAVE-YARDS.— Receptacles for the 
dead, which are often so arranged in this 
country as to be a disgrace to a civilized 
community. Like the imperfect drainage, 
and the other deficient sanitary arrange- 
ments, the grave-yards of our large towns in 
the first half, at least, of the present cen- 
tury, will probably afford material for com- 
ment for its historians of a future age. It 
will be regarded as a curious anomaly, that 
the people of England could, in spite of 
warnings without number, continue to in- 
ter the corrupting remains of mortality in 
the midst of the abodes of the living — a 
practice in itself reprehensible, but doubly 
and trebly so, when the fearfully crowded 
condition of the grave-yards of large towns 
is considered. It would be difficult perhaps 
to estimate the amount of injury to the 
living which has resulted from the abomi- 
nable custom of city grave-yards, for which 
the only excuse, in times gone by, was igno- 
rance. This excuse, however, no longer ex- 
ists, and the investigations of Mr. Walker 
and of others have made the injurious and 
culpable nature of the practice sufficiently 
apparent. This reason might be enough to 
prevent interments in situations where they 
are likely to prove a source of disease and 
death to others ; but there is another reason, 
in the natural feeling which all must have 
toward the remains of those who have been 
near and dear to them, that they should be 
undisturbed — so long at least as they retain 
the semblance of the material body ; but un- 
disturbed they cannot be in the festering 
soil of some city burying-places. The words 
of Mr. Walker, not five years since, respect- 
ing one grave-yard in the heart of London, 
will best place this subject in its proper 
light. Of it he says — "Indecent, pestife- 
rous in every respect, because when a pro- 
portion of 3073 corpses are annually interred 
in an acre of land, it follows as an inevitable 
consequence that the bodies of the deceased 



GKR.E 



272 



GU A 



can remain in the ground only five months, 
instead of ten years. Hence the stacking 
of coffins in deep pits, the brutal dismem- 
berment of bodies, the consumption of coffin- 
wood in many localities, the absolute super- 
saturation of the soil, which can neither re- 
tain nor dissolve the putrescent matters with 
which it is loaded. Hence the daily scenes 
which outrage every moral and religious 
sentiment — hence the danger to mourners 
from attending funerals in such places — hence 
the insidious infection which poisons the at- 
mosphere ; and thus, by undermining health 
or begetting disease, hurries thousands to 
an untimely end." 

Here, surely, are arguments, both selfish 
and unselfish, sufficiently cogent to induce 
all to lay the remains of their friends where 
they will not be distui'bed, and where they 
cannot prove injurious to the living. 

Refer to Burial — Death, $c. 

GREEN-SICKNESS.— See Chlorosis. 

GREGORY'S POWDER, or Mixture.— A 
compound of two parts of rhubarb, four 
parts of calcined magnesia, and one part 
of ginger. It is taken either simply, in 
water, or with water along with some sti- 
mulant, such as a teaspoonful of sal-vola- 
tile : it is a good stomachic and gentle ape- 
rient ; but persons sometimes get in the 
habit of taking it regularly, and injure the 
tone of the stomach by the undue amount 
of magnesia. 

GRIPING — Is pain produced in some 
portion of the bowels, in consequence of 
irregular contraction of the muscular coat ; 
it is in fact a minor form of colic, or spasm, 
and is to be relieved by the management 
recommended under those heads. Some 
medicines are more liable to gripe than 
others, and some individuals are more than 
others susceptible of these griping proper- 
ties. The inconvenience is generally and 
successfully remedied by the addition of 
some carminative or aromatic, such as one 
of the essential oils — clove, cinnamon, &c. 
— or by ginger, &c. Pills which are apt to 
gripe are more effectually corrected by the 
addition of one or two grains of extract of 
henbane, when that medicine is admissible. 
Some medicines are rendered griping by 
faulty preparation. This is especially the 
case with senna. — See Senna. 

Refer to Colic — Spasm, §c. 

GRIPPE.— The French name for the epi- 
demic influenza. 

GROATS — Are oats deprived of the 
husks; "Embden groats," when they are 
bruised also. They are used and useful for 
making gruel, &c. 

GROWTH— Or increase of size of the 



body, as a whole, or of any part of it, is de- 
pendent, as a healthy process, first on o 
proper amount of nervous excitation, and 
second on a due supply of healthy blood. 
When any part, such as the arm of a work- 
man, is regularly and vigorously exercised, 
the nervous power and the flow of blood 
are directed to it in increased proportion, and 
it acquires additional substance, or grows ; 
but should the same arm become paralyzed, 
how quickly will it diminish in bulk ! Up 
to a certain period of life the body grows ; 
in animals this varies with the species ; in 
man, the process continues, generally, up 
to the twentieth 3 r ear, or even beyond. 
When growth ceases, it is not that new ma- 
terial ceases to be added to the body, for 
this is unceasingly being effected to supply 
the place of those constituents of the frame 
which are continually being used up ; but 
the balance between the food taken and as- 
similated, and the waste of the body, is 
equalized ; and after growth has ceased, this 
balance (with the exception of fatty de- 
posites) is, during health, maintained with 
but little variation during the years of life's 
prime. When old age comes on, that is, 
after the sixtieth year, the balance inclines 
the other way ; the waste now exceeds the 
reparative nutriment which it is in the 
power of the system to receive and elabo- 
rate, and the tissues all diminish in bulk, 
the stature, even, becoming less. 

Young persons require nutriment, not 
only to sustain the wasting processes of re- 
spiration, and of motor change or move- 
ment, but they require, also, sufficient to 
supply the growing tissues of their entire 
body with the various elements which go to 
perfect their composition. If these elements 
are not supplied, development is either ar- 
rested, or, the tendency to growth conti- 
nuing, the bones and tissues generally 
lengthen, without acquiring their healthy 
substance. As a rule, the appetite of a 
healthy, growing child for plain and whole- 
some food, ought never to be stinted. — See 
Children, Digestion, Food, §c. 

GRUEL.— See Cookery. 
. GUAIAC [Guiacum]. — The wood and gum 
resin of a tree which is a native of the West 
Indies. They are both used in medicine. 
The wood is extremely hard and tough, of a 
striped yellowish green colour ; the resin is a 
greenish brown. Guaiac, as a medicine, 
acts upon the skin, and is often extremely 
useful in chronic rheumatism. The most 
convenient form of administration is the 
tincture, which may be given in one or two 
teaspoonful doses at bedtime ; milk is the 
best vehicle for its administration ; when 



GUI 



273 



GUL 



taken in water, it must be drunk as soon as 
mixed, otherwise the resin separates and 
floats on the top. 

Guaiac sometimes occasions sickness, in 
which case is is better abandoned. 

GUINEA WORM— Is a parasitic, long, 
round worm, about the thickness of a violin 
string, which burrows beneath the skin, 
chiefly of the feet and calves of the legs. It 
is met with principally in tropical climates, 
particularly on the African west coast, but is 
sometimes brought to this country by indi- 
viduals who have resided in the tropics. 
The length of the animal varies from a few 
inches to five or six feet. After remaining 
under the skin for a longer or shorter time, 
the head protrudes through a small boil 
which forms on the skin. The only treat- 
ment is seizing the head when this occurs, 
and gradually, from day to day, winding 
out the worm, care being taken that it is 
not broken, for should this happen, the 
portion which remains is apt to occasion 
severe irritation. Persons native to the 
situations where these parasites prevail, 
will always be found skilled in the mode of 
extracting it. 

GULLET— The Gullet, or "CEsopha- 
Grs" — Is a tube which extends from the 
throat or fauces to the stomach. Down, or 
through it, the food is propelled by the ac- 
tion of the muscular fibres which form one 
of its coats. It is narrowest at its upper 
end, and it is here that choking from food 
most generally occurs... 

Choking may occur from various causes : 
either the gullet may be contracted from 
some cause or other at a particular point, 
or the morsel of food may be too large, or 
of such a hard irregular character that it 
cannot pass down easily, or the cause of the 
impediment may be spasm, more especially 
of an hysterical character. Impediment to 
swallowing from contraction of the gullet- 
tube is generally a serious matter ; the 
cause should, as soon as possible, be exa- 
mined by a medical man ; sometimes it fol- 
lows recent injury to the lining membrane, 
such as scratching by a sharp-pointed bone, 
or after poisoning by irritant agents. In a 
case under the author's care, it followed 
upon a damson-stone having been swallowed 
some months previously, scratching the 
throat in its descent; the power of swal- 
lowing, which was nearly lost, in conse- 
quence, probably, of thickening of the tis- 
sues immediately beneath the lining mem- 
brane, was restored by the administration 
of codliver-oil for a few weeks. When a 
large morsel of food gets fast in the gullet, 
it may occasion death by pressure upon the 



windpipe ; at all events, it causes much 
distress for the time. If at all within 
reach of the fingers, of course they may bo 
used for its extraction at once: if too far 
for this, a surgeon's assistance will be re- 
quired to push the morsel beyond the upper 
narrow portion of the gullet into the wider ; 
this he will effect by means of the probang, 
(fig. lxxxi.,) an instrument consisting of a 
Fig. lxxxi. 



piece of round whalebone about two feet 
long, to one end of which a portion of 
sponge, about the size of a large marble, is 
firmly attached, and which requires oiling 
or greasing before use. In passing the pro- 
bang, care has to be observed that it is kept 
well to the back of the throat, and the pa- 
tient's head well thrown back at the same 
time; it is then to be pushed steadily but 
quickly down till the obstruction is felt to 
pass readily before it, and away from it. 

These particulars are mentioned, not to 
induce unprofessional persons to attempt the 
operation when a medical man is procur- 
able ; but if he is not, an unprofessional 
operator and an extempore probang, made 
from an umbrella whalebone, a cane, or 
even a curved stick, with a small bunch of 
some soft material securely fastened to one 
end, would be preferable to choking en- 
tirely, or partially even, for any length of 
time. A few smart blows on the back will, 
in the case of children especially, often 
dislodge a morsel sticking in the upper 
part of the gullet. Sharp-pointed or irre- 
gular bodies, such as pins, fish-bones, or 
other bones, may get fixed in the throat, 
and it is generally in the upper part of it ; 
the fingers may be able to remove them, if 
not, a piece of bread, coarsely masticated 
and swallowed, will often, especially if fol- 
lowed by a draught of water, carry down 
the impediment. In some cases, an emetic 
may be useful. Frequently, after a sharp- 
pointed body has stuck in the gullet, and 
has scratched its lining membrane, the sen- 
sation of its still remaining may be felt for 
some time after it has passed away. It is 
well to keep this in mind, that continued 
unnecessary efforts to relieve may not be 
persevered in. If a sharp body remains 
fixed in the upper part of the gullet, press- 
ure at some point or other will almost cer- 
tainly cause a pricking sensation. The 
gullet is sometimes spasmodically affected, 
the food being either stopped in the passagi 
downward, or passed with pain and diffi- 
culty ; this affection falls partly under the 
head of Spasm and Hysteria, but it is some- 



IS 



GUM 



274 



GUM 



times the result of too great haste in eating 
and swallowing. As explained under article 
Digestion, the food does not simply fall into 
the stomach down the gullet-tube, but it is 
conveyed into the digestive organ by the 
regular action of the muscular fibres of the 
tube, which, while they propel forward, 
also close behind the morsel being swal- 
lowed. It must be evident, therefore, that 
if morsels follow one another in too quick 
succession, this action must be interfered 
with ; and if it is, spasmodic pain, at least, 
is produced, and not improbably choking. 

Choking, from things getting fixed in the 
gullet, must not be confounded with the 
sensation of suffocation produced by foreign 
bodies getting into and irritating the upper 
portions of the windpipe which lies in front 
of the gullet. — See Lungs. In the latter 
cases sudden, violent, spasmodic cough en- 
sues, and the appearance and dread of suf- 
focation is generally much more quickly and 
strongly marked. 

liefer to Alimentary Canal, and more espe- 
cially to Digestion — Lungs, §c. 

GUM ARABIC, or Gum Acacia— Is the 
produce of certain species of acacia, and 
is brought chiefly from Northern Africa, 
Egypt, Nubia, Barbary, &c. Gum is con- 
tained in greater or less proportion in the 
juice of most plants, and, by many, it is 
exuded in the form of round concrete drops 
or " tears," as they are called, such as the 
gums of cherry and plum trees, which are 
familiar to all. The gum of the acacia is, 
however, most generally used and esteemed 
as a demulcent in affections of the throat 
or air-passages, in irritations of the urinary 
organs, &c. When gum is dissolved in 
water the solution is named mucilage ; and, 
in this form, it is one of the most convenient 
vehicles for other medicines, particularly 
those which require some degree of suspen- 
sion in liquid, as, for instance, in the com- 
mon chalk mixture. It is also useful for 
facilitating the mixture of oils, camphor, 
&c. in watery mixtures ; but for this pur- 
pose milk is preferable. The powder of 
gum acacia, when genuine, is probably the 
best form for keeping, as it is dissolved in a 
few minutes, whereas gum in its ordinary 
form takes a considerable time, and, when 
made into mucilage, on the other hand, is 
very apt to spoil. Gum is nutritive in some 
degree, probably in the same degree as 
starch or sugar, and is used as an article 
of diet in the countries whence it is pro- 
cured. It is much more used in medical 
practice in France than in this country, 
both for its nutritive and its demulcent pro- 
perties. 



Gum tragacanth, another species of gun\ 
brought chiefly from Asia Minor, Persia, &c, 
is procured from a tribe of plants belong- 
ing, like the acacia, to the leguminous or 
pod-bearing family. It possesses many of 
the properties of acacia gum* but not being 
so soluble, is not nearly so convenient for 
use. 

Mucilage of gum acacia maybe conveniently 
made, by dissolving ten ounces of the gum 
in twenty fluid ounces of water, either by 
gentle heat or by suspending the gum — tied 
in a muslin-bag — in the water. 

GUMS. — The gums which closely invest, 
but do not adhere to the teeth, are com- 
posed of mucous membrane of a dense in- 
sensible character. In the investigation of 
disease, the gums frequently afford valuable 
information respecting general constitutional 
disorder. In sea-scurvy, the gums become 
spongy and swollen, extend over the teeth, 
and bleed easily: the symptom is always 
strongly corroborative of the bodily disor- 
der. In persons who have been long sub- 
jected to the action of lead, slowly intro- 
duced into the system, either in the course 
of their occupation, or, as sometimes occurs, 
from the ordinary drinking-water having 
become impregnated with the metal from 
lead pipes, a blue line is often observable 
along the edge of the gum. A pink line in 
the' same situation has also been pointed 
out as showing itself in persons affected 
with pulmonary consumption. In constitu- 
tional affection by mercury, it is well known 
that the gums become inflamed, sore, and 
spongy ; in some cases of disease affecting 
the mouth, the gums become dark or black 
in colour, and the breath is extremely fetid. 

Of course, in cases where the state of the 
gum is indicative of constitutional affection, 
that must be attended to, (see Scurvy, <jr. ;) 
but the condition of the gums in any case 
may generally be much relieved by the use 
of astringent substances in the form of 
washes ; none, perhaps, is better than the 
tincture of myrrh, but camphor dissolved 
in alcohol may also be used, or, indeed, al- 
most any one of the astringents. A drachm 
of alum dissolved in a pint of water makes 
a very good and cheap wash. 

In the case of black-looking gums, with 
fetid exhalation, a wash made of two 
drachms of muriatic acid to the pint of 
water will be found most especially useful, 
or two drachms of the solution of chloride 
of soda may be used with equally good 
effect. Such a case, however, must require 
medical attendance. The gums in the teeth- 
ing of children require much attention. — • 
See Children. 



GUM 



275 



H AI 



GUM-BOILS — Are small abscesses form- 
ed in consequence of inflammation of the 
gum, generally the result of decayed teeth 
or their stumps. The abscess generally dis- 
charges between the gum and the lip. 

GUN-SHOT' WOUNDS.— See Wounds. 

GUTTA-PERCHA.— This substance, now 
familiar to all, and so extensively used in 
so many different ways, is obtained from a 
tree which is native to the Malay peninsula. 
In medical and surgical practice it has been 
adopted for many purposes, such as splints for 
fractures, &c. Probably, its most valuable 
property, in a domestic point of view, is it's 
being waterproof, and forming a cheap and 
efficacious protection to bedding, in many 
cases in which this is apt to be spoiled by 
the discharges, natural or otherwise, from 
the sick. 

Refer to Bed, §c. 

GYMNASTICS— Are exercises for the 
body which are too often practised in an 
injurious manner, causing violent straining 
of the limbs and joints, for which there is no 
necessity, as a perfectly adequate amount 
of muscular exercise of all the limbs may 
be obtained without it. These observations 
apply, of course, to gymnastics as an exer- 
cise simply; when their object is to give 
strength, agility, and fearlessness to those 
whose future occupations may, probably, 
call especially for such qualities, gymnastic 
exercises are, of course, highly desirable. 

HABIT. — The connection existing between 
the influence of the will and certain sensa- 
tions and motions in the living body, is a 
fact of which every one must be conscious 
from personal experience. When, however, 
the actions resulting from these sensations 
and motions are, after frequent repetition, 
performed without a distinct and conscious 
exercise of the will, they are said to be the 
result of habit. These habits, however, are 
of the body, and are distinct from habits of 
the mind, influences which act upon the will 
itself, with lesser or greater power, and 
impel the individual to certain acts. 

It is, perhaps, needless to advert to the 
proverbial power which habit exercises, not 
only over man, but animals, becoming to 
them a "second nature," and to their off- 
spring a natural tendency. So powerful an 
agent, both mental and physical, as habit, 
cannot fail to be largely implicated in the 
consideration of the nature and treatment 
of disease. It is sometimes of the greatest 
consequence, not only to break the influence 
of habits of which the mind is consoious, but 
even of habits of disease over which the mind 
has generally no control. This is particular- 



ly the case with respect to periodic diseases 
of the nervous system, such as ague, &c, 
which, after a time, appear to be continued 
rather from the habit of the constitution 
than from any other cause. 

Still more widely connected with the treat- 
ment of disease, is the acquisition of good 
habits in the room of bad ones, which are 
often the causes of impaired health. Some 
individuals constantly eat and drink too 
much from mere habit ; others take little or 
no exercise "from habit;" and, although 
conscious of these and other negligences, 
often require considerable exertion of the 
will, aided by the almost despotic com- 
mands of a medical attendant, before they 
can break through them. The good effects 
of habit, in persons liable to constipation, 
have already been pointed out in the article 
on that subject; in this case the habit ori- 
ginating in the will becomes, after a time, 
partly or wholly involuntary. 

There is, however, another state of dis- 
order, and a more intractable one, in which 
the influence of habit may be most benefi- 
cially exercised. It is that state of hypo- 
chondriac unrest called the "troubled mind. " 
In such a condition, nothing is more valu- 
able than the habit of daily, and at certain 
fixed times, forcing the mind to bend itself 
to some definite continuous employment, one 
which it will require some degree of mental 
exertion to carry on, and which will main- 
tain its interest, perhaps an increasing one, 
from day to day. 

HAEMORRHAGE.— See Hemorrhage. 

HAIR — Is a development from, or it 
might be called a prolongation of, the outer or 
scarf skin. Each separate hair (fig. lxxxii. 
1) is contained in a pit which passes into the 

Fig. lxxxii. 




HAI 



278 



HAI 



true skin, (fig. lxxxii. 3,) or through it, into 
the tissues beneath, (fig. lxxxii. 4.) Into 
this pit the outer or scarf skin (2) is folded, 
and from this folding the hair is developed, 
consisting of an external or denser portion 
composed of flat over-lapping scales, and 
an internal porous "pith," which contains 
the colouring matter. 

The condition of the hair is often highly 
symptomatic of the bodily condition; at the 
same time, it is, of course, liable to altera- 
tion from local influences. 

The hair is apt to become split, or forked, 
in consequence of weak growth ; this gene- 
rally occurs in persons in a debilitated con- 
dition. Keeping it cut tolerably short is a 
good preventive; but, of course, removal of 
the bodily weakness of which the state of 
the hair is symptomatic, is essential. The 
colour of the hair is indicative of consti- 
tution and temperament. — See Temperament. 
Its changes in colour indicate generally the 
advance of years, but sometimes the pre- 
mature gray speaks of continued mental 
toil and trouble ; and it has followed at once 
upon violent mental emotion, a few hours 
sufficing for the change. 

The unfortunate queens, Mary of Scot- 
land, and Marie Antoinette, are both said, 
amid many others, to have been instances 
of this effect of mental emotion upon the 
hair ; and the fact of this direct connection 
between the condition of the body and the 
colouring matter of the hair, renders it pro- 
bable that permitting the hair of children 
to be kept long is really subjecting them to 
a source of constitutional weakness. 

Falling out of the hair occurs from weak- 
ness, either of the body generally or of 
the hair-bulbs, or " follicles," themselves. 
Various local stimulant applications are 
used in such cases, of which Balsam of Peru 
— a drachm stirred well into an ounce of 
simple cerate when melted — is said to be a 
good application. 

Baldness, or loss or deficiency of the hair 
on parts usually covered by it, is sometimes 
seen in infants. It frequently occurs in 
adults of the male sex, even in the prime 
of life, and almost universally, in a greater 
or less degree, in old age. The direct oc- 
casion of baldness is defect in the hair fol- 
licles from which the hair is developed ; 
and this defect may arise from diseases af- 
fecting the skin itself, from acute general 
disease, as fever; or chronic constitutional 
disease, such as consumption ; it may also 
arise from constitutional peculiarity, or the 
diminished circulation of blood, such as 
occurs in advanced life. Some families ap- 
pear to be peculiarly liable to become the 



! subjects of baldness even -early in life ; 
J those who perspire much about the head are 
often bald. Generally, however, whatever 
occasions a diminished supply of blood to the 
scalp or skin, gives the hair a tendency to 
shed, and the treatment must be directed to 
stimulating the skin as much as possible (see 
Skin). After acute disease, if the hair falls 
off, shaving the part two or three times in suc- 
cession will probably strengthen the growth. 
In other cases, much covering upon the 
head, which causes perspiration, and conse- 
quently weakens the skin, must be avoided ; 
and the head should be well washed with cold 
water every morning, and afterward rub- 
bed and brushed to promote reaction. Va- 
rious applications are recommended to pre- 
vent or cure baldness ; they are all stimu- 
lant. Those of which cantharides, or Spa- 
nish blistering flies, form an ingredient, are 
generally most serviceable. A drachnu of 
the tincture of cantharides, rubbed up with 
an ounce of lard, will form a sufficiently 
stimulating ointment. [Hartshorn, or water 
of ammonia, combined with castor-oil, is an 
article often sold to prevent baldness, or as a 
"hair tonic" and is an excellent application.] 
The infusion of the leaves of the Asarum Eu- 
ropasum, [Asarabucea,] a plant which occurs 
wild in the woods in England, is a very effi- 
cacious stimulant to the hair follicles ; the in- 
fusion may be used as a lotion to the scalp. 
Falling off of the hair, which is occasioned 
by eruptive disease, or which is accompanied 
with inflammation of the skin, of course 
requires a different and more soothing treat- 
ment ; probably medicine is required, and 
the case is better submitted to the treatment 
of a medical practitioner. 

In the baldness of early life, the hair 
drops off without the previous change of 
colour which occurs in age ; in the latter 
case, of course, no treatment is either likely 
to be resorted to, or to be of service. 

Removal of the hair is a proceeding fre- 
quently called for in the treatment of dis- 
ease, especially of febrile and inflammatory 
affections affecting the head. In these 
cases, it may be entirely removed, at once, 
without risk, and should be shaved off when 
the full effect of the procedure is required. 
Some persons, especially females, are often 
much vexed at the shaving of the head in 
fever, &c. Its necessity is, of course, or 
ought to be, answer sufficient ; but it often 
happens, that if the hair has not been taken 
off during the course of disorder, it must, 
from tendency to shed afterward, be shaved 
off during convalescence. 

When the hair is removed in persons not 
suffering from acute disease, it must be 



HAN 



277 



HE A 



done cautiously, especially if this natural 
clothing has been somewhat long and thick. 
Where it must be taken off entirely, and at 
once, the head should be protected by a cap 
of flannel, otherwise neuralgic or rheumatic 
attacks may be the consequence. 

Frequent cutting undoubtedly strengthens 
the growth of the hair, and frequent brush- 
ing and washing are the best methods for 
preserving its health and cleanliness, and 
ought, along with the assistance of the one- 
sided comb, to be solely trusted to — the irri- 
tating "small-tooth comb" ought to be ba- 
nished from use entirely. 

In Poland, a peculiar disease is met with, 
in which the hair becomes thickened, suc- 
culent as it were, and matted together by 
a peculiar glutinous sweat. It has been 
erroneously reported that the hair, in this 
condition, not only bleeds, but possesses feel- 
ing — the latter idea having doubtless arisen 
from the irritability of the skin at its roots. 

Refer to Skin. 

HAND. — This wonderful agent of the 
human mind is much exposed to injury. 
When this occurs, as it often does, at a dis- 
tance from medical aid, one principle must 
ever be remembered — that the preservation 
of as much of the member as possible, even 
of a single finger, or of part of one, is of 
the highest moment with reference to future 
usefulness. In a crush of the hand, when 
bleeding is not great, the best treatment 
will be to place it in a large warm poultice, 
and keep at rest until^ medical aid is pro- 
cured. The management of various acci- 
dents, &c. will be found under such heads 
as Artery, Dislocation, Wounds, §c. 

HANGING — Suspension of the body by 
the neck, may cause death in three distinct 
modes : by compressing the windpipe, and 
producing suffocation ; by compressing the 
veins of the neck, and causing apoplexy ; or 
more rarely by dislocating the neck. The 
two former modes may be mixed up to- 
gether. The latter, when it does occur, is in 
consequence of a " fall," such as is given at 
a public execution ; it of course causes in- 
stantaneous death. Recovery from hanging 
must, in some degree, depend upon the com- 
pleteness or not of the interruption to the 
passage of air through the windpipe for 
any time : it is not likely that resuscitation 
will be effected if this has continued four 
minutes. The first thing to be done when 
a person is found hanging is, of course, to 
cut them down at once, to loosen the mate- 
rial around the neck, to dash cold water 
over them, and to bleed. In such an emer- 
gency, a person would be quite justified in 
cutting across the temple, where the artery 
Y 



beats, (see Artery,) with a penknife, and 
allowing blood to flow to the extent of ten 
or twelve ounces. The bleeding could be 
controlled until the arrival of a surgeon, by 
means of pressure against the bone. In 
most respects, the treatment of a person 
hanged must be similar to that of one 
drowned, except that the application of 
heat would scarcely be requisite in the same 
degree. 

HARE — Like other game, is extremely 
easy of digestion, apart from the various 
dressings and stuffings. 

HARE-LIP, or Cleft-Lip — Is a deform- 
ity with which infants are occasionally 
born ; the lip being cleft at the furrow, to 
a greater or less extent. Sometimes the 
fissure extends through the roof of the 
mouth. The case ought to be very soon 
submitted to the surgeon for remedy by 
operation. 

HARTSHORN.— See Ammonia. 

HAY- ASTHMA.— (See Asthma.) —Also 
called " Hay-Fever, or Summer Bronchitis." 
It may be caused by other powerful odours, 
as well as by that of hay. Quiet, tolerably 
good diet, quinine, or bark, and paregoric, 
will probably relieve. A cup of strong coffee, 
without milk, or sugar, frequently repeated, 
is said to be an excellent remedy. 

HEAD. — See Brain, Giddiness, Skull, 
Wounds, &c. 

HEADACHE — " Cephalalgia"— Is one 
of the most frequent ailments, the result 
of a great variety of causes ; consequently 
many varieties of headache are enumerated 
by medical writers; the consideration of 
all these in a work like the present would 
tend rather to confuse than to enlighten. 
The subject will probably be rendered most 
clear and useful to the unprofessional reader 
by considering it generally under the divi- 
sions of — 

Headache from overfulness of blood. 

Headache from deficiency of blood, or 
debility. 

Headache from excited or inflammatory 
action. 

Headache from sympathy ; and 

Headache from anomalous causes. 

Headache is so frequent an ailment that 
people generally seem almost to forget its 
connection with so important an organ as 
the brain. There are, it is true, many 
transient slight headaches, and even severe 
ones in the predisposed, which do not call 
for much attention ; but it must be remem- 
bered, that there are others which it is 
dangerous to neglect; and an individual 
who becomes subject to headache, frequently 
recurring, should consult a medical man ou 



HE A 



278 



HE A 



the subject. This is more imperative from 
the fact that there is often considerable 
difficulty in determining the real nature and 
cause of some headaches, and that an error 
in this respect — in diagnosis — may, by lead- 
ing to erroneous treatment, cause the most 
serious consequences. The most diverse 
line of treatment may be requisite, in two 
different individuals ; in one, abstraction of 
blood may, if had recourse to, save from 
a fit of apoplexy; in the other, the same 
treatment might induce paralysis, or epi- 
leptic convulsion. The lowering measures, 
in fact, which cure the one, may kill the 
other. From these considerations, a few 
general remarks on the subject of head- 
aches will probably be more safe and use- 
ful than an elaborate and detailed account. 
If a person who suffers from headache is 
of full habit generally, if he is sleepy, dull, 
the vessels of the face full ; if the uncom- 
fortable sensation in the head is aggravated 
by stooping, by an abundant meal, by sti- 
mulants, or by sleep, overfulness is the 
probable cause, and reduction of the diet, 
purging the bowels with calomel and colo- 
cynth, and with occasional doses of saline 
medicine, exercise, bathing the head with 
cold water, and, if the symptom is very 
severe, the application of a few leeches to 
the temples, will be beneficial. If the urine 
is deficient, cream of tartar in some form 
may be taken with advantage. The above 
species of headache, the result of general 
overfulness of blood, may also be occa- 
sioned by whatever impedes the circula- 
tion, such as affection of the heart or liver ; 
when the latter is the cause, the pain is 
frequently most severe at the back of the 
head. When, on the other hand, headache 
occurs in a person of weak constitution, 
when it is produced by, or aggravated by, 
exertion of mind, much talking, &c, when 
there is listlessness, both of mind and body, 
rather than oppression — the face pale, the 
pulse weak — debility is the probable cause, 
although at the same time there may be 
overfulness of blood in the interior of the 
head itself; very frequently, however, in 
this kind of headache, the head is hot, with- 
out there being any particular flushing of 
the countenance. This form of headache 
also is frequently accompanied with indiges- 
tion, and is very common in students and 
anxious men of business. Any thing like 
abstraction of blood will certainly prove 
injurious ; but cold to the head may be 
of service, not only as a temporary remedy, 
but habitually used by means of washing 
with cold water. Exercise, attention to the 
state of the bowels, without purging, some 



care in diet, and relaxation of mind, par- 
ticularly by means of change of scene and 
air, will be most useful. In such cases, the 
whole system is weakened — the brain and 
nervous system, the circulating system, the 
digestive organs — and they act and react on 
one another. 

Headache from excitement or inflamma- 
tory causes is such as occurs in the first 
stages of inflammation of the brain, and 
in some forms of fever, or it follows vio- 
lence to the head. It of course falls to be 
treated under the articles on these con- 
tingencies generally. 

Sympathetic headache is very common, 
and is evidently connected with disorder 
in some organ of the body, such as the kid- 
neys, womb, &c. Headache, sympathetic 
with disorder in the stomach, or some part 
of the alimentary canal, is, however, the 
most frequent form. The presence of bile, 
or of indigestible food in the stomach, 
almost certainly occasions dull pain in the 
forehead ; an alkaline, or too acid condition 
of the contents of the organ exerts the same 
effect. The various symptoms of indigestion 
will generally point to the cause. In the 
first two, an emetic, or some aperient, such 
as the compound rhubarb pill, or a stimu- 
lant, will probably remove the disorder. A 
vegetable acid, such as vinegar, many per- 
sons know from experience, will at once cure 
headache, especially if it occurs from the 
use of oily or greasy food ; and again, when 
acid eructations, heart-burn, &c. indicate 
the presence of superabundant acid, a dose 
of soda, potash, or magnesia, will correct 
the cause, and remove the effect. 

Under the head of anomalous headaches 
may here be classed all such as are not 
referable to any distinct cause. They con- 
stitute a considerable proportion of the cases 
of headache generally, and frequently baffle 
both the investigation and treatment of the 
medical adviser. 

It would be possible, did space permit, to 
extend this article to much greater length, 
but its intention is rather to convey some 
idea of the general causes of this common 
ailment, than to enter into the minutiae of 
its symptoms, relations, or treatment. Most 
are aware of the cause, and consequently of 
the best mode of managing their occasional 
headaches, and when the affection assumes 
a severe character, the medical man should 
invariably be consulted. Bleeding, blisters, 
setons and issues, cutting the hair or shaving 
it off, cold to the head, shower-baths, snuff, 
purging, acids and alkalies, stimulants, 
brandy, sal- volatile, emetics, and many 
other remedies, are used and may be used 



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in the treatment of headache ; but it would 
be quite impossible here to undertake their 
consideration. 

Refer to Brain — Fever — Indigestion, §c. 

HEALTH.— See General Health. 

HEART. — In connection with this article 
the reader is referred to Artery, Aorta, Chest, 
Circulation. The heart, (fig. lxxxiii. 1,) the 

Fig. lxxxiii. 




central organ of the circulation, is placed 
obliquely in the chest, the base upward, the 
point, or apex, being so situated as, in 
the living body, to strike the side of the 
chest, or "beat," between the fifth and 
sixth ribs, about two inches below the left 
nipple ; this point, however, and indeed the 
position of the heart generally, is liable to 
alteration according to the position of the body. 
The size of the heart is generally computed 
to be a little more than that of the closed 
fist of the individual. The organ is con- 
tained in its own proper bag, or "pericar- 
dium," which in the healthy state is lined 
by an extremely smooth moistened mem- 
brane ; this membrane is also "reflected," 
or carried over the surface of the heart 
itself ; and thus during the constant motion, 
the two surfaces glide easily, and without 
friction, over each other ; the heart lying 
sufficiently loose in its bag to permit of free 
movement. The heart is often described as 
a hollow muscle. It consists of four cavities, 
surrounded by muscular walls, and is in fact 
a double heart ; this being requisite for the 
performance of the double circulation — 
through the body and through the lungs. — 
See Circulation. Of these four cavities, the 
left auricle (2) and ventricle (3) are devoted 
to the circulation of the blood through the 
body, after its return in a purified state from 
the lungs ; the right ventricle (4) and auri- 
cle (5) being devoted to the lung circulation. 



In fig. lxxxiii., 6, 6, represent the great 
veins by which the blood returns to the 
heart from the body generally, 7, 7 the 
great blood-vessel, or aorta, by which it 
leaves the heart to be passed through the 
body, having, between entering the right 
auricle (5) and leaving the left ventricle (3) 
been passed through and purified in the 
lungs. The auricle and ventricle on the 
right side of the heart have not, when pro- 
perly formed, any communication with the 
corresponding cavities on the left side ; but 
the auricle and ventricle on each side are 
separated from each other, and from the 
blood-vessels with which they are connected, 
by means of valves — so arranged and go- 
verned in the motions of the heart, that the 
blood can only pass in the right direction 
when the valves are in a healthy state ; but 
should these valves become diseased in any 
way, the proper currents of the blood are 
interfered with, and disease is the result. 
Thus, the passage from the great blood-ves- 
sel, the aorta, (fig. lxxxiii. 7,) to the heart, 
is closed by three " semilunar" valves, (fig. 

Fig. Ixxxiv. 




lxxxiv.,) which allow the blood to pass freely 
into the vessel, but should it attempt to re- 
turn, these bag-like valves instantly close 
the passage — the blood itself acting as the 
closing agent — and this action takes place 
once for every beat of the heart. If, how- 
ever, from any cause, one or more of these 
valves should become deficient, it is evident 
that each time they close, a small portion 
of blood will pass back, or "regurgitate," 
into the heart — and this actually occurs in 
cases of disease. And the consequence of the 
long-continued and constantly-repeated dis- 
ordered action is to cause stretching, or 
"dilatation," of the cavity which receives 
the regurgitated blood. This one instance 
will explain how one slight derangement 
in the nicely-balanced machinery of this 
important organ gives rise to another. From 
somewhat analogous causes, the blood may 
regurgitate into, or be dammed up in the 
lungs, or in other parts of the body, causing 
hemorrhage, dropsy, &c. 

Again, there may be impediments to the 
circulation ; the valves above alluded to, or 
others, may not yield as they should do, or 



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there may be other causes which render it 
difficult for the heart to propel the blood 
through the body. In such a case, the 
heart, like any other muscle under similar 
circumstances, acquires increase of sub- 
stance, in consequence of the continued 
increased exertion demanded of it, to main- 
tain the proper circulation ; and thus we 
have a cause and effect, producing enlarge- 
ment of the heart — an evil certainly, but a 
lesser evil to prevent a greater, for in this 
very enlargement — this strengthening, as it 
were, of the heart to do its extra work — 
the patient's safety lies. 

There are, of course, many other forms 
of heart disease, but the above instances 
will convey some rational idea of the nature 
and peculiarities of the disorders of the 
organ in general. It would be quite pro- 
fitless in this work to enter into any thing 
like detail respecting diseases of the heart 
or their treatment; disorders so varied in 
their nature and symptoms can only be 
properly investigated and managed by a 
medical man, conversant with the mecha- 
nism and the functions of the human frame 
at large, and in their relations of mutual de- 
pendence. 

As might be expected, affections of the 
heart, generally, are evidenced by pain in 
the chest, difficult breathing, cough, palpi- 
tation, &c. ; and at other times by faintings, 
giddiness, irregular pulse, &c. ; but there is 
not one of these symptoms, or any com- 
bination of them, which may not be de- 
veloped under certain bodily conditions, al- 
though the heart is perfectly sound. None, 
therefore, need alarm themselves merely 
because such symptoms occur ; they happen 
at times more or less to all ; still they ought 
not to be neglected : if they continue to recur, 
a medical man should be consulted. If there 
is no disease the mind is set at rest, and any 
general disorder which may have caused the 
symptoms will probably be rectified. The 
above cautions are given, because there is 
no class of diseases of which people are 
so apt to fancy themselves the subjects as 
those of the heart ; and the more they think 
of the symptoms, the more likely are they 
to continue or increase, from an organ so 
intimately connected with the emotions of 
the mind as the heart. Again, even if the 
heart be unaffected, it is by no means ad- 
visable to permit it to continue to be func- 
tionally disordered, either by mental emo- 
tion or by sympathy with other organs, for 
the functional disorder may end in organic 
disease ; that it does so sometimes is evident 
from the fact that there is no more fertile 
source of heart disease than those convul- 



sions, either commercial or political, which 
occasionally agitate society. 

If disease of the heart, either incipient 
or confirmed, does exist, it cannot too soon 
be discovered by examination, nor the neces- 
sary precautions and regulated mode of life 
too soon adopted ; for with these precau- 
tions, a large majority of persons who are 
the subjects of heart affection may not 
only continue to live for years, sometimes 
many years, but to enjoy life. True, the 
knowledge to any one that he is himself 
the subject of heart disease may be un- 
comfortable, but it cannot be unprofit- 
able. He may be aware that heart dis- 
eases are sometimes apt to have a sudden 
termination, and that his life may be some- 
what more in jeopardy than that of an un- 
affected person ;, but surely to every right- 
thinking man, this fact would rather be an 
argument why he should know his real con- 
dition. The possibility of his being called 
away from the affairs of this life without 
warning, should be a reason for his keeping 
them well arranged ; and still more import- 
ant, should it be a reason that in conducting 
his earthly stewardship, he should do it, not 
only with reference to this world, but to 
give account of it in another. And when 
the many chances and contingencies of life 
are considered, the consciousness of being 
the subject of heart disease amounts to little 
more than such contingencies assuming a 
more prominent position in the mind; and 
to the individual it may be a merciful dis- 
pensation. It may seem to some that in 
thus writing the author is assuming the 
character of the clerical rather than of the 
medical adviser; it is not so — it is but 
taking advantage of the privilege which 
falls to the lot of the physician, — when he 
has in his power times and opportunities in 
his relations with society, — when the word in 
season cannot be out of place, as far as the 
welfare of those intrusted to his care is 
concerned. 

The causes of affections of the heart are 
very numerous. As already noticed, mental 
disturbance and agitation is a most frequent 
one ; also mental depression and grief, which, 
if long continued, appear to exert much 
influence over the organ, and to make the 
phrase " a broken heart" not altogether a 
poetical fiction. Violent passion strongly 
affects the heart — its indulgence may lay 
the foundation of disease, which its repeti- 
tion strengthens, and may bring to a fatal 
termination. Rheumatism, or rather rheu- 
I matic fever, is probably another of the most 
! fertile sources of heart affection. In this. 
i disease, inflammation of some portion of the 



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281 



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membranes covering or lining the heart, 
(see Carditis,') is apt to occur, and to be 
followed by such effects as induce perma- 
nent change. Violent physical exertions, 
dissipation of all kinds, particularly the 
abuse of spirituous liquors, are all origin- 
ators of the above affections. It has been 
said that persons with heart affections may 
continue to live and enjoy life, but it must 
be under a more regulated and restricted 
system of living than is imperative on per- 
sons in health. Every thing which may be 
a cause of heart affection must also be a 
source of aggravation ; all mental or phy- 
sical excitement especially so. When these 
are guarded against, the rest may be 
summed up in — strict attention to the gene- 
ral health. Whenever an old symptom 
becomes aggravated, or a new one, such as 
swelling of the legs, &c. appears, medical 
advice should always be taken. The great 
secret in these affections consists in main- 
taining the balance of the various func- 
tions, and this can only be done by the 
judicious management of a medical at- 
tendant. 

Refer to Angina Pectoris — Carditis — Circu- 
lation — Hysteria — Palpitation, §c. 
. HEARTBURN.— A burning or irritating 
sensation, felt either at the pit of the stomach 
or top of the throat, and occasioned by undue 
acidity, or by acrid matters, in the stomach. 
It is generally relieved by an alkali — potas- 
sa, soda, magnesia, or chalk — which neu- 
tralizes the acid. It is not, however, advis- 
able to have too frequent recurrence to these 
palliative remedies, for they are only pal- 
liatives, they cannot be taken habitually 
without weakening, not only the stomach, 
but the system generally. Heartburn can- 
not continue to recur without there being an 
error somewhere; either the diet is badly 
regulated, or the digestive organs require 
something more than simple neutralization 
of the superabundant acid. This acid is a 
badly-formed gastric juice, and if it is neu- 
tralized, whatever digestive power it might 
possess is destroyed; consequently the sto- 
mach is called upon to secrete another supply 
before the food can be digested — a call upon 
its powers which cannot fail to be injurious. 
Moreover, persons finding how quickly a 
dose of alkaline medicine removes the un- 
comfortable sensation of heartburn, are very 
apt to trust to the palliative, and continue 
their indulgences, rather than to practise 
the self-denial requisite to effect a cure of 
the cause. 

Some persons find Spanish liquorice a 
good palliative in heartburn. 

Refer to Indigestion^ §c. 
y2 



HEAT.— The imponderable agent which 
gives to our senses the feeling of heat, is in 
scientific language called caloric, to distin- 
guish it from the term heat, used to desig- 
nate the sensation. In this article, how- 
ever, the one term heat is employed. It is 
not requisite here to enter into a considera- 
tion of the nature of heat. Its sources, as 
best known, are the great fountain of it, the 
sun ; there is also the heat developed in 
the interior of the earth; that produced, or 
at least manifested, by friction, and also by 
combustion, chemical change, and in the 
bodies of animals, (see Animal Heat,) and 
in some plants. 

Heat is interesting in a medical point of 
view ; first, from its effect upon the healthy 
body — its physiological effect ; and second, 
from its effects as a remedy in disease — its 
therapeutical effect. 

Of the first, the physiological effects of 
heat, much has been said under Acclima- 
tion, Animal Heat, Bile, &c, which it is 
unnecessary to repeat here : these articles 
sufficiently point out the effect of continued 
high temperature, (from 80° to 110°,) such 
as occurs in tropical climates, upon the hu- 
man body. 

When the heat becomes very intense, par- 
ticularly if there is direct exposure to the 
rays of the sun, more immediate and marked 
effects result; the brain may be affected, 
and sun-stroke, or "coup de soleil," as it 
is called, be the consequence. This af- 
fection, which is not uncommon among the 
European residents in India, and especially 
amid troops on march, is sometimes also 
witnessed in the case of harvest-labourers 
in this country, in very hot summer wea- 
ther. The affected person falls insensible, 
the face flushed and swollen, and the ves- 
sels beating violently. The most efficient 
remedies are said to be pouring cold water 
on the head, and the administration of 
a small quantity of stimulant, ammonia or 
brandy. 

The skin of persons exposed to extreme 
heat is liable to be affected with what is 
called " prickly heat;" an eruption of small 
pimples, or of minute blisters. In either 
case, the use of a tepid bath, with a little 
lead lotion, will allay the symptoms, and 
it may be well to take some cooling saline 
aperient. 

Although continued exposure to heat pro- 
duces these effects, it is now well known, 
that the living human body is capable of 
supporting, with impunity, exposure to an 
atmosphere of very elevated temperature, 
considerably above that of boiling water, 
provided the air be dry. The development 



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282 



HEM 



of unusual heat at any part of, or over the 
whole body, is usually an attendant on fe- 
verish and inflammatory attacks. In scarlet 
fever, and in inflammation of the lungs, this 
is particularly the case. 

The use of heat in the treatment of dis- 
ease is very frequently alluded to in this 
work, more especially because it is not only 
one of the most extensively useful, but also 
one of the safest and most generally appli- 
cable remedial agents which can be placed 
in unprofessional hands. Heat may be used 
as a remedial agent, simply as a soother, or 
— if we may be allowed the expression — an 
anodyne. It may be used as a derivative, 
or as a counter-irritant. Its application 
in the latter form will be found alluded to 
under the article on the subject. In cases 
of severe pain such as colic, gall-stones, 
gravel, &c. heat properly applied, seems to 
act as heat simply, upon the nervous system, 
exerting an anodyne effect, and relieving the 
spasm. For this purpose it may be used, 
by means of bottles or tins filled with hot 
water, hot bricks, &c. &c. ; but these solid 
bodies are not so useful or pleasant as other 
more yielding agents ; and bags filled with 
heated grain, oats, salt, bran, or some such 
material are to be preferred. Hooper's 
elastic cushions, which can be filled with 
hot water, are also admirable for the pur- 
pose. When a derivative (see Derivative) 
action is required, as it is in inflammation and 
inflammatory pain, then heat with moisture 
must be used, and nothing answers better 
than the agency of moist, heated bran. 
The great effect of the heat and hot vapour 
when used, in these cases, is to produce 
perspiration from the part, and thus to 
combine this means of relief with the ano- 
dyne action of the elevated temperature. 
The use of heat, especially of moist heat, 
in the treatment of disease, is especially 
pressed upon the attention of the unpro- 
fessional reader, for it is a remedy almost 
always procurable, and almost always safely 
usable. There are, however, a few ex- 
ceptional cases, in which the use of heat is 
not desirable. These are such as call for 
astringing rather than relaxing. Bleeding 
from, and swelling of various parts may be 
increased by heat, which must, therefore, 
be avoided. 

Refer to Animal Heat — Bran — Fomentation 
— Poultice, §c. 

HECTIC, or Hectic Fever — Is an inter- 
mittent form of fever which occurs in the 
latter stages of consumption, and also of 
other diseases of a slow wasting character. 
The paroxysm of hectic usually comes on 
toward six o'clock in the evening — the 



person becomes heated, perhaps thirsty, the 
eyes are brighter than usual, the cheeks 
reddened, (sometimes beautifully coloured,) 
and display the circumscribed " hectic 
flush," at the same time, an almost morbid 
elevation of spirits is not uncommon. To- 
ward midnight the stage of fever is suc- 
ceeded by that of perspiration, which in- 
creases as morning approaches, till toward 
four or five o'clock the patient is completely 
soaked in moisture, and is left in a state of 
painful exhaustion. 

Refer to Consumption, $c. 

HELLEBORE, Black Hellebore, or 
Christmas Rose. — The root has been used 
as a purgative since ancient times, particu- 
larly in cases of insanity, &c. 

HEMATEMESIS.— Bleeding, or vomiting 
blood from the stomach. 

HEMATURIA.— Flow of blood from the 
bladder. 

HEMICRANIA.— Pain confined to one 
side of the head. It is generally of a neu- 
ralgic or rheumatic character, and is often 
relieved by hot fomentation. 

HEMIPLEGIA.— See Paralysis. 

HEMLOCK— Conium Maculatum.— This 
well-known native plant belongs to the 
umbel-bearing tribe. Persons frequently 
call all plants of this tribe " hemlock," but 
erroneously. The true hemlock may at once 
be distinguished by its being the only British 
plant belonging to the umbelliferse which 
has a smooth spotted stem. The knowledge 
of this fact may be useful in case of alarm, 
not unfrequent, from children having eaten 
the leaves of such plants in mistake for 
parsley. The leaf of the hemlock is a very 
deep green, and, when bruised, emits an 
odour like that of mice. Hemlock is used by 
medical men as an occasional substitute for 
opium. Domestically, the leaves may be 
used externally, as a poultice, in painful 
ulcerations or tumours. 

In persons poisoned by hemlock, the 
symptoms are giddiness and dimness of 
sight, convulsive twitchings, paralysis, per- 
haps vomiting. The same treatment as that 
recommended in poisoning by belladonna 
may be adopted until medical aid can be 
procured. The use of strong coffee or green 
tea will also be advisable. 

HEMOPTYSIS.— Bleeding from the lungs, 
or " spitting of blood." 

HEMORRHAGE— Bleeding— Is the es- 
cape of blood from its own proper vessels, 
but the term is usually applied to cases in 
which the effusion takes place in consider- 
able quantity, and is rapidly poured out. 
Hemorrhage may be either external or in- 
ternal. In the former instance, it is almost 



HEM 



283 



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invariably the result of wound of some 
blood vessel, either artery or vein ; in the 
latter, the blood may also be poured out by 
a large vessel, but generally it is exuded 
through the lining membrane, or into the 
tissues of the part in which it occurs, from 
the minute vessels, so minute indeed, that 
after fatal cases of internal hemorrhage, the 
closest examination may fail to detect any 
visible opening, or openings, from which 
the blood can have escaped. 

For information respecting external he- 
morrhage, or such as occurs from arteries or 
veins, the reader is referred to the articles 
under these heads. 

Internal hemorrhage, when it does occur 
from a large vessel, is the result of that 
vessel having been opened by disease, such 
as aneurism, (see Aneurism,) or by ulcera- 
tion, but these instances are comparatively 
few. The head is an exception, however, to 
this remark, for hemorrhage within its cavity 
is almost always occasioned by the rupture of 
a vessel. — See Apoplexy, Brain. Hemorrhage 
from piles is also exceptional. — See Piles. 

Internal hemorrhage may be either of an 
active or of a passive character ; that is, in 
the former case, the effusion of blood is 
preceded and accompanied by feverish 
symptoms, quickened pulse, thirst, with a 
sensation of fulness and heat in the part 
whence the blood flows ; in the latter, these 
symptoms are absent. The effect of active 
hemorrhage is, generally, to give relief, 
either to the constitution at large, or to the 
particular part. Indeed, by some, active 
hemorrhage is regarded as a natural cure 
of what might otherwise prove an attack of 
inflammation. Passive hemorrhage, on the 
other hand, almost invariably weakens ; it 
is the result of weakness and relaxation, 
which its occurrence tends to increase. 

As may be imagined, in the treatment of 
hemorrhage generally, medical men have to 
keep these differences distinctly in mind, 
lest, by interfering with, too precipitately, 
or checking too soon an active hemorrhage, 
they may thwart the natural curative effort ; 
or by permitting passive loss of blood to 
continue, they allow a patient to be unne- 
cessarily, perhaps irremediably weakened. 
Moreover, it is necessary in the treatment 
of hemorrhage, to consider whether the flow 
may not be what is called " vicarious," that 
is, a substitute for some natural discharge 
which has been checked, or whether it may 
not have become an habitual safety-valve. 
The danger of checking long- accustomed 
discharge of blood, such as that from piles, 
is a matter not only of popular belief, but 
(and perhaps justly) of strong popular pre- 



judice, having become so from the notable 
frequency with which attacks of other 
disease, particularly of apoplexy, have fol- 
lowed the suppression of accustomed dis- 
charges. Medical experience abundantly 
supports the general opinion on this head, 
and it is a well-understood rule, that habi- 
tual hemorrhages should never be interfered 
with so long as they do not touch the gene- 
ral health and strength. 

As regards the management of or inter- 
ference with continued cases of hemorrhage, 
therefore, unprofessional persons ought not, 
and cannot, with any propriety, have any 
thing to do ; but, when the occurrence itself 
actually takes place, a knowledge of the best 
mode of" proceeding may be of much service ; 
for, though in the case of active hemorrhage, 
benefit may, up to a certain point, be de- 
rived from the circumstance, the process 
might possibly, especially if improperly ma- 
naged, run on to an undue extent, and even 
affect life. 

Hemorrhagic exudation of blood is more 
liable to occur from some parts of the body 
than others, and particularly from the mu- 
cous membranes which line the nasal and 
air-passages generally, from the alimentary 
canal, and genito-urinary organs. "Another 
important fact in respect to hemorrhages 
by exhalation is, that they proceed more fre- 
quently from certain parts of these mucous 
membranes than others, according to the 
differences in age. Thus, in children, they 
are most common from the membrane that 
lines the nasal cavities ; in youth, from the 
mucous membrane of the lungs and bron- 
chi." In middle life, from the bowels or 
bladder, or in the head. 

When an individual is suddenly seized 
with bleeding or hemorrhage from any part, 
as a general rule, perfect quietude of body 
and mind should be observed, and cold is 
the simplest and readiest astringent, ap- 
plied in the various forms of cool air, cold 
Avater, &c. &c. Medicinal astringents (see 
Astringents) may be resorted to, and should 
the resulting depression be extreme, stimu- 
lants may be required, but their adminis- 
tration calls for the greatest caution ; and 
it must be remembered that the state of 
depression may be the chief security to the 
patient against an immediate return of the 
bleeding. 

The causes of hemorrhage are various. 
As might be expected, general plethora, or 
superabundance of blood, is a common one ; 
hence, persons who take but little exercise 
and live freely are liable to it more than 
others. Perhaps the most general cause of 
hemorrhage is congestion, or accumulation 



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284 



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of blood in any one part or organ of the 
body, in consequence of some impediment 
to the circulation ; thus, disease of the 
heart, by damming up the blood in the 
lungs, or disease of the lungs themselves, 
which impedes the flow, may, either of 
them, cause spitting of blood : or disease 
of the liver may cause hemorrhage from the 
bowels. In some particular states of con- 
stitution, there appears to exist a strong 
tendency to effusion of blood ; this is seen 
in scurvy, and in the disease called purpura, 
or, popularly, the "purples." Moreover, 
there is a certain constitutional tendency, 
or "diathesis," called the "hemorrhagic," 
in which a more than usual liability to bleed 
from slight wounds exists. In persons who 
possess this diathesis, even the extraction of 
a tooth may, and has proved fatal, in con- 
sequence of uncontrollable bleeding. ' The 
tendency is hereditary, and those who in- 
herit it must be extremely cautious before 
submitting to even trifling operations, which 
involve breach of surface and effusion of the 
vital fluid. 

Bleeding from the nose (Epistaxis) is 
sometimes very profuse, and, either on this 
account, or from frequent repetition, may 
be the source of great weakness, in consti- 
tutions that can ill afford the drain, for its 
occurrence is not uncommonly associated 
with tendency to chest affection. Many 
various methods for its suppression are 
had recourse to, but cold applied to the 
forehead, spine, or other parts of the body, 
is the most general. Raising both arms 
above the head has been said to stop the 
flow quickly, or a small quantity of solution 
of alum, as strong as it can be made, may 
be thrown up with a syringe ; or a piece of 
linen, soaked in the solution, may be stuffed 
up the nostril. From ten to fifteen drops 
of dilute sulphuric acid may be given in 
water at intervals, according to the nature 
and persistence of the attack. 

Bleeding from the nose, in persons ad- 
vanced in life, must be much more cau- 
tiously interfered with than in the young. 
In the former, it is generally preceded by 
symptoms indicative of congestion about the 
head, and, consequently, is a natural relief. 
It may, of course, go to an extreme extent, 
and require checking. 

Bleeding from the lungs, or spitting of 
blood, is generally preceded by symptoms 
indicative of undue determination or con- 
gestion of blood to, or in these organs. Op- 
pressed breathing, cough, pain in the chest, 
and feverish symptoms usually precede the 
attack, and just previous to it a saltish 
taste is generally perceived. Bleeding from 



the lungs may occur in every degree, frorr 
a mere tinge of the expectoration, to the 
copious coughing up of fluid blood. The 
blood is coughed up, whereas, when.it comes 
from the stomach, it is vomited, a distinc- 
tion which appears evident enough, but which 
is not always readily made in practice. The 
management of hemorrhage from the lungs 
must be that recommended for hemorrhage 
generally. Until medical assistance can be 
procured, perfect quiet is to be observed, 
cool air, especially on the chest, freely ad- 
mitted, and cold, or iced and acidulated 
drinks given plentifully. Alum will also be 
found useful. — See Alum. Should the attack 
continue, and medical assistance still be 
absent, cupping on the chest, or between 
the shoulders, might be had recourse to. 
Sulphuric acid may be given as recom- 
mended for bleeding from the nose, or in 
an extreme case, when medical aid is far 
distant, one grain and a half of sugar of 
lead may be given, made into pill with 
crumb of bread, every two, or three, or four 
hours, being washed down by a draught of 
vinegar and water. The expressed juice 
of the common nettle is sometimes popu- 
larly used, and, it is said efficaciously, to 
check bleeding from the lungs ; the dose, 
one teaspoonful three times a day. The 
inhalation of the smoke from the burning 
leaves of the belladonna is said to check 
the immediate flow of blood from the lungs. 
For this purpose one drachm of the cut 
and dried leaves is to be thrown upon 
glowing coals. In tendency to passive he- 
morrhage from the lungs, Dr. Theophilus 
Thompson recommends the following lozenge 
to be used as occasion may require : — Take 
of powdered gum arabic and of white sugar, 
each three drachms ; powdered tragacanth 
one drachm and a half, alum two drachms, 
catechu three drachms, rose-water sufficient 
to form a mass, which is to be divided into 
sixty lozenges. When the cough is trouble- 
some, it will be best allayed by a few drops 
of laudanum. 

The causes of hemorrhage from the lungs 
are such as have been named above ; per- 
sons of scrofulous constitution, or who have 
any malformation of the chest, are most 
liable to suffer from it. It rarely occurs 
in children. The exciting causes of this 
form of hemorrhage are such as call the 
lungs into active, strong, or continued ex- 
ertion, such as violent bodily movements, 
much loud exercise of the voice, playing 
on wind instruments, &c. ; these things 
must, therefore, be sedulously avoided by 
those who have any tendency to the dis- 
order. Temperance and moderation, strict 



HEM 



285 



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attention to the condition of the bowels, and 
to any accidental disorders of the chest, 
will be the best safeguards. While treating 
of this subject, it should be mentioned that 
persons are often needlessly much alarmed, 
from thinking they are expectorating blood, 
while the fluid simply comes from the throat 
or gums, or, it may be, is the consequence 
of blood from the nose trickling down the 
back of the throat. It perhaps is scarcely 
necessary to add, that the above details of 
management are not meant to stand in the 
place of competent medical advice. This 
should never be dispensed with in so serious 
a disorder as spitting of blood. 

In hemorrhage from the stomach, "hema- 
temesis," the blood is vomited, not coughed 
up : its causes and treatment, modified, of 
course, by the difference in the organ, and 
its site, are similar to those detailed in he- 
morrhage from the lungs. Vomiting of 
blood in young females is not a very un- 
common accompaniment of disorder of the 
menstrual functions, and can scarcely be 
considered a dangerous affection. The re- 
storation of the proper excretion is, of 
course, the most effectual remedy. 

Vomiting of blood may happen in con- 
sequence of blood which has been effused 
from the nose having been swallowed ; in 
this case it is generally darkened by the di- 
gestive action of the stomach. Blood from 
the lungs is generally much more frothy 
than that ejected from the stomach. In 
either case, the more florid the hue the 
more active or inflammatory the hemorrha- 
gic tendency. Profuse discharge of blood 
from the bowels often occurs in the course 
of fever, or from diseases of the abdominal 
organs, such as the liver, &c. Flow of blood 
from the bladder ("hematuria") will be ad- 
verted to under article Urine. 

Refer to Abortion — Artery — Child-birth — 
Piles — Veins — Wounds, fyc. 

HEMP, or Indian Hemp — From which the 
"haschisch" of the Arab, the bhang and 
gunjah of the East Indian is obtained, is 
used by Asiatics on account of its intoxi- 
cating properties, and is coming into use in 
medical practice in this country for its ano- 
dyne powers, particularly in neuralgia. 

HENBANE — Hyoscyamus Niger — Is a 
native of Britain, and of Europe generally, 
being found on roadsides and uncultivated 
ground, particularly in the vicinity of houses. 
It is, however, cultivated for medicinal use. 
Henbane grows from one to three feet high ; 
its leaves are large, the edges waved — si- 
nuous — pale green, and viscid ; the flowers 
are dingy-yellow, and much and darkly 
veined ; the whole plant smells disagreeably. 



Henbane is one of the narcotic substitutes 
for opium most generally employed. It is 
given either in tincture or extract — the dose 
of the former being from ten to thirty drops, 
and of the latter from five to ten grains. 

The action of henbane is in many re- 
spects similar, but much inferior in power 
to opium. It possesses, however, one great 
advantage over that drug — it does not con- 
fine the bowels ; it is, therefore, a most ad- 
mirable addition to medicines, particularly 
purgatives, which are apt to gripe. In many 
cases, the addition of one-third of the extract 
of henbane to the compound colocynth, and 
other aperient pills, is of much service. ' It 
sometimes occasions (in too large doses) a 
peculiar state of delirious hallucination. In 
a case of poisoning by henbane, treatment 
similar to that recommended under " Bella- 
donna" should be adopted. 

HEPATIC— Belonging to the Liver. 

HEPATITIS.— Inflammation of the Liver. 

HEREDITARY TENDENCY.— The trans- 
mission of a tendency toward certain 
forms of disease from parents to children, 
and from ancestry generally to their de- 
scendants, has been an acknowledged fact 
from remote ages; a proof of the unmis- 
takable character and frequency of the 
incident. Some portions of the body are 
more liable to be affected by transmission 
than others, "but no organ or texture is 
exempt from the chance of being the sub- 
ject of hereditary disease ;" and although 
some diseases are well known to be much 
more generally inherited than others, we 
have no means of determining how far the 
limitation extends, or whether indeed it 
does not include diseases generally, within 
its bounds. 

Although there are maladies, such as 
small-pox, which are so directly inherited 
that the offspring is actually found to be 
affected with them when born, this is not 
the common rule — the hereditary taint act- 
ing rather by giving the bias to the develop- 
ment of the disease ; and it is observed that 
those children which more nearly resemble the 
parents in physical conformation are more 
likely also to resemble them in liability to 
certain forms of hereditary affections. It is 
not necessary, however, for the transmission 
of hereditary disease that it should be de- 
veloped in the parent, who, although the 
connecting link between a grandparent and 
grandchild as regards the disease bias, may 
yet have been entirely free from the trans- 
mitted disorder. In other words, an heredi- 
tary tendency to disease seems often to skip 
over one generation. 

Hereditary predisposition may be derived 



HER 



286 



HIP 



from a parent direct, and from a parent 
only, in whom a certain state of disorder 
has been developed, independent of previous 
hereditary influence. Whatever debilitates 
the system, whether it be advanced life, 
dissipated habits, or the like, is almost 
certain to affect the children, and may ori- 
ginate a tendency to scrofula in a family 
previously free from it. Even a transient 
bodily condition seems frequently to influ- 
ence the offspring, more particularly as 
regards the nervous system. Drunkenness 
in the parent produces idiotic children. 
Mental excitement communicates its own 
tendency. 

Again, disease apparently hereditary may 
be developed in a family without its being 
traceable in the descent, that is, the chil- 
dren, (many, or all of them,) may be liable 
to certain forms of disease, toward which 
neither the parents nor ancestors generally 
had displayed any marked tendency. The 
fact is one not uncommonly met with. 

Scrofula and consumption, gout and rheu- 
matism, insanity and paralysis, asthma, epi- 
lepsy, blindness, and a good many other 
diseases are well ascertained to be trans- 
mitted by hereditary tendency. It is not, 
however, necessary that the tendency should 
develop itself under the exact form of the 
disease of the parent ; thus, scrofula, instead 
of showing itself as consumption, may take 
the form of insanity, or gout may be sub- 
stituted for gravel. 

The practical importance of a knowledge 
of these hereditary tendencies is self-evi- 
dent. There are perhaps few, if any, who 
do not inherit some predisposition to cer- 
tain forms of bodily disorder. It must, there- 
fore, be not only to the advantage, but it 
must be the duty of every responsible per- 
son to consider what these predispositions 
are in himself, and to endeavour, as far as 
circumstances will permit, to avoid their 
being excited. Still more important is it, 
in the contraction of marriage, to consider 
whether union with one having similar 
hereditary tendencies will not certainly 
entail upon offspring an irremedial predis- 
position to disease thus devolved upon them 
from both parents. This argument derives 
tenfold force if the parents happen to be 
nearly related by blood; for even in healthy 
families, the marriage and intermarriage 
of near relatives almost certainly leads 
to the production of weakened and weakly 
descendants.— Refer to Marriage. 

HERNIA — Means the protrusion of a por- 
tion of any organ from the cavity in which 
it is naturally contained ; thus, there is her- 
nia of the brain, or of the lungs. The term 



is, however, most generally applied to the 
protrusion of part of the contents of the ab- 
domen. — See Rupture. 

HERPES. — A disease of the skin, cha- 
racterized by the eruption of aggregations 
of small blisters. Shingles is a form of 
herpes. — See Skin. 

HERRING— Like the other oily fishes, is 
apt to disagree with weak stomachs. 

HICCUP — Is a spasmodic affection of the 
diaphragm. — See Diaphragm. Generally a 
trivial and transient inconvenience, its oc- 
currence in the last stages of acute disease 
is a grave (often fatal) symptom, indica- 
tive of giving way of the nervous system 
generally. 

Continued and obstinate hiccup some- 
times occurs in the persons more especially 
of young females of an hysterical tendency, 
and may continue for weeks without cessa- 
tion, except during the hours of sleep, in 
spite of all kinds of treatment. The causes 
of ordinary hiccup are generally fasting, 
or some sudden stimulant taken into the 
stomach, such as highly seasoned soup ; and 
the affection generally subsides of its own 
accord. When inconvenient, nothing is so 
likely to remove it as some active emotion 
of the mind suddenly excited. The con- 
tinued sipping and swallowing of cold water 
is a frequent domestic remedy ; or antispas- 
modics, such as sal-volatile, may be useful. 
In the attacks of continued hiccup above- 
mentioned, a medical man should be con- 
sulted ; but the disorder will frequently run 
its course in spite of his treatment. Accu- 
puncture has been said to be a successful 
mode of treatment. — Refer to Hysteria. 

HIP- JOINT.— The hip-joint is formed on 
Fig. lxxxv. 




HIP 



287 



HON 



tie one hand by the head of the thigh-bone, 
(fig. lxxxv. 1,) and on the other by the 
deep cup or cavity, (fig. lxxxv. 2,) which is 
excavated for its reception in the bones of 
the pelvis, (3,) or hips, thus constituting a 
ball and socket-joint, which, although it may 
suffer dislocation, can only do so from ex- 
treme violence in peculiar directions, and 
in peculiar positions of the limbs. 

HIP-JOINT DISEASE — Morbus Coxa- 
bius — Is a disease of the joint just de- 
scribed, to which children of a scrofulous 
constitution are more peculiarly liable. It 
is of the highest importance as regards 
ultimate results that this affection should 
be placed under proper surgical treatment 
in the earliest stage in which it can be 
detected ; but its approaches are often so 
insidious that in most cases it has made 
considerable advance before it is even sus- 
pected by parents that there is any thing 
wrong. The following description, by Pro- 
fessor Syme, may, perhaps, put some upon 
their guard : — 

"Hip disease prevails in cold, moist cli- 
mates, and attacks chiefly children between 
the ages of seven and fourteen, though it 
is not unfrequently met with both before 
and after this time of life. The first symp- 
tom complained of is" generally pain of 
the knee, which often exists for months be- 
fore any indication can be perceived of the 
true seat of the disease. Sooner or later 
the patient is observed to walk awkwardly 
and less vigorously than usual ; and when 
the circumstances on which this difference 
depends are investigated, it appears that 
the affected limb is elongated and emaci- 
ated — that the convexity of the hip is flat- 
tened so that the furrow between it and 
the thigh is less distinct and more oblique 
in its direction — and that, in standing, the 
foot is advanced a little before the other 
one, with the toe slightly everted, and that 
the patient does not rest his weight upon 
it. Pain is now felt in the hip-joint itself, 
and, though aggravated by motion, often 
becomes more severe from time to time 
without any such cause of irritation. It 
is most apt to do so during the night, par- 
ticulai-ly when the weather is wet and 
changeable. In this second stage, the dis- 
ease remains generally several months, and 
sometimes a year or two. At length the 
symptoms which have been mentioned, 
either disappear, and the limb recovers its 
former condition, or they are succeeded by 
others still more disagreeable. In the lat- 
ter case, the limb becomes considerably 
shorter than the sound one ; its mobility 
is at the same 4;ime much impaired or 



altogether destroyed, and permanent rota- 
tion either inward or outward is also appa- 
rent. Collections of matter now generally 
make their appearance, most frequently on 
the outer side of the thigh, but occasionally 
in the groin and hip. In some few instances, 
but very rarely, the fluid of these abscesses 
is absorbed, but the ordinary course which 
it follows is to issue externally through 
openings formed, either by ulceration, or 
artificially by the surgeon. The patient 
then, after a tedious illness, becomes hectic 
and dies, or recovers with a stiff joint, and 
a wasted, useless limb." 

HOME-SICKNESS, or Nostalgia— Is a 
peculiar affection of the mind to which the 
natives of mountainous countries, especially 
the Highlanders of Scotland and the Swiss, 
are liable when at a distance from, and 
during prolonged absence from their homes. 
They are seized with a vehement desire to 
return, and if this is not gratified, melan- 
choly, loss of sleep and appetite, and finally, 
perhaps, disease of the lungs, supervene. 
The emotion is liable to be excited by 
whatever recalls forcibly to the mind the 
beloved scenes : national music does this 
most strongly ; so much so, indeed, that it 
has been found requisite to prohibit for a 
time the performance of certain airs when 
I troops have been stationed abroad. 

HOMCEOPATHY— Is the system of treat- 
ing disease founded by Hahnemann, upon 
the principle that diseases presenting cer- 
tain sets of symptoms are cured by medi- 
cinal agents which have the power of ex- 
citing similar symptoms in the body of a 
healthy person to whom they may be admi- 
nistered. In conjunction with this prin- 
ciple, practical homoeopathy enjoins the ad- 
j ministration of the above medicinal agents 
in inconceivably minute doses. In a work 
(like the present it would be futile — in the 
: limited space which could be allotted to the 
| subject — for the author to attempt to lay 
I before his readers those reasons which, to 
'his own mind, would render him loth to 
i trust either his own life or the lives of his 
^patients to homoeopathic treatment. 

HONEY — The well-known substance col- 
. lected by bees from flowers, consists almost 
entirely of sugar, partly crystallizable, and 
I partly not so ; the first being similar to 
! grape-sugar, and capable of undergoing at 
j once the vinous fermentation. Honey varies 
Jin degree as regards fragrance and taste, 
\ according to the flowers from which it is 
| collected ; and in some instances, it is even 
j of a poisonous nature, in consequence of 
| being collected from poisonous plants. As 
r an article of diet, honey is wholesome for 



HOO 



288 



HOO 



most persons, although with some it causes 
acidity, and with others it gripes. It is 
slightly aperient. For medicinal purposes, 
especially domestically, honey is frequently 
used, and answers well as a pleasant addi- 
tion to cough-mixtures, &c. Mixed with a 
little vinegar and lemon-juice, it is useful 
in cases of sore-throat and cough, with ad- 
hesive expectoration. Honey is frequently 
used mixed with borax in cases* of thrush 
in children, and in sore mouths generally. 
The form is a bad one in all such cases, and 
especially in the former disease. 

Refer to Borax. 

HOOPING-COUGH, or Chin Cough— May 
be described as a spasmodic catarrh. It 
is one of those diseases of which one attack 
confers immunity from all future liability 
to the affection, and as it is generally 
passed through in childhood, hooping-cough 
is comparatively seldom met with in adults, 
although they are by no means exempt 
from it. 

The first symptoms of hooping-cough are 
those of common cold, which, having con- 
tinued unrelieved for ten days or a fort- 
night, gradually assumes the spasmodic 
character of the disease, that is, the cough 
comes on in prolonged paroxysms, which 
present the following symptoms : — After a 
succession of violent expulsive coughs, a 
long-drawn inspiration is made, accom- 
panied with the peculiar crowing, or 
"hoop," which characterizes the disease 
and gives it its name ; this inspiratory effort 
is again immediately followed by the same 
expulsive coughs, and the alternation con- 
tinues until the child is relieved by ihe ex- 
pectoration simply of a quantity of glairy 
phlegm, or by vomiting, which also expe- 
dites the expectoration. Very soon after 
the paroxysm is over, the child resumes its 
ordinary condition, whatever that may be ; 
and if the stomach has been emptied of 
food, generally, before long, complains of 
hunger. 

While the expulsive cough is going on the 
child seems on the point of suffocation ; the 
face becomes swelled and livid, the veins 
turgid, the eyes projecting ; the whole 
frame is so shaken, that the little patient 
seeks to steady itself by laying hold of 
some fixed object — its nurse, a table, a chair 
— indeed, children who have suffered some 
little time from hooping cough, instinctively 
run to some means of support as soon as 
they feel a paroxysm coming on. 

The severity of hooping-cough varies 
greatly ; sometimes it is so mild a disease 
that it is scarcely possible to pronounce 
whether it has existed or not, no more than 



one or two "hoops" having been heard du- 
ring its course ; at others, the paroxysms 
of hooping and cough occur many times in 
the twenty-four hours. At first, the expec- 
toration is thin, and got up with difficulty ; 
as the disease advances, especially if fa- 
vorably, it becomes more consistent, and is 
more readily parted with. 

When hooping-cough is on the decline, 
the paroxysms occur only at more distant 
intervals, and are shorter, in consequence 
of the greater freedom of expectoration. 
Bleeding at the nose is not at all an unfre- 
quent consequence of a fit of coughing, and, 
in stout children, may be regarded as a 
relief. The duration of hooping-cough may 
be from one month to six, according to cir- 
cumstances, such as season, summer being 
the most favorable. When it exists alone, 
it is not a serious disease ; but when, as it 
too frequently does, it becomes complicated 
with head affections, such as convulsions, 
&c. or with inflammation of the lungs, it 
is transformed into a most dangerous ma- 
lady, and carries off numbers of children, 
particularly very young children — under 
two or three years of age — to whom it is 
more fatal than to those at a more advanced 
stage of life, and who have passed the age 
of teething. 

There is no question as to the contagious 
nature of hooping cough. 

In one respect, hooping-cough is like 
fever ; it is a disease which, as far as our 
present remedies are concerned, has a course 
to run, and one we cannot prevent; but 
we can guide the disease in that course, 
and by watching symptoms, and meeting 
them, should they assume a conspicuous 
or alarming character, prevent, by ap- 
propriate treatment, those complications 
which constitute it a disease of danger. 
In many cases, if the attack of hooping- 
cough is tolerably mild, parents never re- 
quire medical attendance ; but in the event 
of their not doing so, it is their duty to 
watch their children closely, and on the 
slightest appearance, either of inflammatory 
affection of the lungs, or of a tendency to 
convulsion, to call in proper advice, using 
in the interval — if there must be one — such 
modes of management as are recommended 
under these articles. As regards the actual 
treatment of the disease itself, it is ques- 
tionable whether any system of medicine is 
of very great service, but much depends 
upon proper and judicious management. 
The diet of the child should be strictly at- 
tended to, and ought to consist chiefly of 
milk and farinaceous preparations ; in 
short, a mild, unheating diet, meat being 



HOO 



289 



HOO 



better avoided altogether, unless the child 
is very delicate, in which case tolerably good 
broth will be the best mode of giving ani- 
mal food. The bowels ought to be kept in 
as regular a condition as possible by means 
of simple aperients, and the child protected 
from the influence of weather. — See Clothing. 
Indeed, if hooping-cough occurs in winter, 
the safer plan is to confine the child entirely 
to the house, and especially during the pre- 
valence of the east winds in spring. 

When expectoration is difficult, an emetic 
of ipecacuanha, given three or four times a 
week, will be useful, and the simple cough- 
mixture containing ipecacuanha wine may 
be used regularly. If the cough is very 
troublesome, a couple of grains of Dover's 
powder, given to a child of three years of 
age, at bedtime, will moderate it ; but the 
most efficacious remedy within the author's 
experience, is the combination of laudanum 
and tartarized antimony, or tartar emetic, 
which, indeed, is sometimes used domestic- 
ally. For a child three years old, a single 
grain of tartar emetic is to be dissolved in an 
ounce and a half of water, and to this 
fifteen drops of laudanum are to be added : 
a teaspoonful may be given every five or 
six hours. Dr. Golding Bird recommends 
alum, as in the following prescription: — 
Take of alum twenty-five grains, extract of 
henbane twelve grains, syrup of poppies 
two drachms, dill-water sufficient to make 
a three-ounce mixture, of which a des- 
sert spoonful may be given every six 
hours. Many other internal remedies for 
hooping-cough are given and recommended, 
such as alkalies, cochineal, iron, &c. &c. 
but these already mentioned are sufficient 
for the management of the disease. Ex- 
ternal remedies, such as embrocations, are 
often employed: "Roche's Embrocation" 
has been in much favour for the purpose ; it 
is said to consist of olive-oil two parts, oil 
of amber and oil of cloves each one part ; 
it is, therefore, stimulating, but probably 
any other stimulating embrocation, such as 
camphorated or ammoniated oil, would an- 
swer equally well. If any thing can be said 
to cure hooping-cough, it is change of air, 
which, in the latter stages of the affection, 
seems to act like a charm, and should 
always, when circumstances permit, be had 
recourse to. When the disease has passed, 
or is passing away, if the child, as perhaps 
it may be, is much reduced, strengthening 
remedies, tincture of steel, &c. with good 
diet, may be required. For some time after 
an attack of hooping-cough, more than or- 
dinary care must be taken to guard against 
cold, which is very apt to bring back — 
Z 19 



in degree — the symptoms, and even the 
"hoop." 

It is repeated, hooping-cough is not in 
itself a disease of danger, and, especially if 
it occurs in summer-time, may be safely 
and tolerably easily passed through, with 
judicious and simple management; but 
should it become complicated, as mentioned 
in the foregoing article, it may require all 
the care and skill of the physician to save life. 

Refer to Bronchitis — Catarrh — Convulsion 
— Expectorants, §c. 

HOPS — The well-known bitter agent, are 
the seed "catkins" of the Humulus lupulus, 
or hop-plant, which is native both to Eu- 
rope and the United States, and belongs 
to the nettle tribe. The elegant twining 
hop is too well known to require descrip- 
tion. The hop is an agreeable aromatic 
bitter ; it is, therefore, a stomach tonic. It 
possesses also narcotic properties, though 
not strongly marked ones ; a pillow stuffed 
with hops is frequently used to procure 
sleep, and hops heated in a flannel bag are 
a common remedy for toothache, neuralgia, 
&c. The use of hops to impart bitterness 
to beer was commenced in this country in 
the reign of Henry the Eighth, and there is 
no question that the addition is a perfectly 
wholesome one when not in excess ; with 
this view, the highly-hopped bitter India 
beer, or pale ale, may also be regarded as 
a medicinal tonic ; but it must also be a 
matter of doubt whether its continued use, 
in cold climates at least, is beneficial. 
Bitter tonics, generally, should not be 
taken too long at a time, and there seems 
no reason why bitter beer should be an 
exception to the rule. The practice, there- 
fore, of drinking it regularly cannot be re- 
commended — as far at least as its tonic 
properties are concerned. The infusion of 
hop is a good tonic in weak and irritable 
states of the stomach, either taken alone or 
combined with an alkali ; it is made by 
infusing an ounce of hops in two imperial 
pints of water : the dose a teacupful. The 
young shoots of the hop-plant are, in some 
places, cooked and eaten like asparagus, for 
which they do not form a very bad substitute. 

HOREHOUND— White Horehound— bo- 
tanically named Marrubium vulgare, is a 
tolerably common native plant ; it is, too, 
much cultivated in gardens in the country 
for domestic use — horehound tea being in 
much request for coughs, &c. 

HORSE-RADISH— The well-known con- 
diment, is the root of the Cochlearia ar- 
moracia, one- of the scurvy-grass tribe. It 
is powerfully stimulant. An infusion may 
be made in the proportion of an ounce of 



HOS 



290 



HOS 



the scraped root to a pint of boiling water ; 
and might be used in the absence of other 
stimulants ; or a poultice made of the scraped 
root might be used instead of a mustard- 
plaster. The infusion made into a syrup 
with sugar, and frequently sipped, is said to 
be useful in loss of voice from cold. 

HOSPITALS FOR THE SICK.— In large 
towns these benevolent institutions are an 
inestimable boon to the poor, more particu- 
larly in the present defective condition of 
sanitary arrangements. In them, with the 
exception of privacy, they have all that the 
wealthiest in the land can command : skill, 
cleanliness, food, medicines, and comforts 
of every kind. It is much to be regretted 
that the inhabitants of rural districts are, in 
a great measure, deprived of the resources 
of an hospital of some kind, especially in the 
case of contagious disease invading their 
crowded cottages. 

Amid the poor, many unfounded preju- 
dices and fears exist with respect to hos- 
pitals and hospital treatment. The following, 
from a most interesting popular account of 
St. George's Hospital in London, published 
in Dickens's Household Words, may perhaps 
add force to the assurance that nothing but 
the kindest and most considerate care is 
bestowed upon the poor in these [as well as 
in many other] most benevolent and most 
Christian establishments : — 

"A stranger's preconceived ideas of the 
sufferings in an hospital are not at all borne 
out by the appearance of the patients 
generally. Many of them are quietly read- 
ing the better class cheap literature of the 
day; others are conversing round the ample 
fire. The little child with its leg in a splint 
is as merry as possible, with its bed covered 
with playthings. Every thing that humanity 
can dictate, or to which art can minister, is 
supplied. The most eminent medical men 
— whose attendance sometimes the rich can- 
not purchase — watch the patient with all 
due art and skill ; while carefully-trained 
nurses are at hand, day and night, to ease his 
tired limb or to soothe his racking pain." 

Refer to Bedroom. 

HOUSES. — Nothing, perhaps, will excite 
greater surprise amid future generations, 
than the condition of the houses or dwellings 
in which the mass of the inhabitants of Eng- 
land, of the nineteenth century, were satis- 
fied in some instances, compelled in others, 
to spend the greater part of their lives. 

There can be no question, that to the 
insalubrity of the dwellings of the poorer 
classes especially, and often of the rich, 
much disease is owing. This is, un- 
doubtedly, in great measure due to igno- 



rance, for, spite of the efforts of health of 
towns' associations, and of the many chan- 
nels through which sanitary information has 
been attempted to be diffused of late years, 
it is astonishing how little real or practical 
information is retained by people generally. 
With respect to the various points connected 
with the salubrity of houses, the reader is 
referred to such articles in this work 
as "Bedroom," "Chimney," "Drainage," 
"Light," "Ventilation," " Water," &c. 

It is to be regretted, not only for their 
own sakes, but for that of the community 
at large, that our poor are so generally, in a 
measure, compelled to inhabit the crowded 
and unwholesome dwellings which they often 
do, particularly in large towns. When they 
have the power of the choice, the following 
considerations should be kept in mind. A 
house should not be chosen in a low, damp 
locality ; it cannot be well drained, and 
fever, rheumatism, neuralgia, &c. often 
prevail in such situations. A dry, gravelly 
soil is the most to be preferred, one that 
is well drained naturally — a circumstance, 
however, which should not prevent strict 
attention to artificial drainage. Good ven- 
tilation, and supply of water, ought also to 
be regarded as essentials ; neither is situa- 
tion as regards regular employment an un- 
important consideration. If a man's work 
is of a laborious, active character, he cannot, 
perhaps, live too near the scene of it ; but 
if, on the contrary, he is engaged in confin- 
ing and sedentary employment, it may make 
all the difference between good and bad 
health, if his dwelling be at such distance 
as shall compel a regular moderate walk at 
least twice in the day. 

The author cannot leave the subject of 
"houses" without adverting to the idea, 
that amid the numerous schemes pro- 
pounded for bettering the condition of our 
humbler classes, the facilities afforded by 
the unlimited powers of railway transit, 
have either been too much lost sight of, or 
are not yet sufficiently realized to men's 
minds. The necessities which in times past 
forced the population, first for the sake of 
defence, and latterly for the purposes of 
trade and commerce, to congregate in close- 
packed towns, have evidently passed away ; 
the one has been left behind in the march 
of civilization, the other has vanished in 
the virtual annihilation of space and time 
by railway power. The mechanic who — 
under proper arrangements — may be con- 
veyed in a quarter of an hour over six miles 
of rail, may now, as regards time, be as near 
his daily workshop as he is living in the 
crowded centre. On this fact the pro- 



HOU 



291 



HUN 



position is based, that beyond three or four 
miles from most of our large towns, land, 
for the most part, ceases to be of extra 
value, and thus would permit of decent 
cottages being erected for, and gardens let 
to the industrious mechanic, at an equally 
small, if not smaller rent than he now 
pays for his miserable room in the close, 
unhealthy street ; and at the same time, 
provided such habitations should be erected 
near a line of railway, within reasonable 
distance of the town, and proper arrange- 
ments entered into, their occupancy might 
be equally convenient as regards employ- 
ment in the city they suburbed, as the 
present mode of living. The advantages of 
the humbler classes being located in well- 
regulated moderate-sized communities in 
the country, are in themselves so manifest 
and obvious, that it needs not here to dilate 
upon them. Health, comfort, decent habits, 
new interests, such as those centred in 
the possession and cultivation of a garden, 
children employed in salutary exercise or 
light employment, instead of wallowing in 
the filth and vice of the town purlieus, may 
be mentioned, and with them the facility 
with which the suburban railway village 
may be furnished with its school, its read- 
ing and lecture room, its religious pro- 
vision, and whatever may assist in raising 
the character and moral standing of the 
humbler class ; for without that elevation 
there can be no firm foundation for a real, 
efficient, and lasting sanitary reformation, 
such as befits a civilized and a Christian 
people. 

HOUSEMAID'S KNEE.— See Knee. 

HUMERUS.— The. anatomical name of 
the arm-bone, (fig. lxxxvi.) This bone is, 

Fig. lxxxvi. 




at its upper end, (1,) articulated or jointed 
at the shoulder, to the shoulder-blade, or 
"seapula;" and at the elbow, by its lower 
end, (2,) to the two bones of the forearm. 

Refer to Forearm. 

HUNGER.— The desire for food is an in- 
stinctive sensation, evidently connected with 
the requirements of the body generally, and 
not solely with the condition of the stomach. 
In a healthy state, the appetite for food is 
in proportion to the waste of the body in ex- 
ertion ; in other words, if the motor change, 
or transformation, or using up of tissues, 
goes on more quickly, as it must neces- 
sarily do when much exertion is made, the 
tissue must be more abundantly supplied 
with nutriment, and vice versa, if exertion 
be less. In any case, the call for nutri- 
ment is made through the medium of the 
stomach, by the sensation of hunger. The 
direct cause of that sensation is doubtful ; 
some have referred it to a distended con- 
dition of the vessels, &c. of the stomach ; 
but, however that may be, it is certain the 
brain and nerves participate largely in the 
feeling. Dr. Alison remarks, " Whatever 
be the conditions under which the nerves 
of the stomach become the seat of these 
sensations, it is certain that, in the healthy 
state, they are a true index, not only to the 
state of the stomach, but to the immediate 
wants of the system at large." To use a 
simile, the brain may be likened to a great 
central telegraph-office, to which the wires 
— nerves — convey the information from all 
parts of the body that supplies are wanted, 
and this information is transmitted to the 
stomach by its own special means of com- 
munication — or nerves — and causes hunger. 
How and why this is, we cannot tell. Al- 
though, however, hunger is felt as a sen- 
sation in the stomach, in consequence of 
sympathy with the system at large, it is 
appeased by the introduction of food into 
that organ, long before the digestion of 
that food can have supplied the waste 
which called for it. To resume our simile, 
it would seem as if the stomach telegraphed 
back to the brain the information that the 
"order had been received and complied 
with" — that food had been taken — and so 
the sensation ceases. Moreover, the stomach 
may give false information ; for it is well 
known that the sensation of hunger may, 
for a time, be appeased by the swallowing 
of comparatively innutritious substances, 
which occupy the stomach, but which can- 
not be digested into nutriment for the sys- 
tem; and further, the sensation of hunger 
may be allayed by various medicinal sub- 
stances, such as opium, tobacco, alcohol, &c, 



HUN 



292 



II YD 



which do not nourish. Again, the informa- 
tion respecting the requirements of the 
system, conveyed to the stomach through 
the brain, may, so to speak, be stopped in 
transit ; this is seen in the case of acci- 
dents ; however hungry a man may be, if 
he should happen to sprain a joint, the ap- 
petite will disappear at once. Even mental 
emotions will, by their effect upon the brain, 
have the effect of destroying the sensation 
of hunger ; and Shakspeare adverts to this 
observation, in the words addressed to Wol- 
sey by King Henry the Eighth, along with 
an unpleasant communication : — 

Read o'er this : 
And after, this ; and then to breakfast, with 
What appetite you may." 

Intense engagement of the mind in study, 
or upon any subject which strongly excites 
its interest, it is well known will often over- 
power completely the sensation of hunger. 
This frequently happens to those who are 
much absorbed in scientific pursuits. The 
anecdote of the illustrious Newton is familiar 
to most : — A friend calling to see him was 
shown into the room where Newton's dinner 
— a chicken — was spread out ; being kept 
waiting, he ate the dinner and replaced the 
covers. The philosopher coming in shortly 
after, and finding his dinner gone, simply 
remarked, "Dear me, I forgot I had dined." 
It is, perhaps, unnecessary to remark, that 
such complete forgetfulness of the wants of 
the body is scarcely consistent with con- 
tinued health, either of it or of the mind ; 
and, in consequence of this, even Newton 
paid the penalty. 

The influence exerted by mental emotion 
over the sensation of hunger, may, however, 
tell both ways ; for, if it destroy real, it may 
excite false hunger, and this it frequently 
does. Very many are in the habit of eating 
much more largely than the wants — the waste 
— of the system require. This may be the re- 
sult of an unhealthy excitement of the nerves 
of the stomach, but much more generally 
it arises from epicurism, or love of excess, 
the mind being the cause of a false hunger, 
or desire for tempting and unnecessary ar- 
ticles of food. This is frequently the case 
with people who live idle and indolent lives, 
and who, having little else to occupy either 
mind or body, take refuge in the indul- 
gences of the table. The effects of this ex- 
citement and indulgence of false hunger, 
this habitual consumption of excess of food 
beyond what the wants of the system re- 
quire, may, for a time, be compensated for 
by the various excretory powers of the 
body, but sooner or later disease must be 
the consequence. 



The proper and permanent appeasement 
of hunger would seem, in some cases, to 
depend upon the fitness of the food taken 
for the circumstances of the system gene- 
rally ; every one with healthy appetite feels 
the desire for different kinds of food in 
winter and summer. Sir John Richardson 
mentions, with regard to his arctic experi- 
ence, that under exposure to intense cold, 
bread and such articles were not desired as 
food, which was always most acceptable when 
of as fat and oily a character as possible. 

Refer to Animal Heat — Appetite — Digestion 
— Fasting — Food, §c. 

HYDATIDS — Are parasitic beings belong- 
ing to the animal kingdom, which are found 
imbedded in the tissues, particularly the 
glandular ones, of animal bodies. The hy- 
datid consists of a simple vesicle filled with 
fluid, and multiplies by the development of 
young hydatids in its interior. 

HYDRAGOGUE— Is a term applied to 
some purgative medicines which produce co- 
pious watery evacuations from the bowels. 
— See Purgatives. 

HYDRARGYRUM.— Mercury or quick- 
silver. — See Mercury. 

HYDRIODATE op POTASSA.— See Io- 
dine, Potash. 

HYDROCELE.— A dropsical swelling with- 
in the scrotum. It requires proper surgical 
treatment for its cure, but a patient may 
derive much comfort by wearing a bag- 
truss, or some similar support, until he is 
relieved by operation. 

HYDROCEPHALUS. — " Water in the 
head." — See Brain. 

HYDROCYANIC ACID.— Prussic Acid.— 
See Prussic Acid. 

HYDROGEN GAS— Is the lightest sub- 
stance known, and, when pure, has neither 
colour, taste, nor smell; the latter, how- 
ever, is very frequently present in conse- 
quence of impurity. Hydrogen gas burns 
with a pale yellow flame, the product of the 
combustion is water, this fluid being a com- 
pound of oxygen and hydrogen gases in 
certain definite proportions. The union of 
hydrogen gas with sulphur constitutes the 
very offensive smelling gas, sulphuretted 
hydrogen, which is one of the products of 
the decomposition of organized bodies, and 
also forms the characteristic feature of many 
of the mineral waters, such as those of Har- 
rowgate, [in England, and of Virginia and 
New York, in the United States.] 

Refer to Carburetted Hydrogen. 

HYDROPATHY— Is the system of treating 
disease by the use of water, both internally 
and externally, in the modes introduced by 
Priessnitz. 



HYD 



293 



HYD 



Of the utility of water as an agent in the 
treatment of certain diseases, there cannot 
be a question, when its employment is judi- 
ciously regulated, and combined with other 
methods of cure ; but it is equally certain 
that its indiscriminate and wholesale use, as 
it has been practised in hydropathic esta- 
blishments, is too often a most dangerous 
quackery ; a quackery, because it is put 
forth with pretensions to which it has no 
claim, and is used in an indiscriminate and 
ill-judged manner. There are many con- 
ditions of body — particularly that of the 
overfed and the indolent — in which copious 
draughts of pure cold water, regulated and 
simple diet, exercise and promotion of the 
functions of the skin — all which are strictly 
enjoined under the hydropathic treatment 
— must evidently be of the greatest service ; 
nay, are in themselves sufficient to restore 
health ; and medical men have, perhaps, 
too much neglected such natural methods of 
cure, in their confidence in mere drugging. 
But it is no less certain, that an indis- 
criminate and extravagant use of even these 
natural methods cannot fail to prove inju- 
rious in many states of the system ; and so 
it has proved in many instances, and even 
death has been the result of the experi- 
ments. Still, it must be owned that the 
rise of hydropathy has had the advan- 
tageous effect of directing more attention to 
the value of water in the treatment of dis- 
ease ; and, if the system itself has been 
mixed up with much which must be con- 
sidered dangerous error, that should be no 
reason why the useful suggestions which 
may be gathered from it should not be taken 
advantage of. Indeed, for medical men to 
refuse to do so, is to place themselves in the 
same position as the abettors of an exclu- 
sive system, or the vendors of a " panacea." 
Medical science can only retain its high 
place by liberal investigation of those new 
phases in medical treatment, which must 
ever be arising in the progress of society, 
when these phases offer any tangible ground 
for such investigation — and this hydropathy 
certainly does. To refuse to investigate, 
or to refuse to adopt that which is good, 
because it has been found connected with 
some irregular system, is in itself quackei-y 
of the grossest kind, and is the most certain 
way of strengthening the hands of charla- 
tans or of fanatics. 

Refer to Water. 

HYDROPHOBIA— Literally, "Dread of 
water." — This fearful and justly-dreaded 
disease is especially of a nervous and spas- 
modic character, and is produced by ino- 
culation with the saliva of an animal labour- 
z2 



ing under the malady. Fortunately, it is of 
so comparatively rare occurrences that very 
few medical men ever witness it at all. For 
the information in the following article, the 
author is indebted to the " Lectures" of Dr. 
Watson. 

After a person has been bitten by a rabid 
dog, the wound heals in the same manner 
as an ordinary wound from the same cause 
would. « ' After an uncertain interval — which 
lies for the most part between six weeks and 
eighteen months — the following symptoms 
begin to be noticeable. The patient expe- 
riences pain, or some uneasy or unnatural 
sensation, in the situation of the bite. If it 
has healed up, the scar tingles, or aches, or 
feels cold, or stiff, or numb ; sometimes it 
becomes visibly red, swelled, or livid. The 
pain or uneasiness extends from the sore or 
scar toward the central parts of the body. 
Very soon after this renewal of local irri- 
tation — within a few hours perhaps, but 
certainly within a very few days, during 
which the patient feels ill and uncomfort- 
able — the specific constitutional symptoms 
begin. He is hurried and irritable ; speaks 
of pain and stiffness, perhaps, about his 
neck and throat ; unexpectedly, he finds 
himself unable to swallow fluids, and every 
attempt to do so bi'ings on a paroxysm of 
choking and sobbing, of a very distressful 
kind to behold ; and this continues for two or 
three days, till the patient dies exhausted." 
Hydrophobia has never been cured when 
once the decided symptoms have shown 
themselves. 

" Generally, the disease, when it has once 
set in, and shown the peculiar hydrophobic 
symptoms, runs a short and fierce course. 
The nervous irritability becomes extreme. 
The peculiar paroxysms of choking, spasm, 
and sobbing are excited, not only by at- 
tempts to swallow liquids, but by the very 
sight or sound of them. Even the passage 
of a gust of wind across his face, the waving 
of a polished surface, as of a mirror, before 
his eyes, the crawling of an insect over his 
skin, is often sufficient to excite great irrita- 
tion, and the peculiar strangling about the 
fauces in an hydrophobic patient. Death 
occasionally takes place within twenty-four 
hours after the commencement of the specific 
symptoms. Most commonly of all, it hap- 
pens on the second or third day;" but may 
be postponed even to the seventh or eigMh. 
In some instances the symptoms alter be- 
fore death, and the patient is able to swal- 
low liquids. 

With respect to the infection of hydro- 
phobia, Dr. Watson says — " We are sure 
that the disease, by the inoculation of 



H YD 



294 



H YD 



"Which hydrophobia may be produced in 
man, is common in the dog, and that it has 
been communicated by the fox, the wolf, the 
jackal, and the cat. Mr. Youatt says that 
the saliva of the badger, the horse, the hu- 
man being, have undoubtedly produced hy- 
drophobia ; and some affirm that it has been 
propagated even by the hen and the duck. 
All animals, even fowls, are susceptible of 
the disorder, when bitten by a rabid dog. 

The late Mr. Youatt, who had seen more 
of the disease, probably, both in man and 
in other animals, than any other person in 
this country, did not think that the saliva 
of a rabid animal could communicate the 
disorder through the unbroken cuticle : he 
believed that there must be some abrasions, 
or breach of surface. He held, however, 
that it might be communicated by mere 
contact with the mucous membranes. 

Of its harmlessness on the sound integu- 
ment, he offered this presumption — that his 
own hands had many times with perfect 
impunity been covered with the saliva of 
the mad dog. He records some singular in- 
stances in which the disease was transmitted 
by contact of the saliva with the mucous 
membranes. "A man endeavoured to untie 
with his teeth a knot that had been firmly 
drawn in a cord. Eight weeks afterward he 
perished undeniably rabid. It was then 
recollected that with this cord a mad dog 
had been confined. A woman was attacked 
by a rabid dog, and escaped with the lacera- 
tion of her gown. In the act of mending it, 
she thoughtlessly pressed down the seam 
with her teeth. She died. If these cases 
be authentic, they are conclusive of this 
question ; unless, indeed, the lips of those 
who perished happened to have been chapped, 
or abraded. But Mr. Youatt's own opinion 
was, that the virus could not be received on 
a mucous surface without imminent danger. 

The disease is said to have been caused 
by the scratch of a cat. But as we know 
that cats as well as dogs frequently apply 
their paws to their mouths, especially when 
the latter part is uneasy, (as it clearly is in 
mad dogs,) this fact, of the production of 
the disease by a scratch, if thoroughly made 
out, would not prove that the disease can be 
introduced into the system in any other 
way than by means of the saliva. 

"It is still more interesting to inquire 
whether the saliva of a human being labour- 
ing under hydrophobia be capable of ino- 
culating another human being with the same 
complaint ? Mr. Youatt says, yes, that the 
disease has undoubtedly been so produced. 
If this be so, the fact will teach us — not to 
neglect or desert these unhappy patients — 



but to minister to their wants with certaic 
precautions, so as not to suffer their saliva to 
come in contact with any sore or abraded 
surface ; nor with any mucous surface. On 
the other hand, all carefulness of that kind 
will be unnecessary, if the disease cannot be 
propagated by the human saliva. Certainly, 
many experimenters have tried in vain to 
inoculate dogs with the spittle of hydrophobic 
man ; but there is one authentic experiment 
on record, which makes it too probable that 
the disease, though it may not be communi- 
cated often, or easily, is yet communicable;" 
enough to enforce all necessary caution upon 
those engaged in attending upon an hydro- 
phobic patient. 

"Is a man who has been bitten by a mad 
dog, and in whose case no precautions have 
been taken, a doomed man ? Will he be sure 
to have the disease, and therefore die of 
it? By no means. But few, upon the whole, 
of those who are so bitten, become affected with 
hydrophobia. This frequent immunity from 
the disease in persons who have been bitten 
has tended to confer reputation upon many 
vaunted methods of prevention. Ignorant 
persons and knavish persons have not failed 
to take advantage of this. They announce 
that they are in possession of some secret 
remedy which will prevent the virus from 
operating : they persuade the friends of 
those who die that the remedy was not 
rightly employed, or not resorted to suffi- 
ciently early : and they persuade those who 
escape, that they escape by virtue of the 
preventive remedy. If the plunder they, 
reap from the foolish and the frightened 
were all, this would be of less consequence ; 
but unfortunately the hope of security with- 
out undergoing a painful operation leads 
many to neglect the only sure mode of ob- 
taining safety. 

* * " A still more anxious inquiry 
next arises. Whoever has been bitten by 
a rabid or suspected animal must be con- 
sidered, and will generally consider him- 
self, as being in more or less danger of 
hydrophobia. This dread is not entirely 
removed, even by the adoption of the best 
means of prevention. Now, how long does 
this state of hazard continue ? When is 
the peril fairly over ? After what period 
may the person who has received the injury 
lay aside all apprehension of the disease ? 
To this inquiry, no satisfactory reply can 
be given. In a vast majority of instances, 
indeed, the disorder has broken out within 
two months from the infliction of the bite. 
But the exceptions to this rule are too 
numerous to permit us to put firm trust in 
the unanimity afforded by that interval. 



H YD 



295 



H YD 



•* ¥r " Mr. Youatt describes cases in 
which there had been no symptoms of rabies 
observed in the dog at the time the injury 
was inflicted, though soon afterward the 
animal became decidedly rabid. It is much 
to be regretted that the dog is so often de- 
stroyed. When a person has been bitten 
by a dog or cat suspected to be rabid, the 
beast ought by no means to be killed, but 
to be secured and kept under surveillance, 
and suffered, if it should so happen, to die 
of the disease. If he do not die, in other 
words, if he be really not rabid, that will 
soon appear, and the mind of the patient 
will then be relieved from a very painful 
state of suspense and uncertainty, which 
might otherwise have haunted him for 
months or years. Should the dog die mad, 
the injured person will be no worse off than 
if the animal had been killed in the first 
instance ; nay, in one respect he will be 
better off, inasmuch as certainty of evil is 
preferable to perpetual and uneasy doubt. 

"There are gross errors prevalent with 
regard to the signs of madness in the dog. 
If a dog be seen in a fit in the street, some 
person charitably offers a conjecture that 
perhaps he may be mad; the next person 
has no doubt of it, and then wo to that 
dog. But Mr. Youatt assures us that the 
rabid dog never has fits ; that the existence 
of epilepsy is a clear proof that there is 
no rabies. Again, it is a very common 
belief that a rabid dog, like an hydrophobic 
man, will shun water ; and if he take to 
a river, that is thought to be conclusive 
evidence that he is not mad. But the 
truth is, that the disease in the quadruped 
cannot be called hydrophobia ; there is no 
dread of water, but an unquenchable thirst ; 
no spasm attending the effort to swallow, 
but sometimes in dogs an inability to swal- 
low from paralysis of the muscles about the 
jaws and throat. They will stand lap, lap- 
ping without getting any of the liquid down. 
They fly eagerly to the water ; and Mr. 
Youatt states that all other quadrupeds, 
with perhaps an occasional exception in the 
horse, drink with ease, and with increased 
avidity. 

"There is another superstitious opinion 
not at all uncommon, viz. that healthy dogs 
recognise one that is mad, and fear him, 
and run away from his presence, in obedi- 
ence to some mysterious and wonderful 
instinct warning them of danger. This is 
quite unfounded. Equally mistaken are 
the notions that the mad dog exhales a 
peculiar and offensive smell, and that he 
may be known by his running with his 
tail between his legs ; except when, as Mr. 



Youatt says, weary and exhausted he seeks 
his home." 

It will not be out of place to state what 
are the symptoms of rabies as observed in 
the dog, and as described by Mr. Youatt. 

"The earliest symptoms of madness in 
the dog," he says, "are sullenness, fidgeti- 
ness, continual shifting of posture, a stead- 
fast gaze expressive of suspicion, an earnest 
licking of some part, on which a scar may 
generally be found. If the ear be the af- 
fected part, the dog is incessantly and vio- 
lently scratching it. If it be the foot, he 
gnaws it till the integuments are destroyed. 

"Occasionally, vomiting and a depraved 
appetite are very early noticeable. The dog 
will pick up and swallow bits of thread or 
silk from the carpet, hair, straw, even dung, 
and frequently he will lap his own urine, 
and devour his own excrement. Then the 
animal becomes irascible, flies fiercely at 
strangers, is impatient of correction, seizes 
the whip or stick, quarrels with his own 
companions, eagerly hunts and worries cats, 
demolishes his bed, and, if chained up, 
makes violent efforts to escape, tearing his 
kennel to pieces with his teeth. If he be 
at large, he usually attacks only those dogs 
that come in his way ; but if he be natu- 
rally ferocious, he will diligently and perse- 
veringly seek his enemy." 

According to Mr. Youatt, the disease is 
principally propagated by the fighting dog 
in towns, and the cur, or lurcher, in the 
country ; by those dogs, therefore, which 
minister to the vices of the lower classes in 
town and country respectively. He main- 
tains that if a well-enforced quarantine 
could be established, and every dog in the 
kingdom confined separately for seven 
months, the disease might be extirpated. 

" Very early in the disease, as it appears 
in the dog, the expression of the countenance 
is remarkably changed ; the eyes glisten, 
and there is slight squinting. Twitchings 
of the face come on. About the second day 
a considerable discharge of saliva com- 
mences ; but this does not continue more 
than ten or twelve hours, and is succeeded 
by insatiable thirst ; the dog is incessantly 
drinking or attempting to drink ; he plunges 
his muzzle into the water. When the flow 
of saliva has ceased, he appears to be an- 
noyed by some viscid matter in his fauces ; 
and in the most eager and extraordinary 
manner he works with his paws at the cor- 
ners of his mouth to get rid of it; and 
while thus employed, he frequently loses his 
balance, and rolls over. 

"A loss of power over the voluntary 
muscles is next observed. It begins with 



H YD 



296 



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the lower jaw, which hangs down, and the 
mouth is partially open ; but by a sudden 
effort the dog can sometimes close it, though 
occasionally the paralysis is complete. The 
tongue is affected in a less degree. The dog 
is able to use it in the act of lapping; but 
the mouth is not sufficiently closed to retain 
the water. Therefore, while he hangs over 
the fluid, eagerly lapping for several mi- 
nutes, it is very little or not at all dimi- 
nished. The paralysis often attacks the 
loins and extremities also. The animal 
staggers about and frequently falls. Pre- 
viously to this, he is in almost incessant 
action." Mr. Youatt fancies that the dog is 
subject to what he calls spectral illusions. 
He says "he starts up, and gazes eagerly at 
some real or imaginary object. He appears 
to be tracing the path of something floating 
around him, or he fixes his eye intently upon 
some spot in the wall, and suddenly plunges 
at it ; then his eyes close, and his head droops. 

" Frequently, with his head erect, the dog 
utters a short and very peculiar howl ; or, 
if he barks, it is in a hoarse, inward sound, 
altogether dissimilar from his usual tone, 
and generally terminating with this cha- 
racteristic howl. Respiration is always 
affected ; often the breathing is very labo- 
rious ; and the inspiration is attended with 
a very singular grating, choking noise. On 
the fourth, fifth, or sixth day of the disease 
he dies, occasionally in slight convulsions, 
but oftener without a struggle. 

"Most people think that the disease is 
generated, de novo, in the dog at least ; and 
causes have been assigned for it which cer- 
tainly are not the true or the sole causes. 
Thus, hydrophobia in the dog has been as- 
cribed to extreme heat in the weather. 
It is thought by many to be particularly 
likely to occur in the dog-days ; and to be, 
as Mr. Mayo observes, 'a sort of dog-lu- 
nacy, having the same relation to Sirius 
that insanity has to the moon; which, in- 
deed, in another sense, is probably true.' 
Many cautions are annually put forth about 
that period for muzzling dogs, and so on. 
Very good and proper advice ; but if those 
who have noticed the statistics of the dis- 
ease may be depended upon, it would be as 
appropriate at one period of the year as at 
another. Rabies occurs nearly as often in 
the spring, in the autumn, and even in 
winter, as it does in summer. M. Trolliet, 
who has written an interesting essay on 
rabies, states that January, which is the 
coldest, and August, which is the hottest 
month in the year, are the very months 
which furnish the fewest examples of the 
disease. The disorder has often been as- 



cribed to want of water in hot weather, and 
sometimes to want of food. But MM. 
Dupuytren, Breschet, and Magendie have 
caused both dogs and cats to perish with 
hunger and thirst without producing the 
smallest approach to a state of rabies. At 
the veterinary school at Alfort, three dogs 
were subjected to some very cruel, but de- 
cisive experiments. It was during the heat 
of summer, and they were all chained in 
the full blaze of the sun. To one, salted 
meat was given, to the second water only, and 
to the third neither food nor drink. They 
all died, but none of them became rabid." 

When an individual has been bitten by 
an animal respecting which the slightest 
suspicion of hydrophobia exists, the one 
remedy cannot be too quickly resorted to — 
complete excision of the bitten part. Some 
persons have possessed sufficient nerve to 
do this for themselves — few perhaps could — 
but it has been effected by unprofessional 
persons for others ; indeed, there might be 
more danger in waiting many hours for a 
surgeon than in submitting to unprofes- 
sional operation. The method of excision 
most to be trusted, is the insertion of a 
skewer of wood, made to fit into the wound 
caused by the tooth, and carrying the in- 
cision so far round, that the entire hollow 
or cone of flesh is cut out along with the 
piece of wood. This might be done with 
safety in the thick part of the calves of the 
legs, or on the back part of the thighs or 
buttocks. Where excision is not resorted 
to, the free application of lunar caustic or 
of aquafortis, whichever may be most rea- 
dily procured, would be advisable ; or in 
lieu of these, a piece of iron, heated to 
whiteness, may be inserted into the wound, 
so as thoroughly to destroy the surface 
which may have been poisoned. These may 
seem severe measures, but they are light 
compared with the unceasing anxiety of 
mind which must haunt a person who, after 
having been bitten, feels that due precau- 
tion has not been taken ; and light indeed 
compared with liability to the disease itself. 
In the event of none of the above measures 
being submitted to, or available, the wound 
may be thoroughly washed for hours, by 
means of a stream of warm water poured 
upon it from a height; a cupping-glass being 
applied at intervals. These measures are of 
course only provisional, until the attend- 
ance of a surgeon can be procured. 

As might be imagined, the preventive 
medicines for hydrophobia are very nume- 
rous ; some have been thought highly of by 
medical men, but for the most part they 
are secret quack remedies, and perfectly 



H YD 



29: 



H YS 



worthless. It is absolute folly to trust to 
them, to the exclusion of the only certain 
preventive — excision or destruction of the 
"wounded tissues. 

When, from the peculiar symptoms, and 
taken in connection with the circumstances 
altogether they can scarcely be overlooked, 
an individual is thought to be attacked with 
hydrophobia, if the hope of saving life is 
small, much may be done to alleviate so 
terrible an affliction by proper medical care, 
which should be sought for at once. In the 
mean time, while all those sights and sounds 
alluded to in the first part of this article 
are carefully avoided, as a fearful aggrava- 
tion of the necessary suffering, laudanum 
may be given in thirty-drop doses, and re- 
peated as circumstances seem to dictate. 
If ice can be taken, it is said to afford relief 
put into the mouth in small morsels ; it has 
also been found of service applied to the 
back of the neck. If, on the arrival of a 
medical man, he likes to try any of the va- 
rious remedies which have been proposed in 
this disease, he of course can do so, but the 
above-mentioned will be sufficient for lay 
interference. 

The general interest and anxiety, and the 
very erroneous ideas on the subject of hy- 
drophobia which are entertained by people 
generally, have rendered the length of this 
article necessary, and in taking it almost 
entirely from the valuable writings of Dr. 
Watson, the author has endeavoured to draw 
from the best possible "source, information 
which, fortunately, few medical men have an 
opportunity of acquiring personally. 

HYDROTHORAX.— Water in the chest. 
— See Dropsy. 

HYDROSTATIC BED.— See Bed. 

HYGIENE.— The science of the preser- 
vation of health. 

Refer to various sanitary articles, such 
as Air — Bedroom — Climate — Food — Heat — 
Ventilation — Drainage, §c. 

HYOSCYAMUS.— See Henbane. 

HYPOCHONDRIA.— See Abdomen. 

HYPOCHONDRIASIS. — See Indiges- 
tion. 

HYPOGRASTRIUM.— See Abdomen. 

HYSTERIA — Is a disease more particu- 
larly manifested through the nervous sys- 
tem, and is, almost without exception, pe- 
culiar to females between the age of puberty 
and the fiftieth year of life. The affection 
is, but very rarely so, developed in the male 
sex. 

Hysteria in the female is unquestionably 
closely connected in sympathy with the 
■womb and its functions, and few cases, per- 
haps, occur, in which there cannot be traced 



some disorder of this important organ as 
the exciting cause. 

Hysteria may manifest itself particularly 
in three different modes. First, either as a 
pure nervous and spasmodic affection ; se- 
cond, as a simulator of other and more di- 
rectly definable disease ; and third, as a mo- 
difier of other diseases really existing. The 
varied forms of hysteria, and the way in 
which it modifies and masks, or closely si- 
mulates other more important affections, is 
apt to render it at times one of the most 
puzzling disorders with which the physician 
has to deal ; it is one, moreover, especially 
liable to mislead the young and inexperi- 
enced practitioner. 

A fit of hysteria may assume different 
forms, but, generally, the female becomes 
apparently, of a sudden, partially insensible, 
it may be, falls down, but more generally 
has sufficient warning to seat herself on a 
chair. The eyes are closed, the lids tremu- 
lous, the limbs are stretched out, and spas- 
modically and suddenly contracted at inter- 
vals, or there is violent struggling, the chest 
heaves, the heart and vessels of the neck 
beat violently, and the face is more or less 
flushed. Frequently the patient puts the 
hand to the throat and neck, as if to dispel 
some uneasiness, and not uncommonly gives 
utterance to incoherent or disconnected 
sentences, generally in a peevish or dis- 
tressed tone of voice. In most cases the 
power of supporting the body when seated, 
remains, unless it is worked off the chair 
in the struggles. At length, the attack, 
having lasted for a longer or shorter pe- 
riod, from a few minutes to some hours, 
terminates, probably with a fit of sobbing 
and crying, the patient recovers conscious- 
ness, but is left exhausted and fatigued 
with the efforts and struggles, and, perhaps, 
falls into disturbed or heavy-snoring sleep. 
When the fit has terminated, or even during 
its progress, if continued, the kidneys act 
very freely, and large quantities of urine, 
almost resembling pure "water, are voided. 

Such are the leading features of a "fit" 
of hysteria, but they may be greatly varied. 
The struggles, especially, being so violent 
as to require the assistance of two or three 
strong men to restrain a comparatively fee- 
ble female, and to prevent her injuring her- 
self, and sometimes, though not commonly, 
those around her. 

Such are the outward manifestations of a 
fit of hysteria ; but before it comes on, many 
patients complain of a sense of general op- 
pression or uneasiness, with coldness or 
numbness of the limbs. Just previous to 
the accession, the characteristic hysteric 



HYS 



298 



HYS 



" globus," or ball in the throat, is pro- 
bably felt. It seems as if a ball com- 
menced rolling upward in the bowels, gene- 
rally from the lower left side, and as if it 
kept gradually ascending toward the throat, 
which it seems entirely to fill up, causing 
those sensations which induce hysteric pa- 
tients so often to carry the hand to, and 
pull at the forepart of the neck or throat. 

It would serve no good purpose here, to 
follow the history of hysteria into the mi- 
nutiae of its various phases. It might be 
said, that there is scarcely a disease to 
which the human body is liable which it 
may not simulate so closely as to call for 
all the tact and discrimination of the phy- 
sician to detect the difference between the 
two. Continued, incessant, hard cough, loss 
of voice, delirium of various kinds, para- 
lysis, contractions of the limbs, obstinate 
vomiting or constipation, nay, even preg- 
nancy, may be enumerated amid the various 
simulated conditions. Neither would it be 
profitable, in the present work, to enter 
into an investigation of the way in which 
the hysteric tendency will modify the va- 
rious diseases to which the body is liable. 
This can only be conducted by the me- 
dical practitioner, but it is a matter of im- 
portance, that not only parents, but the 
individuals themselves, should be aware 
of those habits, &c. which tend to develop 
the hysteric tendency; and, further, that 
the best mode of managing an hysterical 
individual during the fit, and in the ab- 
sence of a medical man, should be under- 
stood. 

During the continuance of a fit of hys- 
teria, little either need or should be done, 
beyond preventing the patient hurting her- 
self during the struggling. Cold water 
dashed upon the face may be useful, or it 
may be poured in a stream upon the head 
for a few minutes at a time : a mustard- 
plaster on the lower part of the back may 
be applied. If there is much flatulence, a 
teaspoonful or two of sal-volatile in water 
will give it relief. It must be remembered, 
that in most cases of hysteria, the patient is 
sensible of what is going on around, and 
may, in the excited state of the nervous 
system, be painfully alive to any unguarded 
or unfavourable opinions uttered by those 
in attendance. For this reason, it is not to 
be recommended that, as sometimes is done, 
severe and violent remedies should be pro- 
posed within hearing of the patient with 
the view of frightening her out of the fit. 
Such a course has had the opposite effect, 
causing an aggravation of the symptoms. 
This is a different thing from threatening 



severe remedies while the patients are com- 
paratively well. Such a plan of treatment, 
it is well known, has often succeeded in 
putting a stop to the spread of hysteria 
(by imitation) through schools, or such like 
collections of young females. 

The exciting causes of hysteria are, re- 
motely, whatever tends to exalt the influ- 
ence of the nervous system. Among the 
moderately-fed and hard-working popula- 
tion in the country, hysteria is compara- 
tively rare, but it is not unfrequent in ser- 
vants who remove from the poor living of 
their own homes to the stimulating diet of a 
rich man's house. Most generally, hysteria, 
although in some degree the result of con- 
stitutional tendency, is connected with de- 
bility, and irregularity of the usual con- 
ditions of female health — all these being 
aggravated by emotions of the mind, par- 
ticularly those which are connected with 
the affections ; these, too, when in direct 
excitement, as well as inordinate physical 
exertion, which produces exhaustion of the 
nervous system, must be ranked as amid 
the most general directly originating causes 
of the hysterical fit itself. If, however, 
mental influences, either of excitement or 
of depression, connected with the affections, 
are apt to occasion hysteria — excitement 
of another kind has been found to be one 
of the best counter-agents of the morbid 
tendency. It has been remarked, that 
amid states of great public agitation, such 
as revolutions, &c. &c. hysterical affections 
have decreased in frequency ; and instances 
often occur of women subject to frequent 
attacks of hysteria as long as easy cir- 
cumstances permitted self-indulgent habits, 
losing the tendency when reverse of fortune 
or some other cause has forced them into 
active exertion. Under these circumstances, 
it is not to be wondered at, if marriage, with 
its new cares, and duties, and interests, 
often cures hysteria. 

The prevention of a disease, or of the 
tendency to it, must ever be the most im- 
portant consideration connected with it, par- 
ticularly when, as in the case of hysteria, 
prevention is very possible. Experience 
testifies to the much greater frequency of 
hysteria amid those classes whose mode of 
life is comparatively indolent and luxurious, 
being, in fact, that best calculated to develop 
those hysterical tendencies, of which the 
foundation is too often laid in the absurd 
education of the girl. This subject has been 
sufficiently entered into, under the head of 
education, and requires not further ampli- 
fication here. Suffice it to say, that those 
who would not have their daughters grow 



ICE 



299 



ICE 



up subject to the miseries of "nervousness," j 
should use the rational means of developing 
their physical health, and give them those 
habits of healthful exertion, both of body 
and mind, which, carried up into woman- 
hood, will be the best preventives of hys- 
teria, with its long train of exaggerated 
ideas and exaggerated ailments, which are 
too apt to render single life useless and a 
burden, and, if long continued, to make 
weak mothers and nurses, if marriage is 
entered into. 

As regards the treatment of the hysterical 
tendency, it is needed to say but little in a 
work like this, beyond the enforcement of 
those general means of health which are 
laid down in the various articles. As re- 
gards medicinal treatment, it requires to be 
so varied according to each particular case, 
that it can only be rightly conducted under 
the care of a medical man ; and in a dis- 
ease like hysteria, long continued, and 
also a concomitant of artificial life, medical 
assistance always can and should be pro- 
cured. 

Lastly, although hysteria may be de- 
pendent on physical derangements, it must 
be considered as a disease to a considerable 
extent under the control of the will, and 
this fact should be strongly urged upon the 
subjects of it, even when they are sufficiently 
sensible, as they most generally are, during 
the existence of a fit of the disease. Hys- 
teria is a disease which lives and grows on 
superabundant sympathy and attention ; 
and while all kindness and consideration 
is shown, it is wonderful how much good 
may be derived from a little wholesome neg- 
lect. While recommending that the medi- 
cal treatment of the hysteric tendency 
should be committed to the medical man, it 
is right to caution, that there is always 
much tendency to a confined, and, conse- 
quently, loaded state of the bowels, which 
it is highly necessary should be obviated. 
The compound colocynth or compound rhu- 
barb pills, compound decoction of aloes, in- 
fusion of senna, or clysters, will be found 
the best adapted aperient remedies. 

ICE. — Water solidified or crystallized by 
the action of cold, or, more correctly, by the 
abstraction of heat, is often an agent of the 
greatest value in the treatment of disease — 
one, indeed, for which there is at times no 
substitute. As an external application, 
when cold is desirable for the purpose of 
reducing the heat of any particular part, 
(such as the head,) ice manifestly offers the 
most efficient means. It may either be per- 
mitted to dissolve in the water in which 



the cloths are dipped, or, better, it may 
be pounded and placed on the part in 
bladders, or in elastic water-cushions. As 
an internal remedy, in inflammatory affec- 
tions of the stomach, in obstinate vomit- 
ings, and in hysteria, small fragments of ice 
swallowed frequently, or allowed to dissolve 
in the mouth, are, often, not only of the 
most essential service, but the remedy is 
one of the most agreeable to the feelings of 
the patient. Under the article "Hydropho- 
bia," it was stated that ice used in this way 
had afforded comfort, at least, to a sufferer. 
Of late, the action of the extreme cold pro- 
duced by the admixture of pounded ice and 
salt, has been introduced as an external 
remedial application in neuralgic and other 
similar affections. The treatment consists 
in partially freezing the affected part, and 
is said to be successful. It is, of course, 
not adapted for unprofessional use. In in- 
flammatory affections of the throat and up- 
per part of the windpipe, either the result 
of cold, or of accident, such as that which 
so often occurs to children in consequence 
of their swallowing boiling water from the 
spout of a kettle, ice given in small fre- 
quently repeated morsels, will be found at 
once one of the safest, best, and most agree- 
able remedies. It has been found useful in 
loss of voice. 

Refer to Cold. 

ICES, or Iced Drinks — As articles of 
luxury, if taken moderately, cautiously, and 
slowly, and when the stomach is not full of 
food, are not injurious to healthy persons. 
It was found, however, in Dr. Beaumont's 
experiments, that cold fluids and the like 
produced a reduction in the temperature of 
the stomach to the amount of 20° or 30° 
Fahr., and that the organ did not recover 
its proper heat for some time. As, how- 
ever, the natural temperature of the stomach 
— about 100° Fahr. — is necessary for healthy 
digestion, it is evident that the custom of 
eating ice after dinner, or after any full 
meal, must materially interfere with the dis- 
posal of that meal. 

Refer to Indigestion. 

ICELAND MOSS— Which belongs to the 
class of lichens, in some degree resembles 
the lichen which grows upon the trunks 
and branches of trees ; it is, however, 
more of an olive-green colour. Iceland 
moss is found abundantly in the country 
whence it derives its name, but also in 
Northern Europe generally, and in Britain. 
It has long been noted as a nutritive remedy 
in cases of debility, and, when prepared 
for food, is frequently first soaked in water, 
to deprive it of its bitter principle ; it is a 



ICH 



300 



IDX 



question, however, whether this proceeding 
does not materially interfere with the tonic 
properties of the remedy. Iceland moss may 
be prepared in a similar way to Carrageen 
moss. — See Cookery. It has been estimated 
that a ton of Iceland moss contains about 
as much nutritive matter as half a ton of 
wheat. The Saxon government published 
a report upon this subject a few years ago, 
in which we are informed that six pounds 
eleven ounces of lichen meal, boiled with 
fourteen times its quantity of water, and 
baked in this state with 39J pounds of 
flour, produced 111 J pounds of good house- 
hold bread. Without this addition, the 
flour would not have produced more than 
78f pounds of bread: consequently the addi- 
tion of six pounds eleven ounces of lichen 
meal occasioned an increase of above thirty- 
two pounds of good bread. This increase, 
however, being owing, of course, to addi- 
tional water. 

ICHOR — Is a thin, acrid, often brown or 
bloody-looking discharge from wounds or 
ulcGrs 

ICHTHYOSIS.— A disease in which the 
skin becomes covered with thick hard scales, 
which make it, in some degree, resemble the 
skin of a fish. — See Skin. 

IDIOCY and IMBECILITY— May be re- 
garded as degrees of deficient mental mani- 
festation, consequent upon a similar disor- 
dered or defective state of the brain. Some 
have defined the difference, that idiocy is 
congenital, and imbecility acquired ; but, 
generally, imbecility is regarded as a minor 
degree of idiocy. 

An idiot has been defined as one "who 
knows nothing, wishes nothing, and can do 
nothing," whose instincts scarce prompt 
him to seek food under the pressure of 
hunger ; from this lowest condition of all, 
up to the weak mind or judgment, every 
shade of idiocy, weak intellect, imbecility 
or silliness, is met with, and all perhaps are, 
more or less, capable of improvement, by 
means of attention to the physical health, 
and by education of the faculties. 

Till within the last few years, the general 
idea has been that idiocy was incurable; 
the unfortunate beings, whether in the fami- 
lies of the rich or of the poor, were allowed 
to grow up, their physical wants attended to 
in accordance with the circumstances in 
which they happened to be placed, but their 
mental condition left without attempt at cul- 
tivation. Fortunately, the error has been 
exposed, and institutions, both in this king- 
dom and on the continent, are now in suc- 
cessful operation, for the end of elevating 
these unfortunate beings from their debased 



position. The fact that idiocy has been 
regarded too much as a thing of the mind 
alone, independent of physical influences, 
has tended in some degree to interfere with 
the efforts for its amelioration : attention to 
the physical health is a matter of paramount 
necessity. In the case of the cretins of 
Switzerland, this fact is peculiarly manifest. 
Enough has been said to give hope to those 
who number amid their families an idiot, 
that something may be done to ameliorate 
the calamity, and to induce them, as soon 
as the condition of an idiot child becomes 
manifest, to place it, or, if possible, to get 
it placed under judicious management at 
an early age. In a paper lately read by 
Dr. Forbes Winslow, before the Medical 
Society of London, he remarks with regard 
to the causes of idiocy — " The great mass 
of idiots were said to spring from an un- 
healthy stock, and have either been the 
children of idiotic parents, or of those of 
vitiated organizations, of scrofulous diathe- 
sis, or of intemperate habits. Three hun- 
dred idiots were ascertained to have been 
the children of drunkards." Dr. Winslow 
referred to the effects of intermarriages of 
near relatives, and to the influence of the 
mind of the mother, as well as that of the 
father, upon the condition of their offspring. 

Refer to Brain — Cretin, fyc. 

IDIOPATHIC — Is a term applied to 
primary diseases, in contradistinction to 
"symptomatic," applied to such disorders 
as are evidently connected with, or originat- 
ing from diseases previously existing. 

IDIOSYNCRASY— Is a peculiar state, 
either mental or physical, which renders 
an individual more than usually susceptible 
to certain influences, which do not affect 
the generality of persons. Thus, some 
cannot take the smallest dose of any mer- 
curial without suffering from it constitu- 
tionally, — that is, being salivated, — owing, 
as it is expressed, to their peculiar idiosyn- 
crasy : another cannot eat the pip of an 
apple, a bit of almond, or indeed any of the 
seeds belonging to the same family — which 
contain prussic acid — without suffering 
from cutaneous eruption. These, and nu- 
merous others which might be cited, are 
instances of peculiar idiosyncrasy, and, 
probably, every one is subject to such influ- 
ences, in some way or other ; every one, 
probably, has his idiosyncrasy, whether 
he is aware of it or not. Mental idiosyn- 
crasies are not less common than physical, 
and for neither one or other is it possible 
to fix on any assignable cause. It is, how- 
ever, a matter of considerable importance, 
when any peculiar idiosyncrasy exists, 



IL1 



301 



IND 



more especially with regard to medicines, 
that whenever a medical man is consulted 
for the first time, he should be informed of 
it. As there is no traceable cause for idio- 
syncrasy, it cannot become known to a medi- 
cal adviser, except by experience respecting 
his patient's constitution, or by information 
given him. The latter should always be 
done at a first visit. It is a very annoying 
circumstance for an invalid to find he has 
unwittingly taken a medicine which invari- 
ably disagrees ; and equally annoying is it for 
a practitioner, having every reason to expect 
benefit as the result of his prescription, to 
find that his patient has, perhaps, to say the 
least, been unrelieved, simply because he 
was not warned that calomel invariably 
caused vomiting, that colchicum produced 
distressing nervous depression, or that senna 
griped most unmercifully. 

Refer to Diathesis. 

ILIAC PASSION.— See Colic. 

IMITATION.— The tendency to imitate, 
by which all, perhaps, but especially children, 
are more or less influenced, is, of course, an 
important consideration in the education of 
the latter, particularly with respect to the 
imitation of involuntary movements or pecu- 
liarities, such as stammering, squinting, &c. 
&c. which young persons are very apt to 
acquire, if much associated with those who 
are the subjects of them. The power of the 
tendency to imitate in causing the diffusion 
of disease of the nervous system, such as 
hysteria, epilepsy, &c.~is well known. Per- 
sons of a susceptible nervous system, by ex- 
posure to the influence, that is, by witnessing 
the occurrence of the disease in another, may 
themselves become, involuntarily, imitators; 
in some cases, doubtless, quite involuntarily, 
without power of control, but in others 
only partially so. That in many cases the 
power of the will may prevent the manifest- 
ation or development of disease from imita- 
tion, has often been proved. The anecdote 
related of Boerhaave is known to most. 
This celebrated physician was consulted 
respecting the girls of a school, who, daily, 
one after the other, became the subjects of 
fits of hysteria, simply from imitation. 
Boerhaave had it made known that his 
mode of treatment must be to apply actual 
cautery, that is a red-hot iron, to the spine : 
not another case of hysteria occurred. 

Refer to Hysteria. 

IMPERIAL — Is a drink made by pouring 
upon an ounce of cream of tartar a quart or 
three pints of boiling water, flavouring it 
with a few slices of lemon, and sweetening. 
When the water cools, a crystalline sedi- 
ment, which does not, however, possess the 
2 A 



acidity of the cream of tartar, remains at 
the bottom of the jug, and is not available 
for further use. Imperial forms a cooling 
drink in feverish conditions of the system ; 
sometimes, however, it produces irritation 
of the kidneys and pain in the back. 

IMPETIGO. — A pustular skin disease. 
— See Skin. 

INCONTINENCE of URINE.— See Urine. 

INCUBUS— Night-Mare.— See Sleep. 

INDIGESTION, or Dyspepsia.— Under 
the article Digestion, to which the reader is 
referred, those conditions which are requi- 
site for the healthy performance of this 
important function were pointed out. It 
was shown that the due mastication of the 
food by the teeth, and its admixture, par- 
ticularly when of a farinaceous character, 
with the saliva, were essential to its perfect 
digestion in the stomach by means of the 
gastric juice, and in the alimentary canal 
generally, by means of the various secre- 
tions which become mingled with the food 
mass during its progress through that tube. 
It was further pointed out, that not only is 
a healthy condition of the organs of diges- 
tion themselves requisite for the proper per- 
formance of their functions, but that the 
food must, in some measure at least, bear 
a relation to the natural constitution and 
intention of these organs. And, lastly, that 
the state of the system at large influences 
considerably the exertion and progress of 
the digestive powers ; that is, to insure the 
vigorous putting forth of those powers, the 
system must stand in need of the supply of 
nutriment which the stomach is called upon 
to elaborate ; and, partially at least, and for 
a longer or shorter period, its efforts must 
be devoted, in efficient co-operation with 
those of the stomach, to the preparation of 
the nutriment for its own requirements — 
plastic material for its tissues, and respira- 
tory elements for its animal heat. 

When it is considered how much the sto- 
mach is under man's regulation and control 
— how dependent its management is upon 
his external relations, his habits, and ca- 
prices, whether these affect it directly or 
indirectly — it can scarce be a matter of 
surprise, that in the present condition of 
mankind, indigestion is one of, if not the 
commonest of disorders. The savage, with 
his long periods of fasting, terminated by a 
gluttonous meal of perhaps indigestible, or 
(if cooked at all) badly cooked food, suf- 
fers from it. The pampered, the luxurious, 
and the indolent suffer from it ; the over- 
wrought in body, and the over-taxed in 
mind are all liable to dyspepsia in one or 
other of its varied forms. It is, in fact, 



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one of those maladies most closely and evi- 
dently connected with man in a state of 
disorder, or of vice ; or of ignorant or wil- 
ful disregard of all the conditions of health, 
either by the individual sufferer himself, or 
by those from whom he is descended. 

Many varieties of indigestion are enume- 
rated. In the present work, it will serve 
every practical purpose to consider the dis- 
order, in the first place, as dependent upon 
causes directly connected with the digestive 
organs themselves ; and in the second, as 
indirectly dependent upon causes which, 
although manifested through the digestive 
organs, are traceable to certain disordered 
conditions of the system in general, or of 
some of its organs not specially devoted to 
the preparation of food. 

It is unquestionable that there exists a 
great difference in the natural digestive' 
power of different individuals. Even in 
childhood this is evident ; and when weak- 
ness is evinced thus early, it must be con- 
sidered as a tendency congenital in, or na- 
tural to the constitution, which will pro- 
bably continue with it during life. Persons 
thus constituted, even as children, cannot 
eat the food — either of the same quality, or 
in the same quantity — that their stronger 
companions do ; and if they occasionally 
do so, or, as too often happens, are forced to 
do so, sickness and vomiting frequently 
follow. These individuals, their whole life 
through, are liable to dyspepsia. With all 
their care they cannot always escape its 
visitations, even under the most favourable 
circumstances; and if placed in such posi- 
tions as confined workshops, counting- 
houses, and the like, they are perfect mar- 
tyrs to the disorder — are never happy ex- 
cept when their stomachs are empty, and 
not always then. It is very common to 
hear such persons say, "If I could live 
without eating, I should be perfectly well." 
They are always conscious of sensations in 
the stomach : it is generally most comfort- 
able when free from food, but even in its 
state of rest is apt to be the seat of pain, 
or of craving or gnawing uneasiness. After 
a meal has been taken, instead of the satis- 
fied feeling of health, the stomach and 
bowels generally feel distended ; perhaps 
there is tolerably acute pain ; windy, and 
acid, (very acid,) eructations quickly follow ; 
there is heartburn, perhaps headache, some- 
times, though not often, vomiting, and these 
symptoms continue, with more or less seve- 
rity, till the food has passed off the stomach 
in some condition or other. After this there 
is a state of comparative comfort. Along 
with these periodical dyspeptic symptoms, 



the tongue is at all times more or less furred, 
especially at the back part. On first waking 
in the morning this furring is notably in- 
creased, and the mouth is almost invariably 
dry ; the bowels are costive, the hands and 
feet are almost always cold, and the face is 
very liable to be the seat of pimply erup- 
tions. Notwithstanding all these symptoms, 
the appetite often remains good, too good in 
fact for the digestive powers. 

With such persons, the slightest indiscre- 
tion or excess in diet is liable to bring on 
protracted fits of aggravated dyspepsia — a 
little additional anxiety of mind, a little 
extra fatigue, being almost sure to put them 
wrong. But yet this species of indiges- 
tion, which belongs to the atonic or weak 
form of disorder, seldoms tends materially 
to shorten existence. Many pass on from 
year to year, throughout a tolerably long 
life, without being a single day quite free 
from its visitations. It may be that the care 
they are compelled to take saves them from 
many of the sources of disease to which 
those who do not know they have stomachs, 
and who can take any liberty with them, 
wilfully expose themselves ; but so it is. 
Medicine, that is drugs, does but little good 
in this form of indigestion, except in its 
occasional aggravations ; and aperient reme- 
dies, habitually and frequently taken, mate- 
rially increase the natural weakness of the 
digestive powers. The best remedies are 
strict attention to the laws which regulate 
health, and to the means of invigorating the 
constitution. When a young person shows 
this tendency, the fact ought to influence the 
choice of the employment for life. If pos- 
sible, all such as involve close confinement 
at desks, or work which calls for much wear 
and tear of brain, should be avoided. Agri- 
cultural and such-like pursuits, which re- 
quire regular exertion in the open air, 
should be chosen. A man had better earn 
his daily bread by the literal sweat of his 
brow — earn, as Abernethy used to say, a 
shilling a day, and live upon it — than be a 
miserable hypochondriac, dyspeptic, valetu- 
dinarian, in the more dignified study or 
office. In the form of indigestion we are 
considering, particular regulation of the diet 
is worse than useless ; and especially the 
confinement, once so fashionable, to two or 
three articles of food — to wit, mutton-chops, 
brown bread, &c. — which were considered 
more than usually wholesome. The healthy, 
strong stomach craves for and requires 
change ; still more the weak one. There 
are, it is true, certain general rules of diet, 
to be observed ; such as the avoidance of 
pastry, cheese, and such-like well-known 



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indigestible articles, but this is different 
from the minute considering, nay, almost 
weighing and measuring of food. Nothing 
is so liable to aggravate and perpetuate a 
tendency to dyspepsia, as the constant at- 
tention to the actions and capabilities of the 
digestive organs, which minute dietetic re- 
gulation involves. It is a well-known fact, 
that organs, such as the heart, not usually 
under the influence of the will, may in 
the course of time come to be affected 
thereby, if the attention be frequently di- 
rected to the organ, which, as a conse- 
quence, becomes disordered in action. This 
is well exemplified in the act of breathing. 
This function, though generally performed 
involuntarily, may nevertheless be sensibly 
affected by the will, and if any one tries to 
regulate his breathing by his own will, it 
quickly becomes most fatiguing and neces- 
sarily embarrassed ; so it is with the sto- 
mach, there is no surer way of disordering 
its functions than by keeping the mind con- 
tinually attending to their operation. A 
dyspeptic is more likely to get rid of his 
complaint by casting aside restraints of diet, 
if he at the same time untrammels his mind, 
than by the constant minute dieting, and re- 
ference to tables of the digestibility of what- 
ever he eats : within certain limits, a lati- 
tude and variety is absolutely necessary. 
The dyspeptic who, instead of trusting to at- 
tention to the general laws of health, trusts 
to limiting his food to such things as he 
finds, or thinks he finds, his stomach capable 
of digesting comfortably, will shortly get 
himself driven into a corner by the enemy. 
Water-gruel and sago-pudding will succeed 
the mutton-chop and bread ; and at last, the 
stomach, so long allowed its choice of work, 
refuses it altogether, and reduces its pos- 
sessor to despair. The author has known 
such cases, and the very despair has worked 
its own cure ; the dyspeptic has made a 
rush at some long-dreaded or forbidden 
viands ; a beef-steak and a tumbler of por- 
ter are perhaps taken, with some floating 
idea of its being a suicidal act, and, much 
to the surprise of the despairing invalid, they 
seem to take up their quarters, and to be 
most comfortably received by his stomach, 
which had nothing but acidity for the milk 
and farinacea. In fact, the stomach only 
wanted stimulus, and no sooner does it get 
it, than it rouses to the proper exercise of 
its powers. It may be that it will not con- 
tinue thus after a few repetitions to respond 
to the stimulus so vigorously ; but if reason- 
able judgment and moderation are exercised 
as regards food — if the person trusting to this 
unexpected power does not run into excess, 



(the reverse of his former abstemiousness,) 
and if he attends to the general health and 
strength, especially, if possible, by means 
of change of air and scene, he may to a 
great degree get the better of his former 
miserable condition. The above case is put 
to demonstrate that ultra-dietetic regulation 
is not only useless, but worse than useless, 
in cases of atonic dyspepsia generally ; and a 
large proportion of the cases of the disorder 
met with in medical practice are of this class 
— not, it is true, of hereditary or congenital 
origin, or of life-long continuance, but still, 
long-continued cases, the effects of the vari- 
ous debilitating and depressing influences 
which affect the citizens of large towns. The 
deficient supply of fresh air, and the con- 
tamination of this vital element by noxious 
emanations, the contamination of water, the 
close confinement and anxiety of business, 
and the hurried meal, all tend to produce the 
form of atonic dyspepsia. Such cases may 
perhaps be relieved temporarily by medicine 
and regulation, but they have but little hope 
of cure without removal from the causes 
which originated them ; they are the cases 
which confer celebrity upon watering-places, 
and would confer celebrity on any place 
which happened to become their resort, 
provided it offered plenty of fresh, pure air, 
and relaxation from care and anxiety. It 
matters but little — water-cure, in modera- 
tion, grape-cure, sulphurous or chalybeate 
springs, sea-bathing or shampooing, even 
homoeopathy will suffice — the atonic dys- 
peptic will get well under the influence of 
the natural stimuli of fresh air and cheer- 
ful exercise. 

Persons who suffer from the above form 
of dyspepsia, if they have been accustomed 
to the use of alcoholic stimuli, cannot leave 
them off, at least when following out their 
usual mode of life, without risk of having 
their ailments much aggravated, and suffer- 
ing much both from mental and physical 
depression. They must, moreover, carefully 
avoid whatever tends to exhaust the powers 
of the system : long fasting, long fatiguing 
walks, especially before breakfast, active 
exertion or severe study soon after a meal, 
are all injurious to them. Their digestive 
organs are so comparatively feeble, that for 
the first stages of their operation they call 
upon the whole nervous energies of the sys- 
tem for assistance ; and, if these energies 
are called off for other purposes, the function 
of digestion necessarily suffers. It matters 
little whether the nervous exhaustion or 
derivation takes place immediately before 
or after the meal, the effect is the same. 
Persons who suffer from this form of dys- 



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pepsia, almost invariably experience lan- 
guor after a full meal, in consequence of 
the nervous power going to the stomach in- 
stead of to the muscular system. 

The next form of indigestion to be con- 
sidered partakes more of strength than 
weakness ; it occurs in persons of naturally 
good constitutional powers and digestion. 
It may be brought on by indolence and 
close confinement, but is more generally 
induced by excess in eating and drinking, 
and is, in most cases, connected with more 
or less biliary disorder. The appetite fails, 
the tongue is much furred, there is often 
sickness and vomiting of bile, the bowels 
are rather irregular than confined, the 
urine is high-coloured and deposits red or 
pink sediments, there is heartburn and 
acidity, and generally headache, often pain 
between the shoulders extending to the 
back of the head ; the condition, in fact, 
is in a great degree similar to that which 
precedes an attack of British or bilious 
cholera, and often does end in a "sick- 
headache," or "bilious attack." In this 
form of dyspepsia, abstinence and exercise 
may effect a cure, but it is much facilitated 
by proper medicine. It is in such cases 
that the calomel, or blue pill and black 
draught method are most useful, if properly 
employed; the system at large, and the 
whole of the digestive organs are oppressed 
and overloaded, and one or more doses of 
the above medicines clear them in a way 
that nothing else will, bringing away large 
quantities of acrid, dark bile, with imme- 
diate relief. After this remedy has been 
repeated, the bowels ought to be kept lax 
by means of the blue pill and compound 
rhubarb, or blue pill and compound colo- 
cynth pill, at bedtime. If the tongue re- 
mains furred, and the appetite deficient, 
two or three doses during the day of effer- 
vescing mixture, with the addition of a 
teaspoonful of tincture of columbo, or of 
tincture of gentian, to each, will be of ser- 
vice ; or a mixture composed of a drachm 
of carbonate of potassa, half an ounce of 
nitrous aether, and twelve ounces of infu- 
sion of columbo or of gentian may be used, 
a wineglassful being taken twice a day. 
In this form of dyspepsia also, the infusion 
of dandelion, either alone or combined with 
one of the bitters, is very serviceable. This 
form of dyspepsia does not call for change 
of air and scene, as the first mentioned does, 
although unquestionably — especially if the 
attack has been a severe one — these remedies 
are of service, if taken advantage of after 
the organs have been relieved and the func- 
tions regulated by medical treatment. 



A very necessary caution is requisite witb 
respect to the management of this form of 
indigestion. The immediate and striking 
relief which follows the clearance of the 
liver and digestive organs, by the use of 
the mercurial and purgative, is very apt 
to induce people to trust to this means of 
cure, or rather of relief, and to disregard 
all those methods of self-management and 
self-restraint which would keep them well. 
There is, perhaps, no substitute, nothing 
which will so completely, at the outset of the 
treatment of a case of this form of dyspep- 
sia, clear away the causes of its symptoms, 
and leave a good foundation for after treat- 
ment and management. But to trust to this 
mode of relief alone, and, from time to time, 
to persevere in those habits of self-indul- 
gence and of excess in which the disorder 
originates, is most dangerous, and must, 
sooner or later, lay the foundation of dis- 
ease, or, at least, substitute for the dyspep- 
sia of a strong stomach that of a weak one, 
and with it of a weak system generally. 

The form of dyspepsia of which we now 
treat is, in so great a majority of instances, 
the result of excess in eating or drinking, 
and of inattention to proper exercise, &c. 
rather than of any real weakness of diges- 
tive function, that there are few who suffer 
from it, who might not enjoy, under proper 
restriction, the best possible health. 

The two forms of indigestion above treat- 
ed of, that which results from weakness and 
that which does not, may be taken as the 
types of dyspeptic ailments generally, which 
all incline, more or less, to one or other of 
these divisions. To enter into the varied 
phases which cases of indigestion assume, 
and to detail the varied symptoms they 
present, would demand a volume of itself. 
Although, therefore, in this article less is 
said than in most others respecting appli- 
cation to a medical man, it is not because 
it is not highly desirable in all cases of con- 
tinued or aggravated indigestion ; there are 
often so many anomalous symptoms, and 
the disorder is frequently dependent upon 
so many causes which skill and experience 
only can detect, that it is the safer and 
wiser plan to take advantage of these guides 
whenever procurable. 

One of the most general features of dys- 
peptic disorder is the mental depression, 
often amounting to " Hypochondriasis," or 
even "Monomania," which accompanies it. 
In sufferers from the atonic and continued 
condition, this is more apt to take the form 
of constant dwelling upon symptoms and 
feelings, and magnifying their importance ; 
in fact, such persons' whole time and atten- 



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tion seems to be occupied in registering the 
various sensations they experience in the 
course of the day ; and, if attended by a 
medical man, they do not fail — if allowed — 
to trace the turning and winding of every 
pain and ache, how much and what they ate 
for the last week, and so on. In the form 
of indigestion less connected with constitu- 
tion, the spirits are apt to be more regularly 
depressed, and more decidedly hypochon- 
driacal, or even, in some, suicidal emotions 
are felt. 

Headache, which is so frequent an ac- 
companiment of indigestion, arises from 
very various and very opposite causes. The 
most general headache is a dull persistent 
pain over the eyes, which comes on from 
half an hour to two hours after food, and 
seems to be connected, so to speak, with 
a negative or inactive condition of the sto- 
mach, on which the food lies with but little 
change. This kind of dyspeptic headache 
is accompanied with dulness of the mental 
powers and incapability of their exertion. 
It is best relieved by whatever stimulates 
the stomach : a cup of hot tea, a glass of 
wine, an effervescing draught, and often a 
spoonful of vinegar will relieve it, the acid 
seeming to alter the sensation of the nerves, 
whatever that may be, on which the symp- 
tom depends even acid generated in the 
stomach itself will cause its disappearance, 
and persons who suffer from this headache 
are often aware that* it will probably sub- 
side as soon as the heartburn begins. The 
same description of headache may be pro- 
duced in persons of weak stomach by a 
dose of soda or magnesia, or by any article 
of food which does not stimulate sufficiently 
the stomach and its nerves. A headache, 
exactly the reverse of the foregoing, is 
caused by the presence of superabundant 
acid, and is, of course, relieved by the al- 
kaline remedies — carbonate of ammonia, 
soda, or potassa — which neutralizes the acid. 
Persons liable to indigestion often suffer 
also from various forms of nervous head- 
ache, from giddiness, dimness of sight, &c. 
The chest comes in for its share of disorder 
when indigestion exists. A peculiar irri- 
table " stomach" cough is not unusual ; 
palpitation of the heart is almost a constant 
attendant upon' the condition; and shortness 
of breathing often results from the pressure 
exerted upon the chest by the stomach dis- 
tended with gas. Indeed, there is scarcely 
a symptom which may not, some time or 
other, be met with, traceable to disorder 
of the digestive powers. The sympathetic 
connections of the stomach, and its office as 
preparer of the nutriment which is to sup- 
2a2 20 



ply the body, necessarily makes its derelic- 
tions felt throughout the system ; and gout, 
gravel, rheumatism, cutaneous affections, 
scrofula, and indeed most other disorders, 
may, at times, be distinctly traced back to 
faulty digestion. Moreover, the abundant 
sympathetic connections of the stomach 
make it liable to be affected by the state of, 
as well as to affect, distant organs ; and it 
not unfrequently happens, that obstinate 
cases of indigestion turn out to be not so 
much the consequence of disorder in the sto- 
mach itself, as of its sympathy with disease 
going on elsewhere — in the heart, the kid- 
neys, or womb. When, therefore, indiges- 
tion, spite of all proper regulation and 
treatment, continues to harass a patient, 
something of a deeper-seated and graver 
character must, at least, be watched for. 

Nervous pain at the stomach, also called 
gastrodynia, is one of the most painful 
forms of indigestion, sometimes coming on 
when the stomach is empty, sometimes after 
eating. The disorder ought to be treated 
by a medical man. If there is much ten- 
derness, a few leeches, followed by blister 
or mustard-plaster, may be applied to the 
pit of the stomach. Bismuth, in five-grain 
doses, twice or thrice a day, will sometimes 
relieve. The author has found the oxyde of 
silver, in one-third of a grain doses, as re- 
commended by Sir James Eyre, of consider- 
able service in some cases. In this affec- 
tion of th£ stomach, as well as in other 
forms of dyspepsia, the rhubarb and mag- 
nesia mixture, with or without the addition 
of sal-volatile, is often very useful. When 
the pain is present, and very acute, a cup 
of hot water, swallowed as hot as possible, 
is often of service, with the addition, if 
there is acid on the stomach, of fifteen or 
twenty grains of carbonate of soda, or, as a 
possible addition, four or five drops of lau- 
danum. When the pain amounts to spasm, 
it must be dealt with as recommended in 
the article on the subject. 

The principal features connected with in- 
digestion have now been enumerated ; a 
short general recapitulation of the subject 
will probably make it more clear to the 
mind of the unprofessional reader. The 
first form of indigestion noticed, was that 
dependent on weakness : in this it may be 
taken as an axiom, that it is'better to bring 
the stomach up to its reasonable work, than 
to reduce the work to suit the enfeebled 
powers of the stomach. In doing the foi-mer, 
the whole system must be attended to and 
strengthened, and the stomach made to par- 
ticipate in and to give its proper aid to the 
strengthening process. In attempting to do 



INF 



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the latter, not only do the powers of the 
stomach become less and less — shrink away, 
as it were, from their work — but the whole 
system partakes of the debility. 

In the second form of indigestion ad- 
verted to, that accompanied by strength, or 
at least not dependent on weakness, it was 
shown that medicines and abstemiousness 
offered the proper means of relief. Lastly, 
the varied forms, symptoms, and connec- 
tions of dyspepsia were pointed out, to show 
how often there must be difficulty in deter- 
mining the treatment and true nature of 
the case, and to impress the unprofessional 
reader, that when suffering from any thing 
more than transient indigestion — unless 
indeed his be one of the cases of constitu- 
tionally feeble digestion — the safest, best, 
and perhaps most economical plan will be 
to put himself under proper medical care. 
Above all things, those who suffer from the 
form of indigestion dependent on weakness 
must beware of purgatives ; nothing so 
completely debilitates whatever digestive 
powers they may possess. The bowels per- 
haps, probably, may be regularly costive, 
but they must be, as a rule, regulated by 
the clyster. 

Refer to Alimentary Canal — Digestion — 
Drinks — Food — Exercise — Meals — Dinner, 

Note. — The reader is requested to refer to the above? 
and other articles bearing upon the subject of digestion 
and indigestion generally, as it has bdfen thought su- 
perfluous to repeat information once given. 

INFANTS.— See Children. 

INFECTION. — See Contagion — Disin- 
fectants, &c. 

INFLAMMATION — Is that process or 
action occurring or "setup" in the living 
animal body, which is characterized by red- 
ness and swelling of the part affected, and 
by heat and pain. When these phenomena 
take place, in a decided manner, on a visible 
part of the body, such as the eye, or the 
skin, they are generally recognisable by all: 
when they (that is, inflammation) occur in 
in internal parts, its presence is judged of 
by certain concomitant symptoms. Few 
diseases to which the human body is liable 
are unaccompanied by inflammation to a 
greater or less degree, in some part of their 
course, and many seem to owe their cha- 
racters and influence chiefly to its presence. 
At the same time, inflammation must not be 
regarded as entirely a diseased action ; its 
occurrence is often a necessity ; without it, 
the wound could not unite, the broken bone 
could not be repaired ; that is to say, in- 
flammation must precede the reparative 
processes, or in other words, the means of 



reparation are the consequence of inflam- 
mation — one of its terminations. 

These " terminations," as they are called, 
of inflammation, are very important consi- 
derations, and require brief notice. The 
nature of the process of inflammation has 
long been a subject of investigation to me- 
dical men, and within the last few years 
much light has been thrown upon it ; it is 
sufficient to mention here, that when a part 
is inflamed, its minute vessels are enlarged 
and much more crowded with blood globules 
(see Blood) than in their ordinary condi- 
tion; that in one portion of the inflamed 
part, the flow of blood through these ves- 
sels may be impeded, while in others it is 
quickened ; there is determination of blood 
to the part. These facts are sufficient to 
explain the redness, the swelling, the pain 
— consequent upon the pressure of the 
swelling upon the nerves — and the heat; 
they also explain the throbbing around an 
inflamed spot, caused by the efforts of the 
vessels to overcome the obstruction in these 
parts, which are crowded or blocked up 
with blood globules. 

When a portion of the living body has 
been for some time in the condition above 
described, it may, either in consequence of 
the temporary exciting cause of the inflam- 
mation being withdrawn, or from some other 
reason, resume its healthy condition, with- 
out any trace of the previous action being 
left. This is the termination by "resolu- 
tion," and it is the most desirable termina- 
tion in many diseases, such as inflammation 
of the lungs, in which it is important that 
an organ should be left intact as regards its 
structure and functions ; and it is to bring 
about this termination that the efforts of 
the physician, his bleedings, and fomentings, 
and medicines, are directed, to prevent the 
inflammation running on to one of its other 
terminations, which almost inevitably da- 
mage the structure and after-working of the 
affected organ, and perhaps lay the founda- 
tion of, or form the nucleus for after disease. 
Should inflammation not terminate in the 
most desirable mode by "resolution," it 
may give rise to effusion of serum or of the 
watery part of the blood. This effect of in- 
flammation is familiar to all, as it takes 
place in blisters, from any cause, whether 
Spanish fly, scalds, or friction, as on the 
foot in walking ; it also occurs in pleurisy, 
forming "water in the chest," or in other 
cavities of the body. This effect of inflam- 
mation undoubtedly,in many instances, leads 
to bad consequences, as for instance, when 
it compresses a lung so that air cannot pe- 
netrate it ; but the same action may be also 



INF 



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viewed as beneficial, when, as in the case 
of a blister, it interposes the elastic fluid 
between the inflamed and sensitive surface 
of the true skin and the irritating cause. 

A third and most important effect of in- 
flammation is the effusion of what is called 
"lymph," that is, an adhesive — at first 
liquid, afterward solid — matter, which be- 
comes a permanent medium of connection 
between two parts, which, when undergoing 
the " adhesive" form of inflammation, are 
placed together, or in apposition. The 
edges of a cut are the most familiar ex- 
ample of the above. A few hours after the 
infliction of the wound they inflame ; as a 
consequence of the inflammation, the adhe- 
sive "lymph" is exuded, which glues them 
together. As, however, this exudation of 
adhesive matter takes place as a necessary 
consequence of inflammation in many cases, 
irrespective of circumstances, it must hap- 
pen that it is sometimes as much a source 
of injury, as it is at others of benefit. Thus 
in the case of inflammation within the ab- 
domen, it may glue the bowels together ; in 
the chest it may fix the lungs to the side, 
or the heart to its containing bag. Even 
internally, however, it is often beneficial; 
it may seal parts together in such a way 
as to prevent escape of matters, as for 
instance into the cavity of the abdomen, 
which must otherwise have proved fatal. 

It ought to be mentioned that this effused 
"lymph" always shows* a disposition to as- 
sume the characters of the tissue with 
which it is connected ; the lymph which 
connects a divided tendon will become tough 
and fibrous — that around bone, bony or 
osseous ; this approximation to the natural 
healthy tissue becoming more complete as 
time goes on. In this we recognise a most 
beneficent provision of the Creator for the 
reparation of those diseases and injuries to 
which man and animals are subject ; and if 
the agent, which at one time saves life, may, 
at another and under different circumstances, 
destroy it, we can but see in this the unerr- 
ing, certain operation of his laws which regu- 
late our physical being — feeling sure that 
though the action of the agent may at one 
time be for good, and at another for appa- 
rent evil, all is equally under his wise 
control. 

But inflammation may terminate in none 
of the ways above mentioned ; it may go 
on to the formation of pus, or matter. This 
effect is too familiar to all to require de- 
scription ; suffice it, that it too may be either 
beneficial or the reverse, according to cir- 
cumstances. The matter formed around a 
foreign body lodged in any of the tissues 



may be the means of its discharge, and 
may cure or save the patient ; the abscess 
may burst and prove fatal, or the long dis- 
charge of matter may wear out the powers 
of life. 

Again: ulceration maybe another effect 
of inflammation, which breaks down and 
casts off the component tissues of surface 
parts ; and lastly, mortification, or ."slough- 
ing," or "gangrene" — all names for the 
same effect — may take place in an inflamed 
part : that is, the vitality being completely 
destroyed, the tissues dissolve or break 
down into one putrefying mass. 

These various effects or terminations of 
inflammation are, in some degree, doubtless, 
dependent upon the violence and extent of 
the action in the first instance ; but they 
are also much modified by the nature of the 
affected tissue. Thus, a serous membrane, 
such as lines the cavity of the chest, is 
most liable to " adhesive" inflammation, 
with effusion of serum, and a mucous mem- 
brane, such as that which lines the bowels, 
to the form which terminates in the forma- 
tion of matter, or of ulceration. 

What has now been said respecting the 
nature of this most important process will 
sufficiently indicate to the unprofessional 
reader how closely it is connected with the 
whole science and practice of medicine, and 
how a great part of medical treatment must 
be conducted with reference to it ; how, when 
it occurs, as a process of disease, either in a 
vital organ, or indeed in any organ, the first 
effort must be to procure its termination in 
"resolution," if possible, and when that 
cannot be done, in the method best adapted 
to secure the ultimate well-being both of the 
affected part and of the patient. 

The means used to procure resolution of 
inflammation are, bleeding, either general 
from the arm, or local by means of leeches, 
cupping, &c. which relieve the overloaded 
and obstructed vessels ; further, fomenta- 
tions and poultices, that is, heat and moist- 
ure, which relax the parts, and also relieve 
by producing perspiration; also by medicines, 
such as diuretics, diaphoretics, purgatives, 
&c. which, by increasing the discharge from 
kidneys, skin, or bowels, necessarily deter- 
mine the blood to these organs, and thus 
also relieve the inflamed part. In addition 
to these means, the physician employs 
medicines which experience has taught us 
have a peculiar power in arresting and 
subduing inflammation in certain parts — as 
tartar emetic subdues inflammation in the 
lungs. In some cases, when inflammation is 
seated directly on the surface, it is treated 
successfully by the direct application of 



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astringents to the part. Inflammation of 
the eye, or rather of its outward covering, 
the conjunctiva, is cured by the astringent 
wash; inflammation of the membrane of 
the throat, by the astringent gargle ; some 
treat external inflammation of the skin, by 
the astringent action of cold. 

Along with these more directly medical 
means, the diet in most cases, of active 
inflammation at least, is reduced both in 
quantity and quality ; all stimulants, either 
alcoholic, or in the form of animal food, 
being forbidden, and bland, unstimulating 
diluents freely administered. The dietetic 
treatment of inflammation, however, is 
generally regulated as much by the natural 
appetites as by the physician — the articles 
mentioned above as suitable being instinc- 
tively desired, and the others rejected. In 
the employment of the means, however, for 
the reduction of active inflammation, the 
physician must be careful that in arresting 
the disease he does not unnecessarily weaken 
his patient ; he must look beyond the actual 
existing process going on at one time, to 
what may succeed it, and remember that 
power will be required for the termination 
stage, whatever that may be ; and that what 
it will be may depend upon the condition 
of the patient, as to strength or weakness, 
when that termination arrives. Neither, 
even during the most active inflammation, 
must the tendency to get well — to self-cure 
— existing in the animal constitution, be 
forgot, nor its powers mistrusted. 

In addition to the above considerations, 
there are the constitutional effects of in- 
flammation, which more or less accompany 
the process, unless in its most trivial forms. 
These effects are inflammatory, hectic, or ty- 
phoid fever, according to the nature and ex- 
tent of the inflammation, the part involved, 
or the constitution of the patient. The 
first occurring generally in the active stage 
of inflammation, the second should matter 
be formed, the third if mortification or 
sloughing takes place. When inflamma- 
tion to any extent is going on within the 
body, particularly some forms of inflamma- 
tion, the blood acquires the peculiar pro- 
perty of becoming "buffed," after it has 
been drawn from a vein; that is, instead 
of red or dark red, when it is coagulating, 
a bluish tinge is perceptible on its surface, 
and as the process of coagulation is com- 
pleted, a tough yellow coat of greater or 
less thickness forms on the surface of the 
clot. Redness, swelling, heat, and pain 
have been mentioned as characteristic of 
the presence of inflammation when in com- 
bination : separately they may occur without 



any inflammation being present. Thus th<t 
redness of blushing is no inflammation ; 
swelling may be caused by pressure or by 
air, heat by exercise, pain by spasm. 

The redness of inflammation is by no 
means always of a bright tint; it may be- 
come bluish or yellow-looking, according to 
the congestion of the blood, the nature of 
the part affected, &c. The swelling is also 
similarly modified, and the pain still more 
so ; this latter symptom is not by any 
means of severity commensurate with the 
importance of the part affected, but seems to 
be regulated chiefly by the texture. Thus, 
in loose spongy tissues, such as the substance 
of the liver, pain is comparatively trifling, or 
absent ; in dense, unyielding tissues it is most 
severe or agonizing, as in the ear-passage. 
Moreover, parts, such as bone, which 
in their healthy state possess but slight 
sensation, become, when inflamed, most 
acutely sensitive. Further, in some respects, 
pain in inflammation is a deceitful guide ; 
sometimes it is altogether absent when its 
presence might have fully been anticipated, 
and at others, if felt, it is not at the affected 
part, but at a distance from it. In other 
points of view, however, pain in inflamma- 
tion is a valuable guide. As a general rule, 
inflammatory pain is increased by pressure, 
and is in this way distinguished from the 
pain of spasm [or neuralgia.] 

One other important phase of inflamma- 
tion requires notice : it is that known by 
the name of "metastasis," that is, the 
transference of the inflammatory action 
from one part of the body to another. This 
occurs in various ways, but probably rheu- 
matism affords the most marked example 
of it; in this disease, on one day a par- 
ticular joint is exquisitely painful, it is hot, 
swollen, red; the day following, all these 
symptoms have perhaps vanished from it, 
and left not a trace behind, but have trans- 
ferred themselves to some other joint, or, it 
may be, have attacked the heart. Or again, 
inflammation of an internal organ may be 
relieved by an eruption on the skin, or by 
the formation of an abscess in some distant 
part. Thus, this tendency of inflammation 
to shift its quarters, may, like its other 
characteristics, be exerted either for good 
or evil. Its good the physician endeavours 
to imitate, when, by blisters and other 
means of counter-irritation, (see Counter- 
Irritation,) he endeavours to produce in- 
flammation and its consequences upon the 
skin, with the view of drawing it off from 
some more directly vital and less accessible 
organ. 

The causes of inflammation are very 



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numerous ; -whatever irritates locally, as 
familiarly exampled by dust in the eye, 
will cause it ; but it may also originate from 
causes affecting the constitution, such as 
cold ; or it may arise in the course of con- 
stitutional diseases, such as fever. 

Such are the principal general points con- 
nected with the subject of inflammation, 
with which it is expedient unprofessional 
readers should be acquainted. A clear un- 
derstanding of them will tend greatly to 
assist the formation of rational and common 
sense ideas respecting the nature and pro- 
gress of disease, and throw light upon some, 
at least, of the whys and wherefores of its 
rational treatment. 

The inflammations, or inflammatory dis- 
eases, which affect the body may be classed 
as external and internal. 

The external inflammatory affections, pro- 
perly so called, are the vario\xs skin diseases, 
particularly erysipelas, which is essentially 
inflammation of the skin ; inflammation of 
the eye, ear, throat, &c. The internal in- 
flammatory affections are those of the brain, 
of the chest and lungs, including laryngitis 
and croup, which affect the windpipe ; and 
bronchitis, which is seated in the air-tubes; 
also pneumonia and pleurisy, and carditis, 
or inflammation of the heart. 

Of the abdomen the inflammations are 
those of the stomach and bowels generally, 
and of the other viscera, such as the liver 
and kidneys, and womb. In addition to 
the above, there are inflammation of the 
blood-vessels, especially of the veins, in- 
flammation affecting the bones, joints, &c. 
All these are entered into sufficiently under 
their separate articles, with exception of 
inflammation of the bowels, or alimentary 
canal. 

Inflammation of the bowels, or aliment- 
ary canal, may affect any portion of it — the 
stomach, the large and small bowels, &c. ; 
it may attack its covering membrane, the 
"peritoneum," or its lining mucous mem- 
brane. Inflammation of the peritoneal 
covering of the bowels (peritonitis — see 
Alimentary Canal) is one of the most for- 
midable and often one of the most painful 
of the acute diseases : it may be confined to a 
small portion of the abdomen, (see Abdomen,) 
or be spread over, not only the perito- 
neum, which covers the alimentary canal, 
but that which covers the other contents of 
the cavity, such as the liver; hence medical 
men distinguish general and partial peri- 
tonitis, the latter being named according to 
the part affected. 

The accession of pei'itonitis, or inflamma- 
tion of the covering membrane of the bowels, 



like that of other inflammatory diseases, is 
attended with the usual symptoms of fever, 
languor, depression, shivering, and is fol- 
lowed by heat, thirst, and quick pulse. 
Either simultaneous with these symptoms, or 
shortly after, there is usually intense cutting 
or burning pain in the abdomen, general, 
or confined to one spot, according to cir- 
cumstances. This pain is much increased by 
pressure, so much so, indeed, that even the 
weight of the bed-clothes cannot be borne, 
and the patient lies on the back with the 
knees drawn up — an attitude very charac- 
teristic of this disease — in order to keep off 
the weight of the clothes. At this time, 
the pulse, which is very quick, is usually 
of a peculiar hard, wiry character. The 
symptoms of peritoneal inflammation of the 
bowels are usually so well marked as to be 
distinguishable even by an unprofessional 
person. When they do occur, especially 
under circumstances to be hereafter point- 
ed out, as likely to occasion them, it need 
scarcely be said here that a medical man 
should be called with the shortest possible 
delay. The disease is most serious and dan- 
gerous, often very rapid in its course, and 
cannot too soon be submitted to the active 
treatment which skill and experience alone 
can venture upon. In the mean while, the 
provisional remedies to be adopted must be, 
in some degree, regulated by circumstances. 
If many hours must elapse before medical 
assistance can be obtained, and if the 
affected person is of strong, full habit, bleed- 
ing from the arm, if there is any one com- 
petent to perform it, (see Blood,) ought to 
be resorted to, to the extent of sixteen or 
twenty ounces, and, either with this or with- 
out it, leeches may be freely applied over 
the seat of the pain; a warm bath for half 
an hour will be useful, and hot fomentation 
assiduously used for a long time will give 
much relief, being substituted for the hot 
bran, the weight of which, probably, could 
not be borne, unless made very light — and 
then fomentation is as good. If the bowels 
are confined, they should be gently relaxed 
by means of castor-oil, or by Epsom salts, a 
teaspoonful in half a pint of warm water 
or gruel every two hours, till the effect is 
produced. Warm clysters, repeated from 
time to time, not only keep the bowels 
clear, but act as an internal fomentation ; 
they should not be large, and if the pain is 
severe, may contain twenty to thirty drops 
of laudanum. The best medicine will be 
calomel, combined with opium, six grains 
of the former combined with one — or, if the 
pain is very violent, two — of the latter ; this 
being given, made into a pill, every sis 



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hours, until the doctor arrives. The diet 
must of course be reduced, and nothing but 
diluents, such as thin gruel, barley and 
toast water, allowed. In following out the 
above directions, an unprofessional person, 
at a distance from medical aid, would be 
doing the most possible to keep the disease 
in check ; the means may, of course, require 
varying in some degree, but in this, as, 
indeed, in all such matters, something must 
be left to the judgment of an intelligent 
person. 

Whenever, with the symptoms enumerated 
as characteristic of peritoneal inflammation, 
there is tenderness on pressure, inflamma- 
tion may be strongly suspected, sufficiently 
so, at least, should more active measures 
not be adopted, to forbid all administration 
of stimulants, such as is had recourse to in 
colic and spasmodic pain. Indeed, should 
the attack turn out to be the latter, all the 
remedies recommended for peritonitis, ex- 
cept the blood-letting, would be serviceable, 
especially the warm-bath and fomentation. 
The causes of inflammation of the bowels 
are chiefly cold, the abuse of stimuli, or of 
strong purgative medicines, constipation, a 
loaded state of the alimentary canal, and 
child-birth. The most severe and rapidly 
fatal case of inflammation of the peritoneal 
covering of the bowels the author ever wit- 
nessed, was traceable solely to the indivi- 
dual rising from a warm bed and standing 
for some time on a stone floor barefoot. 
For information respecting inflammation 
after child-birth, the reader is referred to 
the article on that subject. It is, however, 
right in this place to warn him that, under 
this circumstance, a spurious or imitative in- 
flammation is apt to occur, in which bleed- 
ing will do the greatest possible mischief; 
in such cases, therefore, its employment 
will be most prudently left to the judgment 
of the medical man. Inflammation of the 
lining or mucous membrane of the bowels, 
is generally associated with diarrhoea or 
dysenteric affections, and to these articles 
the reader is referred. 

Refer to Abdomen — Alimentary Canal — 
Liver. 

INFLUENZA. — This disease was cited 
under the article Epidemic, as the best speci- 
men of an epidemic disease. It is a peculiar 
feverish attack, accompanied with catarrhal 
affection of the air-tubes of the lungs, and 
great prostration of strength. It is not 
uncommon to call various forms of cold and 
catarrh, influenza ; but the true influenza is 
a very distinct disease, and seldom occurs 
but as an epidemic, attacking large numbers 
at once. 



The symptoms of influenza are those of 
general fever ; coming on suddenly, there is 
shivering, loss of appetite, perhaps vomit- 
ing, heat, and thirst, with cough, frontal 
headache, and generally great depression 
and languor. The feverish symptoms may 
last from one day to ten, but their general 
duration is from three to five, or even seven 
days, the cough usually remaining a variable 
time, after the acute symptoms are gone, 
according to exposure and circumstances, 
such as a predisposition to cough, &c. 

To the strong and healthy, influenza is 
but a trifling disease. It certainly pros- 
trates even them for a few days, and leaves 
them weak ; but it is in almost all cases 
perfectly devoid of danger — with ordinary 
care — and requires little or no medicine. A 
few days in bed, according to the severity 
of the case, with low diet, a gentle aperient, 
and diluents, the feet in hot water, being all 
that is required. If the catarrhal symp- 
toms are severe, treatment similar to what 
is recommended for catarrh or cold may be 
had recourse to. 

To the weakly and the aged, influenza is, 
on the other hand, a comparatively fatal 
disease ; and, from the almost universal na- 
ture of its attack, carries off more, perhaps, 
of these classes than many more apparently 
severe and more dreaded disorders. The 
attack of influenza in the description of per- 
sons above mentioned should be the signal 
for medical attendance. Lowering means, 
especially, must not be resorted to ; con- 
finement to bed, and the use of diaphoretic 
remedies, as recommended under articles 
Cold and Catarrh, will be required ; broth, 
strong or weak, must be allowed, according 
to circumstances ; if the strength is deficient 
wine may be requisite, and stimulant ex- 
pectorant medicines, especially in the aged, 
if the expectoration is abundant, viscid, and 
difficult to be got up. In such cases, the 
following will be found useful : — Take of car- 
bonate of ammonia, thirty to forty grains ; 
tincture of squill, one drachm ; wine of ipe- 
cacuanha, forty drops; water or camphor 
julep, sufficient to make an eight-ounce 
mixture, of which two tablespoonfuls, or 
one-eighth, may be given every few hours. 
If the cough is very irritating and trouble- 
some, two drachms of paregoric may be 
added to the above, but the opium rather 
tends to check the free expectoration which 
is so desirable. Demulcent drinks, such as 
barley-water, should not be neglected, and a 
mustard-plaster or blister to the chest will 
do good. In severe forms of the disease, 
with difficult breathing, if the strength is 
much reduced and the appetite bad, two 



INF 



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INH 



doses of decoction of bark may be given 
during the day. 

Persons who generally suffer from deli- 
cate chests should beware of allowing the ef- 
fects of influenza to hang about them ; as the 
debility and cough are very apt, if predis- 
position exists, to lay the foundation of con- 
sumption. The strong and healthy may trust 
to the domestic management of influenza ; 
but the weak and aged ought to have proper 
medical advice, if it is within reaoh. 

The history of the various epidemics of 
influenza which, at intervals, have visited 
Europe, and, indeed, the world, is a subject 
of much interest. It has been remarked, 
that the invasion of the epidemic has been 
preceded by dense, dark, and in some places, 
it is said, offensive fogs. 

During the last epidemic of influenza, it 
was remarked that the barometer was much 
and unusually affected. 

Refer to Cold — Catarrh — Diaphoretics, §c. 

INFUSION— Is the submission of sub- 
stances to the action of water, hot or cold, for 
the purpose of extracting from them certain 
portions which are soluble in the fluid. The 
most familiar instance of an infusion is com- 
mon tea. For the purpose of infusion, a jug 
with both cover and spout, and with a strainer, 
is the best ; but, of course, a common jug, with 
a saucer or plate placed on the top of it, or 
an earthenware teapot, will make a good 
substitute. The object of an infusion is to 
extract volatile and other substances, which 
would either be dissipated or injured by 
exposure to higher heat, such as decoction 
or boiling ; indeed, some infusions, such 
as that from senna, &c. — as noticed in 
their articles — are better made without heat 
at all. 

The commonest method of forming a hot 
infusion is to pour boiling water upon the 
substance, cover it, and allow the whole 
to stand near the fire for some time, before 
it is permitted to become cold. If the sub- 
stance to be infused is thick or tenacious, it 
ought, of course, either to be cut up or 
well bruised before being submitted to the 
action of water. The chief inconvenience 
connected with infusions is their great ten- 
dency to spoil ; some, such as columbo and 
dandelion, becoming unfit for use in twenty- 
four hours in summer. It is said that if the 
infusion be poured boiling hot into a bottle, 
filled up to the top, and the bottle imme- 
diately well corked, it will keep a good long 
time. 

Concentrated infusions are now made by 
chemists, but many of them contain so 
much spirit that they are almost tinctures, 
and in some cases, therefore, are inadmis- 



sible; otherwise they are good prepara- 
tions. The most useful infusions are — 
Infusion of Bark. 

" Broom. 

" Columbo. 

" • Chamomile. 

" Dandelion. 

" Hop. 

" Gentian. 

" Linseed. 

" Rhubarb. 

" Rose-leaves. 

" Senna. 

INHALATION— Is the "inspiration," or 
drawing in, of vapour — sometimes of pow- 
der — into the lungs, as a form of medical 
treatment for the cure of disease. Inhala- 
tion was much more regarded some years 
ago than it is at present ; perhaps, like most 
other things, the reaction from extravagant 
praise has gone too far the other way. At 
present, inhalation is chiefly heard of in 
connection with sether and chloroform. In- 
dependent of these, the agents which have 
been chiefly administered by inhalation are 
vapour from water, either simple or medi- 
cated, chlorine gas, iodine fumes, fumes 
from mercurials, &c. 

The steam from water may often be used 
as a safe domestic inhalation, in cases which 
require the local application of heat and 
moisture ; indeed, in sore-throat, steaming 
is very commonly had recourse to. It may 
also be employed with advantage in cases 
where the breathing is difficult, with tena- 
cious expectoration, especially in old people. 
In chest affections, such as consumption 
with spasmodic cough, the vapour of boil- 
ing water, into which has been put a few 
drops of sulphuric or chloric a?ther, or ten 
or a dozen drops of laudanum, will fre- 
quently afford much temporary relief. Me- 
dicated inhalations, such as those from 
chlorine, if used at all, must be so under 
direct medical superintendence. It is pro- 
bable that the slow, imperceptible, but 
continual breathing of an atmosphere im- 
pregnated with such medicinal agents as 
chlorine, iodine, &c. &c. is more likely to be 
of service than their temporary use in more 
powerful doses. It has been observed in 
manufactories in which a chlorine atmo- 
sphere prevails, in consequence of the ope- 
rations, such as bleaching, carried on within 
them, that men who have entered the works 
with weak chests or consumptive tendencies, 
have, in the course of time, become much 
improved in health. It is, also, not impi-o- 
bable, that part of the benefit, at least, de- 
rived from sea-side residence, may be due 
to the constant imperceptible inhalation 



INJ 



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INS 



of chlorine salts, and other vaporized sub- 
stances. If, however, the constant inhala- 
tion of some agents "be beneficial, it is still 
more certain that the presence of others in 
the atmosphere breathed is most mimical 
to health. This subject, however, is suffi- 
ciently entered into in other articles, such 
as Air, Atmosphere, Ventilation, §c. 

Various methods of inhaling steam are 
employed : simply holding the mouth over 
a jug of hot water will answer, but if the 
throat be the part affected, the vapour is 
most directly conducted to it by means of a 
tube of some kind. A filtering-funnel, or 
tun-dish, inverted over the vessel from which 
the steam issues, will do very well. Where 
vapour is wished to be inhaled by persons 
confined to bed, or very weak, a good me- 
thod is to place a quantity of hot bran in 
a suitable vessel, pour some boiling water 
upon it, and place it under a light cloth, 
which also covers the face of the patient. 
If desired, various forms of inhalers can be 
procured at the instrument-makers. 

Refer to Chloroform — JEther, §c. 

INJECTION.— See Clyster. 

INOCULATION— Is the introduction of 
a poison into the system by means of a 
wound. Any poison which will thus affect 
the part in which it is placed, or the system 
generally, may be said to be introduced by 
inoculation. The term is most generally 
used with reference to the poison of small- 
pox, to the article on which the reader is 
referred. 

Refer to Poisons. 

INQUEST.— The inquiry into the cause 
of death from violence, or in an unusual, or 
in an unexpected manner, ought to be one 
of those safeguards to human life in this 
country, which every one should uphold 
and promote, instead of, as is too often 
done, throwing impediments in the way of 
the operation of the law. For this purpose, 
in cases of unexpected death (see Persons 
found Dead) those who chance first to be 
at the scene should note carefully whatever 
may be of service in the inquiry of the 
coroner and jury. Probably, never at any 
time was the authority and surveillance of 
the coroner's court more required than it is 
at present, when the crime of secret poison- 
ing seems so fearfully on the increase. It 
is a very common opinion, that inquests 
are only called for when there is a strong 
suspicion of crime. If they are to be con- 
fined to such cases, they might almost be 
superseded entirely. Their great use is to 
investigate unexpected death, whether sus- 
picion exists or not. In this way only can 
|hey be an effectual and dreaded check upon 



crime. Moreover, the full efficiency of tha 
coroner's office is very greatly impaired 
by the anomalous proceeding of generally 
placing what ought to be a medical inquiry 
in the hands of a legal functionary. The 
law of inquest is, or ought to be, in some 
degree, at least, a fixed principle or rule of 
action. The medical questions which are 
involved in the majority of inquests are so 
varied, that they cannot possibly be fully 
judged of by a non-medical inquirer. Me- 
dical men alone are, or ought to be, com- 
petent to seize hold of and follow up many 
clues of inquiry that must and do fail to 
attract the notice of those whose knowledge 
(if possessed at all) is necessarily limited 
on subjects of medical science. 

Refer to Death — Drowning — Hanging — 
Poisons. 

INSANITY — Lunacy — Unsoundness of 
Mind — Are all terms for a disorder, of which 
it has puzzled the most acute to give an 
accurate, and, at the same time, sufficiently 
comprehensive definition, although all are 
aware of the general sense of the terms 
used to indicate the disorder. It is suffi- 
cient for our purpose here, to mention that 
the most general division of the subject is 
into mania, that is insanity, along with 
more or less violence in demeanour and ac- 
tion ; monomania, in which either the un- 
derstanding or the will is perverted on one 
particular point ; and dementia, or inco- 
herent thought, verging to imbecility. 
Amentia, or idiocy, has been already ad- 
verted to. 

The main character of insanity, in a legal 
point of view, is said to be the existence of 
a delusion ; that is, that a person should be- 
lieve something to exist that does not exist, 
and that he should act upon this belief. 
Many persons may labour under harmless 
delusions, and still be fitted for their social 
duties ; but should these delusions be such 
as lead them to injure themselves or 
others in person or property, then the case 
is considered to require legal interference ; 
otherwise not.* 

The approaches of insanity are variously 
characterized. Sometimes, to all appearance, 
it comes on without warning, a sudden out- 
break of violent mania being the first in- 
timation of the disease. Even in these 
cases, however, investigation will generally 
discover that there has been some amount 
of preceding disorder, some sleeplessness, 
some unusual irritability or mental excite- 
ment, perhaps concealed or controlled by 
the individual. In other cases, the mental 

* Taylor's Medical Jurisprudence. 



INS 



313 



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oddities; irritabilities, fluctuations of spirits, 
&c. have been evident, but too slight to 
excite apprehension. At the last, the acute 
attack may be induced by some severe or 
prolonged mental emotion, or by some phy- 
sical depression. The onset of the attack 
itself, is frequently preceded by, or accom- 
panied with feverish symptoms, which par- 
ticularly affect the head. In this case, the 
insanity is probably, at its first onset, ac- 
companied with acute affection of the brain 
or its membranes, and partakes of the cha- 
racter of delirium, properly so called. Where 
the circumstances, such as hereditary pre- 
disposition, or previous warning symptoms, 
give rise to the suspicion of impending in- 
sanity, medical advice must at once be 
sought, preparatory to the one essential and 
most merciful step — removal of the patient 
to an asylum. In the mean while, the most 
perfect quiet, both of body and mind, and 
the treatment recommended under the head 
of "Delirium," will be the most advisable 
mode of proceeding. 

Insanity is a disease which, when once 
developed, ought never to be kept under do- 
mestic management, or rather mismanage- 
ment. The only reasonable hope rests with 
speedy removal to proper care and to a 
state of external circumstances specially 
adapted to promote recovery. Asylums for 
the insane are not what they were, and the 
most attached and affectionate relative need 
not fear to place the afflicted under the pro- 
tection of a well-managed establishment. 

The following extracts from the interest- 
ing " Reports" of Dr. Brown, the energetic 
superintendent of the Crichton Asylum, 
near Dumfries, will best explain the bearing 
and connection of the insane on and with 
society at large, and will show how much 
comfort, and it may be said happiness, may 
be enjoyed by the afflieted under kind and 
intelligent management. In the Report for 
1845; it is remarked — " Prompt treatment is 
of most importance, and obstacles which 
make it difficult of access, afford a pretext 
and palliation for that repugnance to resort 
to isolation, which still exists in the minds 
of friends and guardians, but which is fading 
and falling, and must ultimately fall before 
the influence of a system of discipline 
founded upon humanity, and which is open 
to investigation. The procrastination which 
occurs when an individual is attacked with 
insanity, in adopting the only course which 
can insure the enforcement of judicious 
means of care and cure, is the result of 
various causes. . . . Frequently it may 
be traced to ignorance, that the extrava- 
gance and incoherence which inflicts so 
2B 



much pain, and creates so much confusion, 
are symptoms of diseased organization ; and 
to skepticism that these originate, increase, 
disappear, or are removed, according to the 
same principles, and nearly in the same 
manner that gout and jaundice are miti- 
gated or removed. If the opinion were 
generally prevalent, that insanity in all 
cases, whether its development is determined 
by disappointment or by a blow on the head, 
whether signalized by great constitutional 
disturbance or apparent robustness of frame, 
depends upon bodily disorder, and can only 
be reached, whether curable or not, through 
the body, and by agents which act in ac- 
cordance with the known laws of the eco- 
nomy. Advice should be sought at once, or 
as speedily as in other maladies : the powers 
or efficacy of medicine would be put to a 
fair test, and it is admissible to anticipate 
that the mortality and evils of an intracta- 
ble class of diseases would be materially 
diminished. Even now, when months are 
allowed to elapse before assistance is ob- 
tained, a very large proportion of the more 
transient and trivial cases of mania are 
found to recover under judicious manage- 
ment ; while one-third, at least, of the more 
desperate and chronic and hopeless cases, 
which are sent to public institutions because 
they have set all conciliatory and temporiz- 
ing expedients at defiance, and resisted the 
treatment pursued, are ultimately restored 
to such a degree of intelligence as to capa- 
citate them for the resumption of former 
pursuits and responsibilities, and for the per- 
formance of the duties of active life." 

But even within the walls of an asylum, 
active duties and enjoyments may be en- 
gaged in, if properly arranged. In the 
Report for 1851, Dr. Brown remarks — "The 
character of the moral management is acti- 
vity without excitement, progress, the com- 
bination of self-government with appeals to 
the intellect and sentiments. There is always 
something to expect to prepare for ; some 
anticipation or some retrospect. Patients 
are participators in every arrangement. 
They are identified with the recreation as 
well as the labours of the community. They 
are led to understand that each progressive 
step is not merely for them, but by them. 
They are their own gardeners, labourers, 
players, precentors, [Anglice, clerks,) libra- 
rians, and, under certain restrictions, their 
own police. Each day has its appropriate 
relaxation, as well as its duties ; but mono- 
tony, which engenders torpidity rather than 
tranquillity, even the monotony of continued 
recreation, is obviated by useful pursuits 
and physical exertion. Sub-matrons have 



INT 



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been thrice selected from the patients ; 
they delighted in the badge of office, and 
proved worthy of the trust. The library 
is now intrusted to a patient whose mind 
seems specially constituted for such an 
avocation. He has prepared and nearly 
arranged the catalogue, which is to be 
printed at the institution press." The 
drama has been used and found useful, both 
to "interest and elevate many classes of the 
insane," both as performers and spectators. 
Further, in the same interesting report, it 
is said — "The number of cultivated minds 
which still retain former predilections, 
though shorn of former power, may be 
learned from the solicitude displayed in 
adding to the collection of books, in mul- 
tiplying literary pursuits, and in extend- 
ing the range of intellectual impressions." 
After describing the occupations of many of 
the inmates of the institution, the Report 
continues — "The act of composition, from 
whatever motive it may proceed, is bene- 
ficial and invigorating. It could only be 
by the sudden withdrawal of this liberty of 
thought, and of these intellectual luxuries, 
that their full efficacy could be tested in 
establishing tranquillity, and in suggesting 
a deportment which closely resembles, if it 
do not entirely realize, that of sanity and 
serenity. Worship is regularly performed 
according to the forms of the established 
churches. Members of other communions 
visit their churches in Dumfries, accom- 
panied by officers, or are visited by their own 
clergyman. The timidity which formerly 
excluded the insane from such ordinances, 
or concealed their presence by a vail, has 
passed away ; the error that they were 
incapable of comprehending or joining in 
worship has been demonstrated ; and in 
these assemblies children and maniacs are 
seen to bend the spirit and the knee side by 
side ; in them it is impossible to distinguish 
the sane from the insane, the guardian from 
his charge ; and all ideas are banished from 
the mind of a spectator except those of 
universal brotherhood, and that peace which 
passeth understanding. It may be that 
there is a sense of supplication where there 
is no power of precise and articulate prayer ; 
and it may be, that independently of, and 
even in opposition to, external manifestations, 
there is an 'inner -life hidden with God;' 
but it is certain that reverence and atten- 
tion prevail ; that the tranquillity is greater than 
under other circumstances ; that the acknow- 
ledged effects are contentment and calm." 

Did space permit, there is much of interest 
and information which the author would 
wish to havp extracted from the able reports 



of this splendid and well-managed institu- 
tion ; but enough, perhaps, has been given 
to convey some idea of the interior arrange- 
ments of a well-conducted lunatic asylum 
of the present day. [Many such are in the 
United States.] None, perhaps, are so 
ignorant as to believe that the chains and 
other barbarisms, nay, even the lash, are the 
lot of the inmates of these hospitals — for 
such they may truly be called — but the 
generally diffused ideas, either of the treat- 
ment or of the capabilities of the insane, are 
very undefined or erroneous. 

A very erroneous idea exists, particularly 
among the ignorant, that if a person be 
insane, he cannot act or look like a rational 
being at all, but must be constantly doing 
things in an insane manner. Consequently, 
if the individual be simply lunatic or mono- 
maniac, without being actually under the 
influence of maniacal excitement, or even 
should he have a "lucid interval," that is, 
a temporary cessation of mania, and tem- 
porary return, either wholly or partly, of 
his rational condition, those around are 
apt to be lulled into a false security, the 
vigilance or attendance is relaxed, and a 
momentary return of the delusion is at- 
tended, perhaps, with the most serious con- 
sequences, rendering nugatory hours and 
days of anxious care. 

In addition to the various causes predis- 
posing to, and directly exciting insanity, 
such as hereditary tendency, political or 
commercial excitement, grief and disappoint- 
ment, false or erroneous religious excite- 
ment, &c. no fact is more clearly ascertained 
than the vast amount of insanity caused by 
drunkenness. The temporary insanity of 
intoxication cannot be indulged in with 
impunity ; it may be frequently repeated, 
but at length the mind permanently gives 
way, and the individual becomes a confirmed 
lunatic. On this point Dr. Robinson, of 
Newcastle, in an interesting paper upon the 
Mutual Relations existing between Intemper- 
ance and Insanity, remarks — "Intemperance 
and insanity, the two greatest curses of 
civilization, are in their very nature so inti- 
mately connected, that any examination of 
the one would be necessarily incomplete 
without the other; for both exhibit, as their 
essential phenomena, perversion or disorder 
of those mental powers which impart to 
man his vast superiority over the rest of 
the creation. Since, then, a single dose of 
intoxicating substance possesses the power 
of temporarily disordering the intellect, per- 
verting the moral sentiments, and even 
wholly suppressing the operations of the 



INS 



315 



INT 



tinued use of such agents should frequently 
induce permanent mental derangement." 
In a table drawn up for the returns of 
twenty-five asylums in England and Wales, 
it is found that one-fourth of the cases of 
insanity admitted are referred to intemper- 
ance alone, and to it, in conjunction with 
vice and sensuality, nearly one-third. 

Refer to Delirium — Delirium Tremens — 
Dipso-Mania — Monomania, §c. 

INSPIRATION.— The act of drawing air 
into the lungs, and the opposite of expira- 
tion, which consists of its expulsion ; the 
two together constituting respiration. 

INSTRUMENTS.— But few of these me- 
chanical agents used by the surgeon in the 
treatment of disease can ever be of legi- 
timate use to unprofessional persons living 
within reach of a medical man, and those 
who are likely to be placed in circumstances 
where such assistance is not available, who 
may wish to be prepared for emergencies, 
should get themselves practically instructed 
in the use of the few they may venture to 
take in hand. The instruments required in 
such operations as bleeding, cupping, tooth- 
drawing, &e. are sufficiently described under 
the articles devoted to the subjects. In 
addition to them, the dweller — such as a 
clergyman — in a remote parish, even in this 
country, might find the following useful : — 

A Lancet. A silver probe. 

A gum scarificator. — See Children. 

A pair of plain forceps. ") See Forceps and 

A pair of spring forceps, f Dressing. 

A vaccinating lancet. — See Cow Pox, 

A pair of scissors with blunt points. 

A caustic holder. 

A two-ounce syringe. — See Syringe. 

A clyster instrument, or rather two ; one 
being a syringe, and one the elastic bag. — 
See Clyster. 

To these the emigrant might add with 
advantage — 

A tenaculum. — See Tenaculum. 

A tourniquet. — See Tourniquet. 

A shut-up bistoury, or knife. 

It is perhaps superfluous to add, that these 
should be got at some respectable surgical 
cutler's ; and it is well to add, that all who 
provide themselves with them should endea- 
vour, if possible, to get a little practical in- 
struction in their employment. 

INTEMPERANCE.— See Stimulants. 

INTER-MARRIAGE.— See Marriage. 

INTERMENT.— See Burial— Death, &c. 

INTERMITTENT.— A term applied to 
diseases which, like ague and neuralgia, 
come on in paroxysms, between which there 
is an interval of comparative freedom from 
the symptoms of the disease. The term is 



also applied to the pulse, when some of its 
beats are as it were omitted. 

INTOXICATION— Means literally what 
it really is, a condition of poisoning, either 
by alcohol or by other narcotic agents : the 
former however being the most frequent 
cause in this country. Intoxication from 
the use of opium, Indian hemp, &c. is ad- 
verted to in the articles upon these agents. 
The phenomena of alcoholic intoxication are 
thus described by an esteemed writer: — 
" The effects which follow the introduction of 
a large quantity of moderately diluted alcohol 
into the stomach, are, first, the local excite- 
ment of this organ indicated by the sensation 
of heat in it." "This impression is next 
conveyed to the brain, spinal marrow, and 
entire nervous system ; ideas of unusual 
brilliancy pass through the mind. As the 
power of the stimulus increases, all control 
of the will is suspended ; the ideas are then 
irregular, and instead of being combined in 
such a manner as to produce even agreeable 
conceptions, they arise in the most incon- 
gruous order. The extent of the excitement 
becomes apparent in the unusual vivacity of 
the eye, the swelling of the veins of the 
neck, and the beating of the arteries ; but 
new symptoms quickly follow, namely, pain 
in the frontal region, the head drops on the 
chest, the eyes lose their expression and 
are half-closed, the physiognomy is altered 
and vacant, the voluntary muscles cease to 
act, the arms are pendent or their move- 
ments are irregular, the legs cross one 
another in the effort to walk, giddiness 
supervenes, and delirium follows. The ex- 
hausting influence of such a state is too 
great to continue ; in a short time collapse, 
and sleep, resembling that of apoplexy, fol- 
low." Probably, the influence of alcohol 
upofcthe brain, in the first place at least, is 
partly effected through the nerves of the 
stomach, but it is very quickly absorbed 
into the blood, and speedily reaches and acts 
directly upon the brain itself. This has been 
proved by experiment and examination after 
alcohol had been swallowed, and there has 
been found in the brain a considerable quan- 
tity of fluid distinctly impregnated with 
spirit, to such an extent, even, as to burn. 

The cases of sudden death — too frequently 
recorded in the newspapers— from the rapid 
drinking of a large quantity of spirit, may 
be quite accounted for by the shock com- 
municated directly by application of the 
spirit to the brain itself, or indirectly by a 
shock given to the stomach and its nervous 
connections, with an effect similar to that 
which ensues from drinking largely of very 
cold water when the body is heated and 



INT 



316 



IPE 



exhausted, or from a blow on the stomach. 
Death in the latter stages of intense intoxi- 
cation is similar to that from some forms of 
apoplexy. Some indication of the amount 
of danger to life, existing in a person in a 
state of intense intoxication, may be gather- 
ed from the condition of the iris. — See Eye. 
If this retain its power of contraction, the 
person will generally recover ; if, on the 
contrary, it remain in a state of extreme 
dilatation and immobility when a strong 
light is directed upon it, only a feeble hope 
of recovery can be entertained. The ordi- 
nary duration of fatal cases of intoxication 
is said to be from twelve to eighteen hours, 
but on this head there is considerable varia- 
tion. When death is threatened from the 
absorption of alcoholic fluid into the system, 
the individual, after the usual symptoms of 
intoxication, becomes insensible ; the face 
is flushed and the vessels of the head dis- 
tended ; the pupils contracted and the skin 
hot ; or, contrasting with violent throbbing 
action of the heart and arteries, the face is 
deadly pale, lips blue, pupils dilated, sur- 
face cold and covered with clammy sweat ; 
the natural contraction of the muscles is 
suspended so that the jaw drops. In short, 
there is every appearance of death, which, 
indeed, may speedily take place : neverthe- 
less, a patient may be roused by appro- 
priate measures, even from this apparently 
hopeless state. 

The first proceeding which naturally pre- 
sents itself in the treatment of such cases, 
is to procure the evacuation of any alcoholic 
fluid which may remain on the stomach. 
If a medical man is at hand, he will pro- 
bably effect this by the stomach-pump ; if 
not, sickness may be excited by the first 
procurable emetic — except antimony — or by 
a feather in the throat. After the stopach 
has been emptied by vomiting, a little sal- 
volatile in water, or hartshorn in water, or 
vinegar and water should be given; cold' 
water should be used freely to the head ; it 
is most effectual if poured upon it in a 
regular continued stream for some minutes. 
If the extremities are cold, heat should be 
applied to them. The author has found a 
stimulating injection of an ounce of turpen- 
tine in half a pint of gruel, of much service 
in rousing the depressed system. Mustard- 
plasters may be applied to the pit of the 
stomach, between the shoulders, &c. It ought 
to be remembered, however, that sensibility 
maybe restored and the most serious symp- 
toms dispelled, and yet, if the stomach has 
not been entirely emptied, they may again 
return and prove fatal, unless the patient is 
closely watched. — Refer to Stimulants. 



INVERSION.— The turning inside out of 
an organ, such as the womb. It is a serious 
accident, which sometimes occurs under pe- 
culiar circumstances, as after labour. The 
assistance of a medical man is always im- 
peratively called for. 

INUNCTION.— The rubbing of an oint- 
ment upon the skin, for the purpose of 
promoting the absorption into the system 
of any medicinal substance contained in 
the ointment. Ointments which contain 
mercury or iodine are principally used with 
this intent. 

IODINE — Is a substance at present consi- 
dered as elementary. It is principally obtain- 
ed from sea- water, or sea-products, but is also 
found in some mineral waters, and in some 
plants, such as common watercress. Iodine 
exists in the form of dark, metallic-looking 
scales ; it possesses a strong pungent odour, 
and stains whatever it may come in contact 
with of a deep yellow or brown colour. 
When heated in a flask, iodine rises in the 
form of a beautiful violet-coloured vapour, 
and condenses unchanged on the side of the 
glass. Iodine and its preparations are much 
used by medical men, but can scarcely fall 
within the sphere of domestic remedies ; 
the ointment of the combination of iodine 
with potash is used in bronchocele, or swell- 
ed neck. — See Bronchocele. When combined 
with iron, iodine is a remedy of much value 
in debility, and in scrofulous disease ; it is, 
however, a medicine that should never be 
taken without medical sanction. 

IPECACUANHA— At once one of the most 
valuable medicines of the practitioner, and 
one of the safest remedies which can be 
used domestically — is the root of a pretty 
little South American plant. It is brought 
to this country in pieces about the thickness 
of a goose-quill, and about six inches long, 
brown, wrinkled, and knotty. But its most 
characteristic feature, and that which serves 
to distinguish it from spurious roots often 
attempted to be substituted for it, is its 
ringed appearance ; it seems as if made up 
of a number of separate pieces, or rings, 
strung, as it were, upon one central stem. 

Ipecacuanha is best known as an emetic, 
and it is perhaps the most certain, safest, 
and best of the class we possess. No family 
medicine-chest in the country should be 
without it. It is also a valuable expecto- 
rant and diaphoretic remedy, and facilitates 
greatly the action of aperients. The powder 
and the wine of ipecacuanha are the most 
general forms in which it is used; as an 
emetic, it should always be given in powder 
if possible ; a great error is often committed 
in giving children the wine to act emetic 



IRI 



317 



mo 



ally, for frequently it fails in action alto- 
gether, or requires so much as to make the 
amount of wine given, a consideration, in 
cases of febrile disease especially. As an 
emetic, the dose of ipecacuanha in powder 
from twenty to thirty grains for an adult, 
is half that to a child of ten years old. For 
young children, especially when, as in chest 
affections, the constitutional and expecto- 
rant influence of ipecacuanha is as much 
wanted as its emetic effect, the author pre- 
fers giving it in smaller divided doses ; for 
this purpose, from twelve grains to a scruple 
of ipecacuanha powder may be rubbed up 
with an ounce and a half of sugar and water, 
[or the syrup may be obtained from the 
apothecaries,] and of this a teaspoonful 
given at intervals, according to the effect 
desired or produced. Quarter-grain doses 
of ipecacuanha, combined with any of the 
common aperient pills, seem to facilitate 
their action, and to leave the bowels with 
a better tendency to relaxation than before. 

When ipecacuanha fails in exerting its 
emetic influence, and, indeed, sometimes 
when it does cause vomiting, it acts upon 
the bowels, producing diarrhoea. Its emetic 
action is slower than that of sulphate of 
zinc, and the latter is therefore more gene- 
rally used in cases of poisoning, provided it 
is at hand. Ipecacuanha enters into the 
composition of Dover's powder. — See Opium. 
Ipecacuanha may be kept in the form of 
powder ; but, perhaps, for those who may 
not be able to renew their stock frequently, 
it will be preferable to have it in the form 
of the entire root, as it will thus longer 
preserve its activity. Moreover, the pur- 
chaser may then assure himself that he gets 
the genuine article, which it is impossible 
for him to do when he buys the drug in 
powder. The labour of powdering is not 
very great, and the wine may be made by 
steeping half an ounce of the well-bruised 
root in half a pint of sherry for two or 
three weeks, and then filtering. 

Refer to Emetics. 

IRIS.— See Eye. 

IRON — The well-known metal, is and has 
been used as a medicinal agent in a great 
variety of preparations: it also forms one 
of the most common ingredients of mineral 
springs. The tonic and strengthening pro- 
perties of iron are well known, even popu- 
larly, and, probably, we have no remedy of 
the kind so generally useful and applicable 
in cases of debility ; at the same time, it is 
not so much adapted for domestic use as 
many medicines of less value. The cases 
in which preparations of iron are most em- 
ployed are not emergencies, they are usually 
2b2 



constitutional affections of some standing, 
in which medical advice is not only requi- 
site for the general treatment, but also as 
a guide for the administration of the iron, 
which, improperly given, may do much mis- 
chief. Persons who are habitually costive, 
who suffer from piles, or from determination 
of blood to the head, require to be especially 
careful with respect to the use of medicines 
containing iron, and should never take them 
without medical advice. The weak, the 
pallid, the delicate may, for the most part, 
use them with greater safety, and very ge- 
nerally with benefit. 

The tincture of the muriate of iron, or, as 
it is called popularly, " tincture of steel," is 
one of the most generally used and useful 
preparations, in doses of from ten to fifteen 
drops twice a day, in water, for an adult. 
It is not disagreeable, and children take it 
readily ; the dose is four or five drops for a 
child of six years of age. This preparation 
is powerfully astringent, and is extremely 
useful in relaxation of the throat, applied 
by means of a camel's-hair brush. The 
common sulphate of iron, or green vitriol, 
is a very cheap and good preparation, in 
doses of from half a grain to a grain dis- 
solved in water, or made into pill with 
crumb of bread. The ammonia-tartrate of 
iron, the citrate, and the citrate of quinine 
and iron, are all recent introductions ; the 
former is very soluble in water — dose, one, 
two, or three grains. — See Citrates. 

When iron is really required by the con- 
stitution, it cannot, probably, be taken in 
any more beneficial form than that of a 
mineral water. At the same time, these 
natural sources of the medicine are open 
to the same objections a»d causes as its 
artificial preparations, and many persons 
injure themselves by inconsiderately, and 
without advice, drinking these waters regu- 
larly, merely because they happen to be 
close to them for the time being. In 
mineral waters, iron is found in a state 
of great dilution, and the striking benefit 
which follows its use in this state in proper 
cases, justifies the fact that, when given 
artificially, it is found to be most service- 
able in small doses in a considerable quan- 
tity of water. 

Persons who are taking preparations of 
iron, should pay extra attention to their 
teeth during the time, to prevent discolor- 
ation. The evacuations from the bowels 
always assume a dark or black colour, 
during a course of iron, and particular 
attention is always required to keep them 
in a perfectly open state during the continu- 
ance of the remedy. 



IRE, 



318 



ITC 



IRRITABILITY— Cannot perhaps have a 
better definition than that of Abernethy, 
"excited debility." It is a symptom of 
many diseases, trying both to patients and 
to their attendants, but one for which every 
allowance and consideration ought to be 
made. Those who have never suffered from 
the weakness of disease, especially such as 
affects or has affected the nervous system, 
cannot imagine in how many ways, which 
appear not only trifling, but absurd, to a 
person in health, the irritability of the 
invalid may be jarred upon. 

The term irritability is also used to ex- 
press that property of muscular fibre to 
which it owes its powers of contraction. 

IRRITATION— May be defined as diseased 
excitement, not amounting to inflammation. 
Many of the diseases of children partake 
more of irritation than inflammation. What 
is called irritation of an organ may take 
place at a distance from the source of the 
irritation; thus, worms and other matters 
in the intestines may cause convulsive and 
other affections consequent upon irritation 
of the brain ; or the irritation of the gums 
in teething may also cause convulsion, or 
spasmodic croup. The irritant action being 
in these cases in the first place felt by the 
brain, and thence reflected so as to affect 
the muscles which are thrown into spasm. 

Refer to Convulsion. 

ISINGLASS.— See Gelatine. 

ISSUE. — An issue is an artificial sore, 
from which a discharge of matter is kept 
up by artificial means ; it may, therefore, 
be formed in various ways, such as burning 
with a red-hot iron, by caustics, &c. ; but 
the most general, and indeed common form 
in popular use, is the pea issue. This is 
made by pinching up a fold of the skin, 
and making an incision into it, which will 
admit the insertion of two or three peas, 
which are to be secured in the wound by 
adhesive plasters. In the course of a few 
days the irritation occasioned by the peas 
causes discharge of matter. The peas are 
generally changed every day, or two days, as 
long as the issue is desired to be kept open. 

A very good issue may be formed by blis- 
tering the skin by means of one of the blis- 
tering tissues, and applying daily a piece of 
the same tissue to the sore, to keep up the 
irritation. 

The seton is only another form of issue, 
made by passing a skein of silk through a 
fold in the skin, by means of a seton-needle 
prepared for the purpose. 

The principle on which issues, setons, 
and other means of counter-irritation are 
established, is that of producing derivative 



action, and to the article on that subject 
the reader is referred; also to "Counter- 
Irritation," "Blister," &c. The strictest 
cleanliness must always be observed about 
an issue or seton, or any other discharging 
sore. It is perhaps superfluous to add, that 
an issue should never be made on a portion 
of the skin which is liable to be visible. 

ITCH. — This dreaded skin affection con- 
sists of the eruption of small pointed vesi- 
cles, which show themselves chiefly upon 
the wrists and between the fingers, but also 
at the bends of both the upper and lower 
extremities — in children, upon the breech 
— and is attended with excessive itching, 
when the person affected gets warmer than 
usual, either in bed or after taking stimu- 
lating food or exercise. The itch attacks 
persons of all ages, or of either sex, and 
may be spread by contagion through those 
of any rank of life. It is, however, more 
likely to become established and to be pro- 
pagated wherever cleanliness is neglected ; 
and among the poor, especially in those of 
bad constitution, and who are also badly 
nourished and clothed, it is apt to be mixed 
up with other eruptions, indicative of the 
impaired constitutional power. 

Coincident with the eruption of itch, 
there is often discoverable a minute insect 
of the mite kind, which burrows in and 
deposits its eggs in the skin. By some, the 
origin of the disease is ascribed to this in- 
sect ; by others this is denied. 

Fortunately the cure of this disagreeable 
affection is in almost all cases certain and 
quick, sulphur, in the form of ointment, 
made by rubbing up one part of the common 
flowers of sulphur with two parts of lard, 
being the agent generally employed. Before 
this application is used, the entire skin 
should be thoroughly washed with soap 
and water; the ointment must then be well 
rubbed in all over the body, and washed 
off again next morning — the person sleep- 
ing in a flannel dress, or between blankets. 
This process may be repeated two or three 
times if requisite. In persons of full habit 
of body, it is advisable for them to take an 
active purgative the day before using the 
sulphur ointment. 

A much quicker method of cure is said to 
be employed in the Hospital of St. Louis, in 
Paris. It is thus reported in the Lancet for 
December 20, 1851: — "The patient is put 
into a warm bath, and rubbed for an hour 
with yellow soap ; he then passes into a 
clean bath, where he continues to cleanse 
his skin for another hour. After leaving 
this bath he is taken to a particular room 
fitted for this purpose, and, with the aid of 



JAL 



319 



JOI 



one of his fellow- sufferers, he is ruTbbed all 
over for half an hour with the following 
ointment: — Lard eight parts, flower of sul- 
phur two parts, carbonate of potash one 
part." After this friction the patient is 
generally cured. 

In a disease of so contagious a nature as 
itch, the utmost care is requisite in the 
avoidance, not only of contact with the 
person suffering, but with any article of 
dress, or otherwise, which he may have 
made use of; and when the person who has 
suffered is cured, it is requisite for him 
to exert equal care with respect to these 
things himself, until they have been puri- 
fied, either by washing, or by fumigation 
with sulphur — bearing in mind the effect 
of the latter agent in changing or discharg- 
ing the colour of articles of furniture or 
dress. By some it is said that itch can be 
cured by the rubbing in of simple lard, or 
of olive or any of the fixed oils into the 
skin — the application being used twice 
daily, for two or three days in succession. 
The author has no experience of the prac- 
tice, but it is worthy of trial, if it will 
supersede the somewhat filthy, and cer- 
tainly not very odorous application of sul- 
phur. Mr. Erasmus Wilson states that he 
has found camphor dissolved in olive-oil, 
one part to eight, perfectly efficacious as an 
application in the cure of itch. When 
sulphur is used for the cure of itch, it may 
occasion some amount of irritation of the 
skin, which, being mistaken for the uncured 
disease, sometimes causes persons to go on 
rubbing long after the itch is cured, there- 
by keeping up unnecessary irritation and 
causing needless trouble and uneasiness. 

JALAP — So well known as a ptirgative, 
is the root of a species of plant resembling 
the convolvulus, a native of South America, 
its name being derived from Jalapa, a town 
in Mexico, in the neighbourhood of which 
the drug is produced. Jalap is an active 
purgative, in doses of from ten to thirty 
grains, but with some persons it causes 
great nausea, and other it gripes severely. 
The best form for its administration is the 
compound powder, composed of jalap in 
powder three ounces, cream of tartar six 
ounces, and ginger two drachms, well rubbed 
up together ; the dose half a drachm to a 
drachm. There are purgatives more con- 
venient for domestic use than jalap. 

JAMES'S POWDER.— See Antimony. 

JAUNDICE — Is one of the secondary dis- 
eases, the result of a primary one ; that 
is, some cause, in the first place, stops the 
flow of bile from the liver; and jaundice, 



which consists in the absorption of that 
bile into the blood, is the effect. 

This impediment to the flow of the bile, 
may arise from whatever blocks up the 
canal of the gall-duct. — See Gall-Bladder. 
Probably, gall-stones, or thickened bile, 
are the most common obstructions ; but 
tumours which press upon the duct, or spasm, 
may also stop the bile and induce jaundice. 
Jaundice has sometimes succeeded to vio- 
lent mental emotions. The presence of 
bile in the blood is quickly manifested by 
the color of the skin, and also more par- 
ticularly of the white of the eye ; the 
shade of colour varying from the slightest 
perceptible tinge, to deep golden yellow, or 
even brown. At the same time, the stools 
become white and chalky-looking, and the 
urine — sometimes the perspiration — is 
deeply tinged with bile ; the constitutional 
symptoms are generally those of disorder- 
ed digestion, headache, and languor. For 
many reasons, jaundice is a disease which 
ought, when possible, to be under proper 
medical treatment, not so much from the 
danger of the affection itself, as from its 
being symptomatic of disorder elsewhere. 
Should gall-stone or spasm be the cause of 
jaundice, the case is generally plain, (see 
Gall-Stone ;) but should the presence of a 
tumour, or disease of the liver be the origin, 
it requires medical examination for its elu- 
cidation. 

The treatment of jaundice, which unpro- 
fessional persons may adopt in the absence 
of a medical man, is very simple : from five 
to eight grains of "gray powder" being 
given at bedtime, either alone, or, if there 
is pain, made into pill with extract of hen- 
bane, and followed by a dose of castor-oil 
or senna in the morning. When there is 
much acidity of the stomach, carbonate of 
soda may be given. The diet should be 
simple, devoid of milk, fat, or saccharine 
articles while the jaundice exists, and all 
alcoholic stimulant avoided. Of- course, 
when violent spasmodic pain indicates gall- 
stones, the measures recommended under 
the article on the subject must be adopted, 
" Refer to Bile — Gall-Bladder — Liver, $c. 

JAWS.— See Skull. 

JEJUNUM.— A portion of the small in- 
testines. 

JELLY. — See Cookery — Gelatine. 

JESUIT'S BARK.— See Bark. 

JOINTS. — Also called articulations. The 
joints, generally, from their mobility and 
exposed situation, are very liable both to 
accident and disease ; in either case, much 
care on the part of the attendants, and 
much patience on that of the patient, is 



JOY 



820 



called for, as it need scarcely be remarked, 
that the most perfect rest is, in most cases 
of disease affecting the joints, Me essential, 
for which no other remedial measures will 
compensate. Incurable disease of the bones 
of a joint does not now, under the improve- 
ments of modern surgery, necessitate the 
loss of the limb : the joint, such as the elbow 
— and even the knee — may be cut out, and, 
in the course of time, a tolerably useful 
member remain, a kind of new joint being 
formed. 

Refer to various joints — Ankle — Hip — 
Knee, §c. Refer also to articles Dislocation 
- — Skeleton, $c. 

JOY. — This powerful and instantaneous 
mental emotion may act upon the body, be- 
neficially or the reverse. There are so many 
recorded instances, either of overturned rea- 
son or of death resulting from excessive and 
sudden joy, that too great caution cannot be 
exerted in arousing it in persons of a nervous 
temperament, or in those who are debilitated 
by disease. Epilepsy has resulted from sud- 
den joy. 

JUGULAR VEINS— Are the large veins 
which convey the blood from the head and 
face back to the heart. They are both in- 
ternal and external. 

Refer to Neck — Veins, fyc. 

JULEP — An old name for what are now 
called Camphor Mixture — Mint- Water, $c. 

JUNIPER. — Two species are used in me- 
dicine ; the common, well-known juniper, 
which grows in England, [and also in the 
United States,] and the juniper which yields 
the savine. The former of these, the com- 
mon juniper, is a diuretic, a property it owes 
to its essential oil, and cannot be employed in 
any better form than that of Hollands gin, 
which was originally introduced as a medi- 
cine. — See Gin. The savine is notorious from 
having been frequently employed for crimi- 
nal purposes, and when so employed, from 
its fatally irritant properties being frequent- 
ly manifested. Savine has been used as a 
remedy for destroying worms in children, 
but cannot be regarded as safe. 

KALI — Potash.— See Potash. 

KIDNEY. — The kidneys, or glands whose 
office is the secretion of the urine from the 
blood, are situated on either side of the 
spine, (fig. lxxxvii. 1,1,) just in what is 
usually called the "small of the back," 
where they lie imbedded in fat. Each kid- 
ney is supplied with blood, by vessels, (2 2) 
which proceed from the aorta or main blood- 
vessel. — See Aorta. From each kidney 
issues a duct, (fig. lxxxvii. 3, 3,) the 
ureter, which conveys the urine into the 



KID 

Fig. lxxxvii. 




Fig. lxxxviii. 




bladder, (fig. lxxxvii. 4.) When cut open, 
(fig. lxxxviii.,) the kidney presents, even to 
the naked eye, two very different structural 
arrangements ; an outer one, granular 
looking, the "cortical" substance, (fig. 
lxxxviii. 2, 2,) and an inner or "tubular" 
structure, (fig. lxxxviii. 3, 3, 3,) the latter 
being, as represented, arranged in pyramids 
or cones, with their bases situated upon 
the cortical substance, and their points or 



KID 



S21 



KNE 



apices, which are free, pointing inward, 
and opening into a central cavity, (fig. 
lxxxviii. 4,) the "pelvis" or basin of the 
kidney, which may be regarded as an ex- 
pansion of the upper portion of the ureter, 
(6, 7.) The entire kidney is enveloped by a 
sufficiently strong membrane or "capsule," 
and is lined by a smooth "mucous" mem- 
brane, continued into its cavity, by the 
ureter, from the bladder. Those who are 
curious on the subject may easily make 
out these particulars, by examining the 
kidneys of the sheep. When the minute 
structure of the kidneys is microscopically 
examined, it is found to present a very 
beautiful arrangement. The tubular por- 
tion (fig. lxxxviii. 3) is seen to consist of 
numbers of minute tubes about the diameter 
of a hair, and minute blood-vessels, placed 
side by side ; these tubes, as they proceed 
toward the bases of the cones, or toward 
the cortical structure, (fig. lxxxviii. 2,) be- 
come forked and twisted, and at last end in 
a minute globular expansion, on which the 
" capillary" of hair-like branches of the 
artery of the kidney are spread out in a 
kind of tuft. It is these globular expan- 
sions, each about the one-hundredth of an 
inch in diameter, which give this portion of 
the kidney its granular appearance. The 
minute blood-vessels which had been spread 
out in a tuft are again collected into one 
vein — and these minute veins are distributed 
amid the tubular structure, previous to 
being collected into larger trunks for the 
conveyance of the blood out of the kidney. 
The object of all this elaborate arrange- 
ment is this: the urine is secreted from the 
blood, which is conveyed into the kidney by 
its own proper artery, the watery portion 
of the fluid being strained off, as it were, 
from the minute tufted vessels, described as 
being expanded over the globular expan- 
sions, and the other constituents being se- 
parated by secreting cells from tbe blood, 
after it has been recollected from these 
tufts, and as it passes among the tubular 
structure. The mingled watery and other 
constituents of the urine (see Urine) being 
thus separated from the blood, and united, 
pass down the straight tubes in the form of 
urine, which is discharged from the points 
of the cones, (fig. lxxxviii. 3,) into the cen- 
tral cavity or pelvis, (4,) whence it is con- 
tinually being drained off by the ureter (7) 
into the bladder. The ureter is about 
the diameter of a goose-quill, is about 
eighteen inches long, passes behind the 
bladder as represented by the dotted lines, 
(fig. lxxxvii.) and enters that organ at its 
lower part. 



21 



The diseases of the kidneys could not be 
profitably entered into with unprofessional 
persons, and when suspected, should, with- 
out delay, be submitted to proper medical 
care. In the mean while, should there be 
much pain in the back, the application of 
hot moist bran, or of heat and moisture in 
some way, (see Heat,) will be of service ; a 
gentle aperient, such as castor-oil, should 
be given, and also warm demulcent drinks, 
and warm clysters used. Should there be 
shivering and signs of fever, with much 
tenderness over the kidneys, and no medical 
advice at hand, blood may be taken away by 
leeches or cupping, and a dose of opium 
given. Gravel — either in one piece, or in 
grains — sometimes collects in the cavity, 
(fig. lxxxviii. 4,) and causes pain in the back 
while it remains ; when, however, it passes 
into the ureter, (7,) it causes extremely 
violent spasmodic pain, constituting what is 
usually called "a fit of the gravel." — See 
Urine. 

KING'S EVIL. — A name for scrofula, 
which originated in the superstition that 
the disease was cured by the touch of a 
king. The practice is said to have ori- 
ginated with Edward the Confessor ; it is, 
perhaps, needless to add that it has become 
obsolete. 

KING'S YELLOW — Is a compound of 
arsenic with sulphur. — See Arsenic. 

KINO — Is the concrete juice of a tree, 
and is brought chiefly from the East Indies ; 
it is an astringent closely resembling ca- 
techu, and is used for the same purpose. — 
See Catechu. 

KNEE. — The knee is, perhaps, the most 
important joint in the body, and is certainly 
the most serious to be affected either by 
disease or injury. It is formed of three 
bones, (fig. lxxxix.,) the extremity of the 
thigh-bone, (1,1,) the upper extremity of the 
larger leg-bone, (2,) and the knee-cap, or 
"patella," which lies on the forepart of the 
joint, but which is supposed to be removed 
in the figure. The small bone of the leg 
(3) does not enter into the construction of 
the joint. The rounded ends of the thigh- 
bone rest in shallow excavations in the ex- 
panded broad head of the bone of the leg : 
the knee-cap protects the joint in front, and 
enables the muscles of the thigh to act with 
more advantage and greater leverage in the 
movements of the leg; the entire joint 
being fitted and bound together by means 
of cartilages and ligaments, (5, 6.) — See 
TAgaments. 

The knee-joint is liable to become the 
seat of inflammation, either acute or chronic, 
caused either by violence or wounds, or as 



KNE 



322 



KOU 



Pig. Ixxxix. 




the result of constitutional causes. In any 
case, the disease is of so serious a nature, 
that it should as soon as possible be put 
under proper medical care. If the knee- 
joint has been opened by a wound, the 
only course for an unprofessional person to 
pursue, in the absence of a surgeon, is to 
close it as quickly and effectually as possible, 
(see Wounds,) to put the joint in a state of 
the most perfect rest, to keep it cool with 
cold water applications, the sufferer being 
put on low diet, and the bowels attended to. 
When inflammation of the knee-joint arises, 
either as the consequence of a wound or from 
any other cause, very free leeching is re- 
quisite, along with fomentations and poul- 
tices, and the constitutional treatment of 
inflammation generally. Blisters near the 
joint should never be used in an early stage. 
" White-swelling" of the knee, so dreaded 
popularly, consists of increased effusion of 
fluid into the joint, consequent upon dis- 
ease of some portion of its structures. This, 
however, and other chronic diseases of the 
knee, require so much educated skill and 
care, that they must be treated by the me- 



dical man. Till his aid is procured, the most 
perfect rest of the limb, the suppression of 
extra heat by cooling applications, the 
soothing of pain by warm fomentations or 
poultices, attention to the state of the 
bowels, and to the diet, is all that should 
be attempted. White-swelling is often con- 
nected with a weakened and scrofulous state 
of the constitution ; consequently, all debili- 
tating measures are, generally, to be avoided. 
The knee is sometimes the seat of a very 
unpleasant affection, termed " loose carti- 
lage," which consists of a rounded gristle- 
like body lying loose within the joint, and 
which, being apt in the motions to be 
squeezed between the surfaces of the bones, 
causes severe sickening pain, and may oc- 
casion the person to fall. The surgeon 
must be applied to. 

The knee-cap, from its exposed situation 
in front of the joint, is liable to various ac- 
cidents, to fracture, (see Patella,) also to 
dislocation, being pushed to one side. It 
may be replaced, either by the knee being 
bent by a second individual, or by straight- 
ening the knee, and bending the thigh upon 
the body, so as to relax the muscles on the 
forepart of the thigh, within the tendons of 
which the knee-cap is situated. On the fore- 
part of the knee-cap, between it and the skin, 
is placed a small "bursa," (see Bursa,) which 
is liable to become inflamed in persons who 
have to kneel much on hard substances. 
The affection is called "housemaid's knee," 
from its frequent occurrence in that class 
of servants, who kneel a good deal : it also 
occurs in thatchers, who press the knee 
upon the ladder when at work. Matter is 
liable to form in consequence of the inflam- 
mation, and in this case the treatment of 
abscesses generally is requisite. If the dis- 
ease be taken early, the knee should be 
rested, and the inflammation subdued by a 
few leeches and fomentations, &c: a blister 
will frequently remove the swelling, or it 
may be painted over with tincture of iodine - 
once daily, for some time. Occasionally it 
remains in spite of treatment, and ulti- 
mately disappears of itself. 

Refer to Leg — Patella. 

KOUSSO— The new remedy for tape- 
worm, is the product of a plant brought 
from Abyssinia, and it certainly appears 
to be a most efficient cure for the above 
most troublesome and intractable dis- 
order. In two cases — which had resisted 
all previous treatment — the author found 
the kousso perfectly successful. At the 
same time, it is not improbable, if the root 
of the male fern, found so abundantly in 
this country, was employed with the same 



KEE 



323 



LEA 



precaution as the far-fetched AfriWn re- 
medy, that it would prove equally effica- 
cious. The following are the directions is- 
sued by Mr. Hooper, of Pall Mall, with 
each dose of kousso : — "The kousso should 
be taken in the morning, fasting. The only 
preparation necessary is that all solid food 
should be abstained from for twenty-four 
hours before taking it ; and a dose of castor- 
oil, or a saline purgative, administered the 
previous evening. The powder is to be tho- 
roughly mixed with about half a pint of 
lukewarm water, (for an adult,) and al- 
lowed to infuse for a quarter of an hour, 
being occasionally stirred. The whole is to 
be taken, liquid and powder, at one, two, or 
three draughts, at short intervals, being 
washed down by cold water and lemon-juice, 
or any agreeable fluid. To promote the 
operation, tea (without sugar or milk) may 
be taken, but nothing else. In three or 
four hours, if the remedy has not operated, 
a dose of castor-oil, or a saline purgative, 
should be administered." 

[The fresh bruised seeds of the common 
pumpkin have also proved efficient in doses 
of two ounces every hour for four hours, and 
then one ounce the next morning.] 

Refer to Fern — Worms, §c. 

KREASOTE.— See Creasote. 

LABOUR. — See Child-birth. 

LABURNUM.— The seeds, and also the 
bark, of the common laburnum are highly 
poisonous, and a few cases have occurred in 
which children have been severely affected 
in consequence of their eating the former. 
Vomiting, with delirium and stupor, are 
said to be the consequences. Treatment 
similar to that recommended under "Bella- 
donna" should be resorted to, and medical 
assistance procured without delay. 

LACERATION.— See Wounds. 

LACTATION.— The secretion of milk. 

LACTEAL. — See Absorbents — Diges- 
tion. 

LACTUCA.— See Lettuce. 

LAMB — Like other "young meats," is 
not so desirable for invalids as mutton. 

LAMENESS. — See Ankle, Deformity, &c. 

LANCET.— See Blood-letting. 

LANGUOR — Is a very general symptom 
of disease, and is — both true and false lan- 
guor — sufficiently treated of under the head 
of "Debility." 

LARYNX. — The organ of voice situated 
at the top of the windpipe. — See Lungs. 

LAUDANUM — Tincture of Opium. — See 
Opium. 
_ LAUGHTER— Which arises from an ex- 
cited condition of the nervous system, though 



proverbial as a promoter of health, may, 
nevertheless, if excessive and prolonged, 
give rise to serious consequences ; the fit 
of laughter might pass into one of convul- 
sions in a predisposed constitution, or in a 
child. The practice of tickling children, and 
thus keeping them in a state of laughter for 
some time, is strongly to be condemned, and 
may be attended with some mischief. 

Refer to Convulsion. 

LAUREL. — The common laurel, more par- 
ticularly its young shoots and leaves, con- 
tains a considerable proportion of prussic 
acid, and a few cases of poisoning have oc- 
curred by their distilled water. [Partridges, 
or quails, which sometimes feed on the ber- 
ries, have also proved poisonous as articles 
of food in the United States.] The practice 
of using laurel-leaves in confectionary for 
the sake of the flavour is not to be recom- 
mended. 

LAVEMENT.— A clyster.— See Clyster. 

LAXATIVE.— See Purgative. 

LEAD. — This metal is of importance in a 
medical point of view, both on account of its 
medicinal and of its poisonous properties. 

Of its various medicinal preparations, it 
will be sufficient here to notice three : the 
acetate, or "sugar of lead;" the solution 
of an acetate of lead, or Goulard's extract ; 
and the lead-plaster. The acetate of lead 
is used both externally and internally. In 
the former case, in the proportion of from 
one to five or six grains to the ounce of dis- 
tilled, or rain water, it forms one of the 
best cooling lotions ; it may also be used 
slightly warm, either simply, or with the 
addition of one or two drachms of laudanum 
to the half-pint. The weaker solutions of 
sugar of lead, one or two grains to the ounce, 
are often used as an eye-wash, but are not 
so generally useful as zinc. Internally, 
sugar of lead acts powerfully as an astrin- 
gent, and may be given in doses of from two 
to four grains, once in eight hours, in cases 
of emergency, by the unprofessional. It is 
generally made into pill with crumb of 
bread ; often a quarter of a grain of opium 
is combined with it, and it is advisable to 
wash the dose down with a draught of weak 
vinegar and water. The few cases, such as 
abortion, in which, in the absence of all medi- 
cal assistance, sugar of lead may be given 
domestically, are particularly noted when 
treated of in this work. 

The solution of lead (liquor plumbi) is used 
in the proportion of about one drachm to 
the half-pint lotion. It ought to be known, 
that symptoms of lead-poisoning have been 
developed in consequence of the continued 
use of lead lotions to ulcerated surfaces. 



LEA 



324 



LEE 



Lead-plaster is the most unirritating form 
of plaster we possess, and is preferable to 
diachylon on irritable skins ; it is also the 
best in abrasions and bed-sores. Lead, 
when conveyed into the system in minute 
doses for any length of time, occasions 
serious constitutional effects, the most re- 
markable being palsy, and obstinate con- 
stipation, with colic. — See Colic. Persons, 
such as painters, type-founders, &c. (see 
Artisan,) who work with lead, or its prepa- 
rations, are peculiarly liable to be thus 
affected by it. The subject is sufficiently 
entered into in the articles above mentioned. 
Another very fertile source, however, of 
the introduction of lead into the system in 
individual minute doses, but ultimately by 
the accumulation of these, in poisonous 
quantity, is from the pipes in which water 
is conveyed for household purposes. — See 
Water. 

The common use of lead or its prepa- 
rations in the arts, either legitimately or 
fraudulently, is not an unfrequent cause of 
disagreeable, sometimes of fatal attacks, in 
consequence of the metal finding its way 
into the body. The use of lead as a glazing 
to earthenware vessels may prove a source 
of great injury, being liable to be dissolved 
off, (especially when the vessels are new,) 
either by fatty or acid matters. — See Drip- 
ping. Confectionary is sometimes coloured 
with the yellow chromate of lead, or with 
Turner's yellow or chloride of lead ; or 
whitened by the most poisonous prepara- 
tion of all, the carbonate of lead. Wine, 
when sour, has been sweetened by the use 
of litharge, or oxide of lead, and, in conse- 
quence of this fraud, a fatal epidemic colic 
at one time prevailed in Paris. Wine is also 
sometimes accidentally impregnated with 
lead, in consequence of shot, which had 
been used to clean bottles, having been left 
in them. Poisoning has occurred from this 
cause. New rum and cider are both apt 
to become impregnated with lead in the 
manufacture. Symptoms of colic have been 
brought on in persons living much in a room 
newly painted with lead colours. The white 
glazed cards are made so by means of lead, 
and might injure children, who are apt to 
suck them at times if they come in their 
way. Many of the hair-dyes contain lead, 
and have caused injury. 

When the causes of lead poisoning act 
slowly, from the smallness of the quantity 
taken in at once, the symptoms are gene- 
rally those described under Colic; but when 
the dose is large, it quickly brings on pain- 
ful colic, vomiting, and extreme depression. 
In such cases, the best measure to be 



pursued until medical assistance can be 
procured, would be the administration of 
vinegar in the first place, and in six or 
eight minutes after, an emetic of half a 
drachm to a drachm of sulphate of zinc, or 
some other sulphate, such as Epsom salts or 
Glauber salts, in quantity proportionate to 
the lead swallowed. The vinegar in the 
first place converts the lead into one of 
its least poisonous salts, and the one most 
easily decomposed by the sulphates. 

The accumulation of lead poison in the 
system is, in many cases, denoted by the 
existence of a bluish line along the margin 
of the gums, at their junction with the 
teeth, and is a sign which should always be 
looked for when any suspicion exists. 

Refer to Artisan — Colic — Constipation — Li- 
tharge — Palsy — Water, fyc. 

LEECH. — The general appearance of the 
leech it is unnecessary to describe, the soft, 
ringed body being common to all the tribe. 
Two species only, however, are recognised 
in this country as fit for medical purposes ; 
these are each distinguished by six greenish- 
yellow chain-like stripes disposed down the 
length of the animal on the back and sides, 
the belly being, in the one dirty yellow 
spotted with black, in the other greenish 
olive and unspotted. The former of these 
species of leech is found sparingly in this 
country, but occurs throughout northern and 
central Europe. 

Leeches fit for medical purposes are said, 
by Dr. Royle, to abound in India: many of 
those now used in this country are brought 
from Hamburg, where they are collected 
by the merchants from different parts of the 
Continent. The former of the two species 
mentioned, that with the spotted belly, is 
often known as the "brown leech;" the 
other, unspotted, as the " green leech." 

The narrowest extremity of the leech (fig. 
xc. 1) is the sucking-mouth ; the broader, 

Fig. xc. 




is simply provided with a sucker, (2,) by 
means of which the animal attaches itself 
to any substance. The mouth is furnished 
with three "mandibles," (fig. xc. 3,) the 



LEE 



325 



LEE 



edges of which are set with minute teeth, 
by means of which the animal perforates 
the skin, by a sawing action after it has 
been sucked up ; the mandibles also, pro- 
bably, keep the edges of the wound asunder, 
and form a sort of tube through which the 
blood passes. The invaluable properties of 
the leech as a local abstracter of blood are 
sufficiently well known; at the same time 
these are often, in a measure, neutralized 
by unskilful and ignorant management in 
application. When leeches are required, it 
is always better to be provided with more 
than the number thought requisite, in case, 
as often occurs, some cannot be made to 
fasten. When persons can choose their own 
leeches, the readiest mode of selection is to 
take a number up in the hand and gently 
to close it upon them — the strongest and 
most vigorous of the animals will contract 
themselves into a tolerably firm ball : the 
same may be done just previous to applica- 
tion. Some persons recommend leeches to 
to be removed from the water in which they 
are kept about an hour before they are 
wanted, being in the meanwhile laid upon a 
a towel. The part to which leeches are to 
be applied must previously be thoroughly 
cleansed with warm water ; and when they 
are put on by the order of a medical man, 
it is, in many cases, better to have the space 
within which they are to be fixed, marked out 
with ink. Many methods of applying leeches 
are recommended, but. none, perhaps, is so 
generally applicable as confining them within 
the proper space, by means of an inverted 
wineglass ; in situations where this cannot 
be done, they may be put on individually by 
hand, holding each one by the larger end, 
till it has fastened, by means of a piece of 
cloth. In some situations, such as the in- 
terior of the mouth, a leech-glass, or tube, 
made to enclose a single leech, is conve- 
nient. When leeches have fastened they 
should be allowed to suck perfectly undis- 
turbed, resting on the smooth skin, or some 
smooth surface ; if they hang down upon 
hair, or any rough material, they are apt to 
get fidgety, and to drop off too soon. After 
leeches have come off, it is, in most cases, 
desirable to encourage further flow of blood ; 
and for this purpose, hot poultices of bread 
or bran are most useful : in situations and 
circumstances where the moisture is ob- 
jectionable, pieces of soft linen or calico, 
made quite hot, will answer very well, ap- 
plied folded two or three times upon the 
place. In children and some persons who 
bleed freely but little encouragement is re- 
quired, the difficulty often being to stop the 
flow of blood. 
2C 



The possibility of this occurrence should 
always be kept in mind when leeches are 
applied to such persons, and, as a rule, they 
ought always to be placed over a bone against 
which pressure can be made, and never, unless 
for some very cogent reason, upon such places 
as the neck or abdomen ; most of the cases 
of fatal bleeding from leech-bites in chil- 
dren, have probably occurred from want of 
attention to the above precautions. 

When bleeding from leech-bites continues 
longer than is thought necessary, it may 
generally be stopped by placing a small pad 
of folded lint over the wound, and keeping 
up pressure with the finger for some time, 
provided there is the bone underneath to 
press against. When the bleeding seems to 
be arrested, the little pad may be kept in its 
place by one or two strips of adhesive plaster. 
If the simple pad appears insufficient, it 
may be soaked in a strong hot solution of 
alum. Even should there be no bone under- 
neath against which pressure can be made, 
the above plan may succeed — but it may not. 
In such cases, it is often recommended to 
pass a pointed piece of caustic into the 
wound ; but this is not a very efficient plan, 
and the pain it causes, by making a child 
cry, increases the tendency to the flow of 
blood. In an extreme case, a sewing-needle 
passed through the wound from side to side, 
and wrapped about with a thread, (fig. xci.,) 




will stop further loss of blood. At the same 
time, the author must add, that he never 
found a case resist pressure well and care- 
fully used. Such cases ought, of course, to 
be attended to by a medical man, if possible ; 
but at a distance in the country, it would be 
better for a mother even to use the remedies 
stated than to let her child bleed to death. 
Any other astringent remedies may, of 
course, be tried, if they are procurable. — 
See Astringents and Styptics. A wire or 
skewer, heated to a white heat, has been 
employed for the purpose, being thrust into 
the wound. 

It ought further to be remembered that 
even after leech-bites have ceased to bleed 
in children, they may, especially under the 
influence of warmth, burst out again ; and 
fatal consequences have ensued from chil- 
dren being placed in bed after leeching, and 
not being looked at during the night — they 
have become completely drained of blood. 
On this account it is always desirable, when 



LEE 



326 



LEE 



it can be done, that leeches should be put 
upon children in the fore part of the day, and 
also, that examination should be made from 
time to time after the operation is over, to 
see that all is right — if it is night, a light 
should be burned in the room. It is not 
only the immediate consequence of exces- 
sive bleeding which is to be dreaded, but 
the unnecessary loss may make all the dif- 
ference between a child struggling through 
an illness or not. — See Blood and Hemor- 
rhage. 

In a few individuals, the application of 
leeches is apt to be followed by inflamma- 
tory swelling of the skin, resembling ery- 
sipelas. Of course this is an. obstacle to 
their use on slight occasions. The swelling 
may be subdued by the lead lotion, cold or 
warm, as most agreeable to the feeling of 
the patient. 

There is often considerable difficulty in 
getting leeches to fix where and when they 
are wanted. This may arise from various 
causes ; the leeches may be sickly, or torpid 
from cold, or may have been recently used, 
or, as they are rather sensitive, the skin may 
be unclean, either from its own perspiration, 
&c. or from applications, such as embroca- 
tions, &c. which have been used to it. It is 
vain to attempt to apply leeches if this is the 
case. The skin, therefore, must be made 
thoroughly clean, and if there is hair on the 
spot, it must be shaved off clean and smooth ; 
as a further inducement, a little cream, 
sugar and water, or blood, may be put on 
the skin. If cold is thought to have rendered 
the leeches inactive, their immersion for a 
quarter of an hour in water (temperature 
70°) will be the best remedy. The addition 
of a couple of tablespoonfuls of porter to 
the half-pint of water will not unfrequently 
make them more lively. 

If it is wished to detach a leech before it 
has finished sucking, it must not be pulled 
off — a few grains of common salt sprinkled 
on its head, will cause it to drop off very 
quickly. When leeches come off, it is the 
common practice to put them upon a plate 
of salt, which makes them disgorge the 
blood they have sucked. This is better done, 
by putting them into a little not very strong 
salt water, which is equally effectual, but 
does not injure them ; as the salt in substance 
is apt to do. After the greater amount of 
blood has been thrown up under the influ- 
ence of the salt, the leech should then be 
"stripped," that is, its tail end being held 
firmly between the thumb and finger of the 
left hand, the animal is to be drawn between 
the thumb and finger of the right, nearly up 
to the head. By this means it is freed from 



the blood, and is sooner fit for use. Blood 
which has been drawn by leeches, affords 
no guide to a medical man like that taken 
by the lancet ; it therefore need not, as is 
often done, be kept for his inspection. After 
the leeches have been stripped, they should 
be put into some fresh water, which will re- 
quire changing twice a day for the first two 
or three days ; afterward, only every four 
or five days. 

The great expense of leeches renders it 
important that the best means of preserving 
them, and of rendering them, if possible, 
again quickly ready for use, should be 
known. 

They are best kept in good-sized wide- 
mouthed jars or bottles, half filled with 
rain or pure spring water, covered at top 
with gauze, or some such material, and 
having at the bottom a little clean sand or 
gravel on which the creatures can rub them- 
selves, and so clear the skin of the slime 
which naturally covers it, but which they 
cannot get quit of in a vessel with smooth 
surfaces. The temperature of the water in 
which leeches are kept should never get 
below 50° Fahr. The water should be 
changed every ten days. The place in which 
they are kept must be airy and free from 
strong odours. Of course, dead or sickly 
leeches should be removed at once from the 
healthy ones. 

It has been stated that leeches which 
have been used may be rendered in a few 
days as active and useful as ever, by dis- 
solving a little white sugar in the water, 
and renewing this solution twice, at inter- 
vals of twelve hours, and twice afterward 
at intervals of a day. Dr. Christison says, 
" I have tried this plan, and found that the 
same leeches drew blood three times at 
intervals of three days, with scarcely any 
diminution of activity, and without a death 
among them." Another method recom- 
mended is, after stripping, " to put them 
into a vessel with half an inch of sand at 
the bottom, and containing water, with two 
teaspoonfuls per quart, of French white 
wine, and to change the liquid daily till 
the fourth day, -when pure water is to be 
substituted." With respect to the choosing 
of leeches, the following remarks of Dr. 
Christison are important: — "The gorging 
of leeches is a more common fraud than the 
substitution of spurious species. They are 
known by being less velvety in their coat, 
less flat when pressed, and by presenting a 
little tumour when squeezed between the 
fingers from the head to the tail. Leeches 
which have been used are often sold for un- 
used, or 'virgin' leeches. These are best 



LEE 



827 



LEM 



known by putting them on a •white cloth, 
and dusting the fore-part with finely pow- 
dered salt. In thirty seconds a little blood 
will be emitted, but not a particle if the 
leech be quite fresh. 

The greatest inconvenience connected 
with leeching, even when well managed, 
is the uncertainty of the amount of blood 
taken ; but generally it may be calculated, 
that the' application of each good leech 
should, on the average, including what the 
animal itself draws, and what flows after- 
ward, amount to about half an ounce. 

The great expense of leeches, and other 
considerations, have given rise to many 
attempts to make an artificial substitute, 
but none have as yet been fully successful. 
Kidston's artificial leech is the most recent 
invention, and is said to be efficient; it 
might be worth the attention of the emi- 
grant and others, [were its utility certain.] 

Leeches applied to such places as the nos- 
tril, mouth, or ears, occasionally get beyond 
reach, and find their way into the stomach 
or bowel. The best remedy, and one which 
should be used without delay, is strong 
saltwater, either swallowed or injected into 
the bowels — this quickly kills the animal. 

LEEK — As an article of diet, does not 
generally agree with persons of weak diges- 
tion. It is most wholesome when blanched 
like celery, and stewed. 

The vapour from boiling water poured 
over leeks is something used as a popular 
remedy in piles. The leeks are cut up, and 
put in the pan of a night-chair, or in a 
chamber utensil, on which a person sits. 

LEG. — Swelled-leg, or white-leg, as it is 
sometimes named, is one of the most trou- 
blesome of the disorders which are apt to 
follow child-birth. It is inflammation of the 
veins connected with the lower extremity. 
The symptoms of swelled leg may com- 
mence within the first two or three days 
after delivery, or not for some weeks. There 
is more or less fever, and the parts about the 
groin and thigh feel hot, stiff, and painful, 
swelling commences, and extends over the 
whole limb, which, however, does not 
change colour, being pei'haps paler or whiter 
than usual ; at this time the pain is often 
very severe. After a time, these symptoms 
are ameliorated ; but the limb remains for 
long swollen, painful, and comparatively 
useless. 

The above, it need scarcely be remarked, 
is a disease which requires proper medical 
assistance as soon as possible. In the 
mean time, leeches, fomentations and poul- 
tices to the parts about the groin and 
thigh will be at once the best and the 



most soothing treatment ; the bowels being 
regulated either by mild aperients or clys- 
ters, and opium given, if the pain becomes 
severe. For this purpose, ten grains of 
Dover's powder, with two of calomel, may 
be given at bedtime. Blisters are often used, 
but as troublesome ulcerations are some- 
times apt to form, their application should 
be left to medical judgment. Continued fric- 
tion with simple oil is of much service. Du- 
ring convalescence, bandaging, friction, the 
salt-water douche, together with strengthen- 
ing remedies and diet, will be requisite ; but 
these must be left to the regulation of the 
medical attendant. 

THE LEG— The portion of the inferior 
extremity between the knee and the ankle 
— is formed of two bones, (fig. xcii.) The 
Fig. xcii. 




larger or main of the leg (1) is named the 
tibia; the smaller, or "splint" bone, (2,) 
the fibula. The upper broad portion of the 
tibia (3) forms part of the knee-joint, (see 
Knee,) but the fibula does not; at the lower 
end of the leg, however, both bones are 
required in the formation of the ankle-joint. 
— See Ankle. These bones may be broken 
together or separately ; fracture more gene- 
rally occurs below their middle than above. 

Refer to Fracture. 

LEMON. —This well-known fruit and 
sick-room luxury is cultivated chiefly in 
Southern France, in Italy, Sicily, Spain, &c. 
The best lemons are smooth on the skin, and 
have a thin rind ; if packed in newly slaked- 
lime in closed vessels, lemons may be pre- 
served good for a considerable time. The 
rind of the lemon, and the agreeable essen- 
tial oil derived from it, are chiefly used in 
cookery and confectionary. The juice of 
the fruit, which owes its acidity to citric 



LEN 



328 



LIE 



acid, is used as the most agreeable medium 
for the formation of effervescing draughts ; 
the proportionate quantity required to be 
used with alkaline carbonates will be found 
under article Effervescing. Its use in the 
formation of lemonade is familiar to all. 
— See Cookery. Until lately, the chief, 
direct medicinal use of lemon-juice was in 
the treatment of scurvy, (see Scurvy,) but 
recently it has been introduced by Dr. 
Owen Rees as a remedy in rheumatic fever, 
and there are many testimonies to its value 
in this painful, and often tedious affection. 
The author has reason, from his own expe- 
rience, to speak favourably of its remedial 
power in the above painful disease. Lemon- 
juice is not only a curative medicine in 
scurvy, but it is also a preventive ; and it 
should, therefore, form part of the " sea- 
store" of all who are going a long sea-voyage. 
The juice may be procured at a moderate 
price from confectioners in large towns. 
The best method of preparing it for keeping, 
is to add about one-tenth of spirits of wine, 
to separate, by straining, the jelly-like 
matter which coagulates in consequence, 
and then bottle for use. " Salt of lemon," 
which is sold for removing the stains of ink 
or iron, is no preparation of lemon at all, 
but is a salt of oxalic acid : the name might 
lead to serious mistakes. 

LENITIVE ELECTUARY.— See Senna- 
Confection. 

LENS.— Crystal lens.— See Eye. 

LENTILS — Belong to the pea tribe, and 
are used as food. The Egyptian lentil, 
known, when in the form of meal, as the 
revalenta, or Ervalenta Arabica, is not only 
nutritious, but possesses aperient properties, 
which render it, in some cases, a valuable 
auxiliary to treatment, if it agrees with the 
stomach. 

LEPROSY.— See Skin, Diseases op. 

LETHARGY— An unnatural tendency to 
sleep, is closely connected, as to cause, with 
languor and debility, and approaches apo- 
plexy in character. It may arise from the 
opposite causes of over-fulness of blood, or 
from deficiency of circulation in the brain, 
from nervous exhaustion of that organ, or 
from actual disease in it, such as tumour or 
abscess. The lethargic state may also arise 
from an impure or poisoned state of the cir- 
culating fluid, such as precedes an attack of 
British or bilious cholera, or diarrhoea, or is 
a consequence of suppression of urine. It 
may also, of course, be the consequence of 
the action of narcotic drugs, or of alcoholic 
intoxication. These latter contingencies 
should be kept in mind in the event of 
lethargy coming on suddenly: in such a 



case the treatment, with precautions, re- 
commended under article Apoplexy, should 
be adopted — modified, of course, in some 
degree, on account of the milder character 
of the disorder. In the aged, especially, 
lethargy is always to be regarded with sus- 
picion ; but in any case, the cause should be 
investigated by a medical man as soon as 
may be. 

Refer to Apoplexy — Biliary Disorder — De- 
bility — Languor — Palsy, Sfc. 

LETTUCE.— Two kinds of lettuce are 
used, the common garden or edible lettuce, 
and the stronger or medicinal lettuce. The 
botanical name of lettuce, "Lactuca," from 
lac, milk, is given on account of the milky 
juice which exudes from the plant when 
cut: this milky juice turns brown, and dries 
on exposure to the air, and is then called 
lactucarium, or "lettuce opium," from its 
narcotic properties, in some degree re- 
sembling those of opium. The milkiness of 
the juice of the lettuce, and its narcotic 
properties, are not fully developed until the 
period of flowering approaches ; the plant, 
however, possesses them more or less at all 
stages of growth. 

As an article of diet, lettuce is in very 
general use, and with most persons agrees 
well, though some find it, in common with 
uncooked vegetables generally, disorder di- 
gestion ; others find its narcotic properties 
— even in its mildest condition — inconve- 
nient. Lettuce eaten at night has been had 
recourse to successfully, amid others, by 
the celebrated anatomist Galen, as an anti- 
dote to sleeplessness. 

Extract of lettuce, or lactucarium, or let- 
tuce-opium, might be used in doses of from 
ten to fifteen grains, as a substitute for 
opium, with this advantage, that it does not 
confine the bowels : it is not, however, by 
any means so powerful or certain in its ac- 
tion. 

LEUCORRILEA.— See Whites. 

LICE.— See Acari. 

LICHEN. — See Skin, Diseases of. 

LIFE. — The word, here, is simply taken 
in its one sense of man's actual material 
existence in this world : that existence 
which, however it may be regarded as but 
the prelude of another and more perfect 
state, all persons of healthy mind have an 
instinctive desire to preserve — instinctive, 
truly, it may be called at the present day; 
for the feeling with a large — a very large — 
class, seems to rise no higher. It seems 
to protect from immediate, urgent, threat- 
ened danger, but beyond that it appears 
not to go ; and life is yearly, daily, 
hourly extinguished in England, by causes 



LIF 



329 



LIF 



"which are perfectly under man's own con- 
trol to prevent — by causes -which it is 
utterly unworthy of intelligent and respon- 
sible beings should continue, or be allowed 
to continue, in operation among them. It 
is confirmation enough to reiterate the fact, 
that fever carries off yearly in England a 
larger number of victims than fell in the 
ranks of the allied armies at Waterloo ; and 
that one-third of the children die before 
they reach the age of five years. As these 
tiny victims have been well called in a late 
number of a popular periodical, "drooping 
buds;" they languish and die in the un- 
wholesome dwellings of city, town, and 
village. And this need not be ; for, fearful 
as the loss of life now is, it is less, con- 
siderably, than it was a hundred, fifty, even 
twenty years ago ; and might be much les- 
sened still. It is enough to refer the reader 
to the case of the Dublin lying-in hospital, 
mentioned under the Article Children, to 
demonstrate how quickly — how remarkably 
— the value of life may be increased by 
a few well-directed and comparatively sim- 
ple measures. The whole science of medi- 
cine, surgery, the efforts of hygiene or 
sanitary precaution, even the object of such 
a work as the present, is the preservation 
and prolongation of human life ; and that it 
is not preserved nor prolonged to a much 
greater extent than it now is, cannot be 
for want of knowledge, at least amid the 
higher classes. Parliamentary commissions, 
and "blue books," and sanitary publica- 
tions of all kinds, have, or ought to have, 
diffused information respecting those sources 
from which the curtailment of life arises ; 
but indifference, self-interest, prejudice, 
interferes, and the small band of those who 
would push forward the good work can 
scarcely make head " against the wind, 
against the tide" of opposition — can hardly 
stir the huge mass of inertness that will not 
move. At the same time, it is not the part 
of the people to wait till these things are 
wholly done for them ; it may be, that the 
principles of a true political economy ren- 
der the preservation of every man's life in 
the state a duty, and a direct advantage to 
the community ; but each man must in the 
matter act for himself as far as lies in his 
power. The preservation and prolongcation 
of life can never be simply a selfish con- 
sideration ; man does not live for himself 
alone. But if none can doubt that the 
duration and value of life might be extended 
far beyond what it now is, it is equally 
certain that it is much greater than it was 
formerly. A glance at the past in this 
respect may give hints for the future. One 
2c2 



great cause for the short duration of human 
life among a barbarous or semi-civilized 
people, is the little value set upon it ; hence 
it is sacrificed for the most trivial reasons — 
and from the destruction of the weakly or 
unwished-for infant, so common, not only 
amid a savage people, but even among the 
comparatively civilized Chinese — to the 
abandonment of the aged parent on the 
prairie, by the North American Indian, or 
the destruction of adults in public war or 
private quarrel amid these nations generally, 
all tend to shorten human life. True, the 
wars and revolutions of civilized nations, 
even in Europe, do cost many useful lives, 
but their occasional action is not marked 
like the regular systematic cutting short of 
life in all its stages, which unceasingly goes 
on in uncivilized communities. 

As a nation rises in civilization, there- 
fore, the lives of its members are in part 
prolonged, simply because they are not 
violently curtailed — other causes at the 
same time coming into action. Increased 
comfort of dwellings, and more effectual 
shelter from the weather, both by these 
and by clothing, more regular supplies of 
wholesome and better-prepared food — all 
reduce the chances of disease and death. 
Improvements in the practice of medicine 
and surgery more quickly and effectually 
alleviate the former when it does occur, 
and diminish the probability of the latter ; 
and, lastly, for it comes last, increased — 
though far from sufficient — attention to 
hygienic and sanitary precaution counter- 
balances in some degree those unhealthy 
influences and combinations of circum- 
stances which inevitably arise during, and 
advance with, the progress of civilized com- 
munities. Hitherto, the increase of the 
comforts of civilization, though in one 
mode it has tended to prolong life, has 
nevertheless, in some degree, balanced this 
advantage, by giving rise to other sources 
of disease. The wandering savages, or na- 
tives of thinly peopled countries, if liable 
to suffer from privations and exposure, are 
nevertheless, in a great measure, free from 
the fever-generating drain, and closely 
crowded street or habitation ; and in this 
and other similar ways it happens, that 
although the value or duration of life in a 
community ought to be a test of its civil- 
ization, the fact has not as yet assumed its 
full preponderance in the history of national 
progress. Ignorance of the laws of health 
in the first instance, and obstacles to the 
carrying out of those laws in the next, have 
hitherto kept the average of life, in this 
kingdom at least, far below the average it 



LIF 3 

ought to hold. Probably too, indifference as 
to the means of prolonging human life has 
partly arisen from the very common error 
which supposes that the evil of premature 
deaths has some compensating advantage 
in removing a portion of surplus popula- 
tion ; whereas, in the general case, it is 
not the surplus, but the valuable portion 
of life that is thus lost. If a boy dies 
at some period between ten and sixteen, 
his existence has been an absolute cost to 
the community, and he was but just ap- 
proaching the period when he might have 
become a productive member of it. If a 
husband dies in the early years of his mar- 
ried life, he leaves as burdens on the world 
a widow or children, for whom, in the 
general case, if he had lived, he would 
have worked : " bearing out the fact, that a 
parish or country where life is precarious 
pays more poor-rates — has to support more 
unproductive members — than its neigh- 
bours." 

Connected with these remarks is the 
statement of Dr. Southwood Smith, made 
before the Parliamentary Commission, on 
the "State of Large Towns," "that the 
period of human existence, during which 
fever can alone be said to be prevalent, is 
from the age of twenty to forty ; that is, 
the period of maturity — the most precious 
portion of the term of existence — that 
during which the individual is best fitted 
for all the duties and enjoyments of life — 
during which he is most capable of pro- 
moting the happiness of others, and of se- 
curing and of appreciating his own;" and 
fever is the fatal scourge of the ablest and 
most useful working members of the com- 
munity. 

The effect of the adjuncts of civilization 
in prolonging life will best be illustrated 
by the following extracts from the Messrs. 
Chambers's most useful publication on " Sa- 
nitary Economy," by which is shown how 
greatly the duration of life is extended 
under favourable circumstances, how much 
it is diminished under the reverse. 

Dr. Duncan, Officer of Health for Liver- 
pool, says in his paper on the high rate of 
mortality in that town — "Not the least 
striking result of the investigation is the 
very high rate of mortality which we have 
found going on in the various districts ; for 
while in Rodney Street, and Abercromby 
Wards, with upward of 30,000 inhabitants, 
the mortality is below that of Birmingham 
— the most favoured in this respect of the 
large towns of England — in Vauxhall Ward, 
with a nearly equal amount of population, 
the mortality exceeds that which prevails 



10 LIF 

in tropical regions. In Rodney Street and 
Abercromby Wards, 100 persons die an- 
nually out of 4162 ; in Vauxhall Ward 2350 
persons are sufficient to furnish the same 
number of deaths, leaving an excess of 1812 
persons engaged in furnishing additional 
deaths at this high rate of mortality. In 
other words, 177 persons die annually in 
Vauxhall Ward, for every 100 dying out of 
an equal amount of population in Rodney 
Street and Abercromby Wards." 

In one of the Registrar-General's Reports, 
two districts are compared with each other, 
one of twenty-five towns, another of seven 
counties. "The number of deaths in the 
former, from all causes whatever, was 51 ,492, 
while in the country districts it was 33,039. 
Yet out of this smaller number, the deaths 
from old age amounted to 4699 ; while out 
of the much larger amount of deaths in the 
town districts, the number that had sur- 
vived causes of premature disease, to die of 
old age, was only 3525. In round numbers, 
a seventh part of the country population 
has thus been allowed to run the natural 
course of their days, while only a twelfth 
of the town population have had the same 
good fortune to avoid the snares which dis- 
ease and accident have laid for them. The 
following tables from a Sanitary Report of 
Mr. Chadwick's, show the different value of 
life in the different classes of people in the 
same districts : — 

Whitechapel Union. 

No. of Average Age 

Deaths. of Deceased. 

37 Gentlemen and persons en- 
gaged in the professions, 

and their families 45 years. 

387 Tradesmen and their families 27 " 
1762 Mechanics, servants, and la- 
bourers, and their families 22 " 
Strand Union. 
86 Gentry and persons engaged 
in professions, and their 

families 43 " 

221 Tradesmen and their families 33 " 
674 Mechanics, servants, and la- 
bourers, and families 24 " 

Kendal Union. 
52 Gentlemen and persons en- 
gaged in professions, and 

their families 45 " 

128 Tradesmen and their families 39 " 
413 Operatives, servants, labour- 
ers, and families 34 " 

We here find that in some communities 
— such as Whitechapel Union — there will 
be differences so great between the average 
duration of life in the differen^classes, that 
those born in the large house of the pro- 



LIF 



331 



LIG 



fessional man or independent gentleman, 
live rather more than twice as long as those 
born in the crowded houses of the small 
alleys which ramify hither and thither 
round it. It is a melancholy truth, rest- 
ing on evidence only too strongly over- 
whelming, that the lives of the poorer 
classes, who inhabit the crowded districts 
of large towns, are liable to be shortened 
by a variety of causes." 

And yet these things need not be ; there 
is no possible reason why the duration of 
life in a district in which it is low should 
not be greatly raised, the amount in some 
degree of course depending upon the nature 
of the district. Neither is there a reason 
why the standard should not be elevated in 
every district. That such will be the case 
at some future day there can be little doubt, 
nor is it unreasonable to suppose, that 
there is yet a "good time coming," in which 
the value and duration of life will be ex- 
tended greatly beyond what it is at present 
— greatly beyond, perhaps, what we at 
present can imagine — when 
science and benevolent exer- 
tion have corrected the errors 
and retained the good of an 
advanced civilization, when 
sources of disease from without 
are removed, and when man has 
learned that health is better 
than great riches, and ceased to 
offer -the former, either*his own, 
or that of work-people, worn 
down, at the shrine of mam- 
mon. 

LIFE ASSURANCE.— The se- 
curity of a sum of money to the 
family or to the survivors of an 
individual whose death involves 
loss or diminution of income to 
those survivors, may become an 
important consideration, when 
the chances of death or recovery 
in severe illness are nearly balanced — when 
the tranquillity or disturbance of the mind 
may make that balance incline to the one or to 
the other side. The racking thought of a 
wife and family left without provision, may 
drive away the sleep that would precede 
amendment — may give the last jar to the 
sinking nervous system. In this remedial 
point of view only, can this important sub- 
ject be alluded to here. 

LIFTING CHILDREN— Is a subject on 
which a few words are highly requisite. 
It is really surprising to see in what a cruel 
and dangerous manner children are often 
lifted about, not only by their nurses, but 
by their mothers ; and the evil results are 



very commonly brought before medical men, 
in the shape of sprains, separations of " epi- 
physes," (see Epiphysis,) dislocations, and 
even fractures. When a heavy child is 
perhaps seized by the hand or arm, and 
swung over a gutter, or the like, the won- 
der is, not that injury results, but that it 
does not always result from the practice. 
Among boys, and even by those who are 
old enough to know better, there is a trick 
of lifting children or boys, by the hands 
placed under the chin and at the back of 
the head. This is a most dangerous practice 
— dislocation of the neck and instant death 
has been the result. 

LIGAMENTS— Are white glistening bands 
of inelastic fibrous tissue, which retain the 
different bones in contact at their points of 
junction. There is also a yellow fibrous 
tissue, which in some places is called a liga- 
ment, but which is extremely elastic. 

It would answer no good purpose here to 
enter into a detailed account of the liga- 
ments. The example (fig. xciii.) which repre- 

Fig. xciii. 




Fig. xciv. 




LIG 



832 



LIG 



sents the ligaments (1) which bind the collar- 
bones (4, 4) and upper ribs (2, 2) to the 
breast-bone, (3,) and the example (fig. xciv.) 
which exhibits the " capsular ligament" 
(1) which envelops and connects the bones 
at the shoulder-joint, will sufficiently illus- 
trate the use and position of these connect- 
ing media. 

In their ordinary condition, the ligaments 
are not very sensitive ; but when, in conse- 
quence of a strain of the joint, or " sprain," 
they are overstretched, they become acutely 
so. 

LIGHT.— "The prime work of God." 
We know that the great source of light is 
the sun, and that we have sources of arti- 
ficial light. We know that it is light by 
which we are enabled to take cognisance 
of the colour, size, shape, and position of 
various bodies ; we know that this light is 
subject to laws which it is in our power to 
trace ; but we cannot frame a definition of 
the agent itself. To enter into a considera- 
tion of the optical properties of light would 
be out of place here ; its effects as a stimu- 
lant on animal life and development are 
extremely important. The stimulant action 
of light not being of such obvious universal 
necessity to vital action as that of heat ; 
nor its effects and influence so prominently 
marked, its full power as an excitant upon 
animal and vegetable life has not been until 
lately sufficiently well recognised, although 
every day it is becoming more so. The ef- 
fect of the deprivation of the stimulus of 
light in producing blanching, or etiolation, 
in vegetables, has long been practically 
applied ; and the effect of the absence or 
diminution of the stimulus on animal de- 
velopment and health, though compara- 
tively little is certainly known respecting 
it, is being more attended to in consequence 
of the present sanitary movement. Dr. 
Edwards, whose experiments upon the in- 
fluence of light are well known, has re- 
marked, that persons who live in abodes 
excluded from the free access of light, are 
apt to produce deformed children. It has 
been stated on the best authority, that the 
cases of disease on the dark side of an ex- 
tensive barracks at St. Petersburg have 
been uniformly, for many years, in the pro- 
portion of three to one to those on the side 
exposed to strong light. Humboldt has 
attributed the absence of deformity amid 
the Caribs, Mexicans, Peruvians, &c. to 
constant exposure of the body at large to 
strong light. It is now, therefore, a re- 
ceived fact, that a free supply of light is 
almost as necessary to health as fresh air or 
pure water. It is, too, a fact which should 



not be lost sight of with respect to the laying 
out of dwellings. The powerful stimulant 
action of light upon the eye is evinced by 
the fact that strangers in the arctic regions 
are liable to suffer from inflammation of that 
organ produced by the glare of reflected 
light from the snow, and that, from the same 
cause, the natives of those regions suffer 
from snow blindness. Light, however, ex- 
erts different effects according to its colour: 
as well known, bright white, yellow, or red 
lights are much more apt to injure the eye 
than those of a blue or green tinge. When, 
therefore, persons find exposure to the 
former coloured lights injure the sight, it is 
usual to protect the eye by the use of glasses 
of a bluish shade. 

Refer to Amaurosis — Blindness — Eye, $c. 

LIGHTNING. — Injury or death from 
lightning appears to be principally inflicted 
through affections of the nervous system ; 
although, at the same time, severe and exr 
tensive wounds are not unfrequently pro- 
duced. Burning, on the other hand, is not 
occasioned by the electric fluid itself, so 
much as by the clothing, which is generally 
set on fire. Persons who are stunned, but 
not killed, by lightning, generally remain in 
a state of insensibility for some time, the 
breathing being slow and deep, the muscular 
system relaxed. In such cases it will be 
proper to use means for preserving the 
animal warmth, which has a tendency to 
become depressed, to keep up artificial re- 
spiration, as recommended under article 
Droivning, to use mustard-plasters to the 
spine and pit of the stomach, to administer, 
from time to time, a little sal-volatile in 
water, if the patient can swallow — if not, to 
give a warm clyster containing half an ounce 
of turpentine — or to use such other means 
as are recommended under the articles 
Drowning and Carbonic Acid, which may seem 
adapted to the case. It is a common idea, 
that persons who have been killed by light- 
ning do not stiffen, and that the blood re- 
mains fluid, but this is erroneous. It would, 
considering how often the fact is reiterated, 
seem almost superfluous to point out the 
ordinary precautions which those who 
chance to be exposed to a storm of thunder 
and lightning ought to adopt : but not a 
summer passes without lives being lost from 
sheer ignorance. Harvest labourers and 
others will persist in sheltering under trees ; 
people will continue to put up even iron 
umbrellas in the midst of a thunder-storm, 
and mowers walk unconcernedly home with 
their scythes over their shoulders. If au 
individual is overtaken by a thunder-storm 
in a place where trees abound, he should 



LIM 



333 



LIN 



avoid them as much as possible. A thorough 
soaking will be rather a protection than 
otherwise. If, on the contrary, the position 
is on a moor or wide plain, where the body 
is the highest object, lying down is the 
safest procedure. In any case, metallic 
objects, such as sickles, scythes, &c. being 
laid aside at considerable distance. Under 
shelter, the most hazardous position appears 
to be in a draught or current of air, such 
as between a door and window, this seeming 
to exert considerable influence upon the 
course of the electric fluid. 

LIME — Is one of the alkaline earths, 
formed by the union of oxygen gas with 
the metal or metallic base calcium. In its 
various forms of carbonate, such as marble, 
chalk, limestone-rock, &c. it is very widely 
distributed over the globe. Quicklime is 
formed by expelling the carbonic acid from 
one of these carbonates, by means of heat. 
Its appearance, when freshly burned, is fa- 
miliar to all. It, however, quickly changes 
if freely exposed to air and moisture, at- 
tracting both carbonic acid (for which it 
has a strong affinity) and water, and being 
again converted into a carbonate of lime. 

Lime is used in medicine in its pure form. 
It is used as a carbonate in the form of 
chalk, (see Chalk,) and as chloride of lime. — 
See Chlorine, &c. Pure lime is given in the 
form of lime-water. This is made by putting 
some freshly-burned and newly-slaked lime 
into a bottle, and filling it to the top with 
water, agitating it slightly. When the lime 
subsides, it leaves the water above perfectly 
transparent, and holding a certain amount 
of lime in solution. When any of the lime- 
water thus formed is withdrawn for use, all 
that is necessary is to fill up quite to the 
top again with fresh water, giving the 
bottle a shake, and to cork tightly. This 
may be repeated for a considerable time 
before the lime requires renewal. Lime- 
water is used as an antacid by some indi- 
viduals, even habitually. It is taken in 
doses of from half an ounce to three ounces, 
generally in, or along with milk, which it 
renders lighter, and more likely to agree 
with the stomach, while the milk covers the 
somewhat acrid taste of the lime. If lime- 
water is exposed to the atmosphere, a pel- 
licle forms on its surface, and it quickly 
becomes turbid, from attracting carbonic 
acid — the carbonic thus formed being less 
soluble than the lime itself. The same 
thing will be seen to take place more 
quickJy if an individual propels the breath 
through some lime-water in a glass, by 
means of a quill — the water at once becomes 
turbid, demonstrating, at the same time, 



the presence of carbonic acid in the breath. 
If, however, the breath be kept passing 
through the lime-water for some time, it 
again becomes transparent, in consequence 
of the additional amount of carbonic acid 
redissolving the carbonate of lime, and 
making it a bicarbonate. In many hard 
waters lime exists in solution, in this form 
of bicarbonate of lime. — See Water. The 
property possessed by quicklime of absorb- 
ing carbonic acid, renders it valuable in 
cases where, such as in old wells, this nox- 
ious gas exists and requires removal. — See 
Carbonic Acid — Bedroom. Burns from lime 
are not uncommon. In such cases, the best 
application is vinegar and water, or some 
other acid, if vinegar is not at hand, [or 
sweet oil,] freely applied; the acid in this 
case converting the caustic lime into a harm- 
less substance. The same treatment is to 
be pursued in the event of lime getting into 
the eye, the vinegar or acid being, of course, 
more largely diluted than when used to 
other parts ; [but the oil is better.] In any 
of these cases, the after consequences, such 
as ulceration of the skin or inflammation 
of the eye, must be treated as recommended 
in burns generally. — See also Eye. 

LINCTUS.— Medicine made into a thick 
syrupy consistence. The form of linctus is 
not often prescribed at the present day. 

LINIMENT.— An embrocation.— See Em- 
brocation. 

LINSEED, or Lint-Seed, [or Flaxseed] 
— The seed of the Linum usitatissimum, or 
common flax, contains a fixed oil, well known 
by its name of linseed-oil, which is procured 
from the seeds by pressure. The seeds also 
yield, when boiled, or infused in boiling 
water, a thick, almost tasteless, mucilage. 
Linseed-oil was formerly more employed in 
medicine than it is at present, its chief use 
now being in the formation of the carron- 
oil, used by some in the treatment of burns. 
This is made by agitating together equal 
parts of lime-water and linseed-oil. — See 
Burns. The infusion of linseed, or " linseed- 
tea," [flaxseed-tea,] may be made in the 
proportion of half an ounce of the seed to a 
pint of boiling water. — See Infusion. It is 
a cheap and very good demulcent remedy in 
coughs, and in irritation of the urinary 
organs. The meal of linseed is made by 
grinding the seeds after the oil has been ex- 
pressed from them. It is chiefly used for 
poultices. — See Poultice. 

LINT — Which was formerly old linen cloth 

scraped to give it a soft woolly surface, is now 

manufactured on purpose, of new material, 

and of good width and length, instead of the 

I bits and scraps in which it used to be sold, 



LIP 



334 



LIV 



Professedly, lint is made of flax or linen 
thread alone, but microscopic examination 
will often detect a considerable admixture 
of cotton fibre. — See Dressing. Taylor's 
new patent linen is thicker and more spongy 
than the other sorts, and therefore more 
suited for the same purposes ; it does not 
tear well, which is a disadvantage. 

LIP. — The lips owe their colour to their 
extreme vascularity, and to the thinness of 
the skin by which they are covered, and 
their sensitiveness to a more than usual 
supply of nerves. 

The colour of the lips is closely connected 
with that of the blood, and also depends 
upon the vigour of its circulation. When 
the blood is poor and deficient in red glo- 
bules (see Anaemia) the lips become pale. 
When, again, from failure of the heart's ac- 
tion, as in fainting, the blood is not circu- 
lated properly, the lips also become pale ; 
when, from disease, the blood does not 
undergo its proper changes, the colour of 
the lips, instead of being red, inclines more 
or less to purple. The lips (particularly 
the lower) are apt to become the seat of 
cancer in old age, especially, it is said, 
in those who have smoked much from a 
short pipe. A continued sore upon the lip 
that will not heal, in an old person, should 
be examined by a medical man. If it is 
such as to require removal, this cannot be 
done too soon. 

Refer to Rare-lip — Lip-sore. — See Skin. 

LIQUORS. — See Alcohol — Stimulants, 
&c. 

LIQUORICE and Liquorice Root. — 
Liquorice root, which is long and creeping, 
is produced from a plant belonging to the 
leguminous, or pod-bearing tribe, a native, 
chiefly, of Spain, and of Southern Europe, 
but cultivated in England. The extract of 
the root, known as hard "extract of liquo- 
rice," or "black sugar," or "Spanish juice," 
is used chiefly as a demulcent remedy in 
coughs and irritation of the throat, in irri- 
tation of the stomach and bowels, and of 
the urinary organs. Many persons take it 
largely, and find it useful, in heartburn. 
It does not disorder the stomach, or cause 
thirst, like common sugar, even when used 
in considerable quantity. The extract is 
also employed to cover the taste of nauseous 
drugs, such as aloes, &c. and is added to 
demulcent drinks generally. It also forms 
the basis for various kinds of lozenge. 

A soft extract of liquorice is used by 
druggists in the composition of pills, and 
the powder of the root is used for the same 
purpose. 

LITHARGE— Is an oxide of lead, which 



occurs in the form of reddish-white scales. 
It is sometimes used to adulterate wine. — ■ 
See Lead. 

LITHONTRIPTIC— An old term applied 
to medicines which were supposed to possess 
the power of dissolving or disintegrating 
urinary calculi. 

Refer to Urine. 

LITHOTOMY.— The operation of cutting 
for the stone. 

LIVER. — The liver is the largest organ 
in the body, weighing, on the average, in 
man, about four pounds. It occupies the 
upper part of the abdomen, (see Abdomen,) 
just beneath the diaphragm or midriff, to 
which it is attached, or, as it were, slung, 
by what are called the ligaments of the 
liver. By anatomists the liver is divided 
into various "lobes," but here it is suffi- 
cient to point out the general division into 
a larger, or right lobe, (fig. xcv. 1,) and a 

Fig. xcv. 




smaller or left lobe, (2,) the former occupy- 
ing the right "hypochondrium," the latter 
extending far into the left. The gall- 
bladder (fig. xcv. 3) is seen occupying the 
forepart of the under side of the right lobe 
of the liver, in which aspect it is represented 
in the cut. The liver is made up of a num- 
bers of minute lobules, about the size of a 
millet-seed, which are composed of the 
smallest or "capillary" branches of the 
blood-vessels; of the cells which seem to 
separate the bile from the blood; and of the 
ducts which convey the secreted bile into 
the larger common ducts. These converge 
to the one main duct of the liver through 
which the bile flows, either into the gall- 
bladder, or directly into the digestive canal. 
The bile (see Bile) is formed from the 
blood which has circulated through the 
organs within the abdomen, and which 
passes through the liver on its way back to 
the heart. In this passage, the bile is sepa- 
rated from it, thereby purifying the blood, 
and affording a secretion which performs an 
important part in the processes of digestion, 



LIV 



335 



LOC 



and probably in the body at large. This 
intimate connection, however, of the liver, 
by means of the blood, with the other or- 
gans within the abdomen, and particularly 
with the stomach, renders it extremely lia- 
ble to be disordered ; and, indeed, there 
are few cases of disorder of the stomach or 
bowels, in which the liver is not in some 
degree implicated, either primarily or se- 
condarily. Probably, in no way is the con- 
nection between the stomach and liver more 
strongly manifested than by the manner in 
which the latter is affected by the inordinate 
use of alcoholic liquors. In this case, the 
spirit being absorbed directly from the sto- 
mach by the veins, and conveyed directly to 
the liver, acts very powerfully upon it, par- 
ticularly if the form in which the alcohol is 
taken be that of pure spirit, such as gin or 
brandy. In this instance, if the use of the 
spirit be persevered in, a low form of inflam- 
mation is excited in the substance of the 
gland, which ends in the formation of what 
has got the name of the "gin-drinker's 
liver" — a disease, indeed, of which the only 
traceable cause is the excessive use of spiri- 
tuous liquors, and which proves fatal to 
many in this kingdom annually. Its symp- 
toms and treatment could not profitably be 
laid before unprofessional persons, but its 
cause should be impressed on all. In its 
advanced stages, it generally causes drop- 
sical swelling of the lower extremities and 
of the abdomen. 

Inflammation of the liver is attended by 
the usual feverish symptoms which accom- 
pany inflammation of internal organs gene- 
rally, and must be managed on the same 
principles (see Inflammation) until proper 
advice can be obtained. The pain varies 
considerably in this affection, being usually 
very acute when the surface of the liver, 
with its covering membrane, is implicated ; 
but less so, or of a duller character, when 
the substance of the gland is the part in- 
volved. As is the case in liver affections 
generally, pain is often felt somewhere 
about the shoulder-blades, most frequently 
in the right, but sometimes in the left, or 
between them, extending even to the back 
of the head. Inflammation of the liver is 
much more frequent in warm climates than 
it is in this country ; and, in the former, is 
very apt to end in the formation of abscess. 
The disease, of course, requires the most 
active treatment of a medical man ; but it 
should be known to those going to a hot 
climate, (see Climate,) that this, like other 
liver diseases, is much more likely to attack 
the free-living than the temperate man. 
For further information respecting liver- 



disorder, the reader is referred to articles 
Biliary Disorder — Climate— Gall-stone — Jaun- 
dice, $c. 

LOBELIA, or " Lobelia Inflata" — Is a 
plant native to, and very commonly found, 
in North America. It was one of the medi- 
cines of the Indians. It has been used by 
medical men in England as a remedy in 
asthma, and, in some instances, proves of 
service ; but this is generally the case when 
its emetic action has been exhibited. It is 
not a remedy, however, for unprofessional 
hands, for it may prove a powerful irritant 
poison. Lobelia has, within the last few 
years, acquired notoriety in consequence of 
its being the medicine of a set of quacks, in 
whose hands it has, in more than one in- 
stance, produced fatal effects and been the 
means of subjecting them to legal proceed- 
ings and punishment. 

LOBSTER— Like most shell-fish, is unfit 
for persons of weak digestion. 

Refer to Fish. 

LOCHIA.— The " cleansings" after de- 
livery. 

LOCK-JAW — Is the popular name for 
the first and partial symptom of a fearful 
spasmodic disease, known to medical men 
as tetanus, in which, not only the muscles 
of the jaws, but the muscles of the body 
throughout are, more .or less, extensively 
thrown into violent spasm, so strong indeed, 
that the teeth or bones may be broken by it. 
The set of muscles most generally affected, 
after those of the jaws, are those of the 
back; the patient, by the spasm, is bent 
like an arch, so that the back of the head 
and the heels alone touch the bed ; occa- 
sionally the body is bent forward. The 
disease most frequently commences with a 
sensation of stiffness and soreness of the 
muscles of the neck and jaws; the latter 
become fixed, and the spasm extends more 
or less over the body. It is needless to add, 
that this extensive cramp is attended with 
the most severe pain, which is also, in most 
cases, experienced severely about the pit of 
the stomach, being dependent, doubtless, on 
spasm of the diaphragm. 

The most usual exciting causes of lock- 
jaw or tetanus are wounds, especially of a 
punctured character, but in some persons 
the very slightest injury is sufficient to de- 
velop the disease. In England, however, it 
is fortunately comparatively rare ; in warm 
climates it is common. It is also liable to 
prevail among the wounded after battles, 
if exposed to much vicissitude of weather ; 
indeed, cold will occasionally give rise to 
lock-jaw independent of injury. When lock- 
jaw arises from a wound, it shows itself in 



LON 



836 



LOW 



from four days to three weeks after the in- 
jury. It is a very fatal disease, the greater 
proportion of those affected by it dying; 
some, however, recover. Of course, as soon 
as practicable, a medical man should be 
called to a case exhibiting even the slightest 
tendency to lock-jaw after an injury ; in the 
mean time, large, very large doses of opium, 
in the liquid forms of laudanum or of seda- 
tive solution, may be administered, even by 
unprofessional persons ; they may mitigate 
the sufferings of this dreadful disease. Com- 
mencing with from thirty to sixty drops of 
laudanum, the same doses, if they can pos- 
sibly be swallowed, may be repeated at in- 
tervals of from half an hour to an hour, as 
long as the system remains unaffected by 
the drug ; if the medicine cannot be given 
by the mouth, it must be by a clyster. In 
addition to the above, the affusion with cold 
water may relieve. The patient having been 
taken out of bed, and a quantity of cold 
water dashed over the body and down the 
spine, is immediately to be rubbed dry and 
replaced in bed — quiet sleep may possibly 
follow. While the jaws are firmly closed, 
nourishment cannot, of course, be given in 
the usual way ; a medical man will probably 
administer it by means of a tube passed into 
the stomach, either by the nose or by mouth, 
passing it behind t£e teeth ; until his ar- 
rival, should that De delayed, the adminis- 
tration of small clysters of meat-broth will 
assist in maintaining strength. 

Refer to Convulsions — Wounds, §c. 

LONGEVITY — Prolonged Life— It is 
well known popularly, is, in some respects, 
hereditary, the ages at which different mem- 
bers of a family usually die bearing a very 
near average to one another, even despite 
the influence of occupation, habits, and con- 
dition of life, although these, undoubtedly, 
exert considerable influence in determining 
the period at which the component tissues 
of one or more of the organs begin to give 
way. Many tables and calculations have 
been made at different times, with a view of 
determining the extent to which the dura- 
tion of life is affected by the circumstances 
in which individuals may be placed. The 
following table from Casper of Berlin, if it 
may not exactly apply to this country, 
shows, at all events, how greatly the ave- 
rage duration of life may vary in different 
classes : — 
Of 100 theologians, there have attained 

the age of 70 and upwards 42 

Agriculturists and foresters 40 

Superintendents 35 

Commercial and industrious 
men 35 



Of lOOmilitary men... 32 

Subalterns 32 

Advocates 29 

Artists 28 

Teachers and professors 27 

Physicians 24 

Another table, by a different observer, 
exhibits the difference of locality as follows ; 
the observations were taken from a French 
department : — 

Inhabitants to one 
death annually. 

Mountain parishes 38-3 

Seaside 26-6 

Corn districts 24-6 

Stagnant and marsh districts 20-8 

Refer to Age, Old — Life, §c. 

LOINS. — See Lumbar. 

LONGING— Is the term applied to the 
almost morbid craving for certain articles 
of diet, with which some females indulge 
themselves during pregnancy ; it is pro- 
bably a phase of hysteria. Under the cir- 
cumstances, it is only right and humane to 
yield to those fancies in some measure ; 
but when there is any real or adequate 
reason for their being debarred, it may be 
insisted upon without the risk of the conse- 
quences popularly supposed to follow. 

LOSS of BLOOD.— See Hemorrhage. 

LOTIONS — Are liquid applications, prin- 
cipally composed of water, used either to 
the skin or to the mucous surfaces, such as 
the inside of the mouth or of the nostrils. 
The variety of lotions, from plain water — 
which is often a most excellent one — up- 
ward, is very great. Lotions may be classed 
as — 1. Cooling; 2. Stimulating ; 3. Astrin- 
gent; 4. Soothing; and, 5. Sedative. Of 
the first, water is an example, either alone, 
combined with spirit, from half an ounce to 
an ounce to the half-pint, or combined with 
vinegar. The lead lotion (see Lead) is an- 
other example of the cooling lotion, but in 
this case it is astringent at the same time. 
Water, with one-third or one-half spirit of 
wine, applied to the skin by means of lint, 
which is covered to prevent evaporation, is 
a good example of a stimulating lotion. 
Very cold water, the lotion of sulphate of 
zinc or of white-vitriol, in the proportion 
of from one to ten grains to the ounce of 
water, and other astringents in solution, 
(see Astringents,) form the astringent lotions. 
The various preparations of opium, decoc- 
tion of poppies, decoction of hemlock, &c. 
are soothing lotions : the prussic acid lotion 
a sedative one. 

The reader is referred to the various ar- 
ticles, such as "Lead," "Zinc," &c. 

LOW DIET— Must necessarily be a com- 



LOZ 



337 



LUN 



parative term, influenced by the previous 
habits of the patient, but generally it means 
the absence of all stimulants and animal 
food from the allowances — generally of eggs 
also — and a diminished amount of bread 
nourishment. Weak tea, bread, diluted 
milk, cocoa, gruel, arrow-root, sago, and 
such-like preparations, generally constitute 
the staple of low diet in this country ; to 
these, however, the cooling fruits may fre- 
quently be added. Half diet includes the 
above with the addition of puddings of milk 
and eggs, of broth, and it may be of a small 
allowance of meat. — See Abstinence — Fasting 
— Hunger, $c. 

LOZENGE. — A hard compound of sugar 
and gum, which contains either simple fla- 
vouring or some medicinal agent. The 
system of giving medicine in the lozenge 
form has fallen into comparative disuse ; it 
is, however, a useful and agreeable method 
in some cases, particularly in affections of 
the throat, such as relaxation, when it is 
desirable to apply the medicinal agent gra- 
dually. In children, the lozenge form of 
medicine is useful, either for the adminis- 
tration of ipecacuanha, domestically, or of 
morphia, under medical sanction. Such 
lozenges, however, ought to be carefully 
made, so as to contain a certain definite 
dose — in the case of morphia, the twenty- 
fourth of a grain — and the amount of the 
dose should be stamped upon the lozenge. 
The manufacture of lozenges is now almost 
entirely transferred from the apothecary to 
the confectioner. Lozenges are sometimes 
adulterated with what is called "mineral 
white," in other words, plaster of Paris : 
it cannot be regarded as a harmless ad- 
dition. 

LUMBAGO — Is rheumatism of the large 
muscles of the back, and, like rheumatic 
affections generally, is often extremely pain- 
ful, the pain being increased by stooping, 
and again when the person attempts to rise. 
This peculiar aggravation of the pain by 
these movements is generally stated to be 
the distinction between this disease and 
painful affections of the kidney. In lum- 
bago, nothing affords more, if so much, re- 
lief as hot moist applications to the back, 
(see Heat,) continued from twelve to twenty- 
four hours at a time, and followed by the 
soap liniment combined with one-sixth part 
of turpentine, rubbed well into the back 
and loins Ten grains of Dover's powder, 
with a couple of grains of calomel, given at 
bedtime, and followed in the morning by a 
dose of castor-oil or infusion of senna, will 
expedite the cure. While the person is con- 
fined to bed under the influence of the hot 
2D 2 



applications to the back, it will be advisable 
to give warm diluent drinks tolerably freely. 
In a severe or obstinate case of lumbago, 
the " thermal hammer" of Dr. Corrigan (see 
figure, Counter- Irritation) might be used as 
directed ; in such cases, however, the safest 
plan is to have medical attendance, if pos- 
sible. Should the urine be scanty or high- 
coloured, ten grains of carbonate of potassa, 
with a teaspoonful of sweet nitre, may be 
taken in a wineglassful of water twice a 
day with advantage. Persons liable to 
attacks of lumbago should wear a flannel- 
belt round the loins. [The application of 
six cups to the small of the back will often 
expedite the cure of lumbago, especially 
when the attack is recent and severe.] 

Refer to Rheumatism. 

LUMBAR.— Belonging to the loins. The 
term is frequently used in connection with 
abscess. In children of weak and scrofu- 
lous constitution, an abscess in the loins, or 
"lumbar abscess," is apt to occur, and is 
often connected with disease of the ver- 
tebrae, or bones of the spine. Continued 
complaint of pain in the back, with any 
awkwardness in walking, particularly if 
accompanied with failure of the general 
health, should awaken suspicion, and give 
occasion for the child being examined by 
a surgeon. Lumbar abscess may occur in 
adults. 

LUMBRICUS.— A worm. Applied to the 
large round worms which occur in the in- 
testines. — See Worms. 

LUNACY.— See Insanity. 

LUNAR CAUSTIC— Nitrate of Silver. 
— See Silver. 

LUNCHEON. — A kind of intermediate 
meal, and therefore sometimes an unneces- 
sary one. The English labourer has his 
"lunch" between breakfast and dinner, and 
again between the latter meal and supper. 
The English of the higher classes, particu- 
larly if their time is not well occupied, are 
apt to make luncheon a kind of dinner — a 
meal of animal food and stimulants, which, 
if superadded to dinner, is certainly unne- 
cessary, and therefore productive of disor- 
der. Either the luncheon should be made 
a bond-fide dinner at an early hour, [as is 
the practice of very many in the United 
States,] or it should be a meal without 
animal food — provided, of course, that an 
additional amount of animal nutriment is 
not considered necessary by a medical man, 
as a remedial measure. Fruit is generally 
more wholesome at luncheon than in any 
other part of the day. 

LUNGS. — The organs of respiration. The 
lungs are two, each occupying its own side 



LUN 



338 



LUN 



of the chest, (fig. xcvi. 1,1,) the left being 
rather the smallest, on account of the greater 
space taken up by the heart on the left side. 
The latter organ is situated in the space 
(fig. xcvi. 4) between the two lungs, which 

Fig. xcvi. 




are separated from one another by a middle 
partition. Air passes into the lungs by 
means of the windpipe, or trachea, (fig. 
xcvi. 2,) to the top of which is fixed the 
larynx, or organ of the voice ; at its lower 
extremity, the trachea divides into two 
branches, or bronchi, of unequal length, 
one for each lung ; these bronchi on enter- 
ing the lung subdivide into branches, and 
these again into still smaller tubes, until, 
after continued division and subdivision, 
they end in the air-cells. These air-cells 
are minute membraneous cavities, on the 
membraneous walls of which the blood cir- 
culates in a network of veins, in such a 
manner as to be brought into intimate con- 
tact with the air which is drawn into the 
lungs at each inspiration. Nothing, indeed, 
intervening between the blood in the veins 
and the air in the air-cells but a membrane 
so thin that it allows the transpiration of 
the gases and vapour, which takes place as 
the blood becomes purified by means of 
this air contact. In consequence of their 
structure being adapted for the admis- 
sion of air into numberless minute cells, 
the lungs feel spongy when pressed be- 
tween the fingers. Those who are curious 
on the point will learn more from five 
minutes' examination of the lungs and wind- 
pipe of a sheep or calf, in a butcher's 
shop, than from any description. In these, 
however, the mode of death, by bleeding, 
gives the lungs a much paler colour than 
their natural one. The tubes, the air-cells, 



the blood-vessels, &c. of the lungs are held 
together by "cellular" tissue, and the entire 
organ is enveloped by a membrane — the 
"pleura" — which covers its surface, and is 
thence "reflected" to cover the inner sur- 
face of the ribs of the chest ; in this way 
forming a shut pouch, or sac, the inner sur- 
faces of which are in contact, and these 
being in the healthy state perfectly smooth 
and moistened with a lubricating fluid, they 
glide over each other in every motion of 
the chest. The trachea and the bronchi, at 
first, are composed of incomplete "rings" 
of cartilage, connected together by an elas- 
tic tissue ; the former tube — the windpipe — 
as generally known, occupying the forepart 
of the neck and lying in front of the gullet. 
— See Neck. 

The larynx, or organ of voice, which is 
placed on the top of the Windpipe, extends 
to the base of the tongue; its situation is 
often strongly marked in thin men, espe- 
cially if somewhat advanced in life, when 
it forms the prominence popularly called 
"Adam's apple." This prominence is caused 
by a cartilage which forms a main portion 
of the body, or box, of the larynx. Into 
tho composition of this wonderful instru- 
ment of articulate and vocal sound, various 
other cartilages, ligaments, muscles, &c. 
enter, and the whole is lined by a continua- 
tion of the mucous membrane of the mouth, 
which, after passing through the larynx, 
lines the trachea, or windpipe, and follows 
the branchings of the bronchi. The cavity 
of the larynx is divided by a constriction 
of a triangular form — the glottis — and is 
protected from injury by a heart-shaped 
cartilage — the epiglottis — which, especially 
in the act of swallowing, when the larynx is 
drawn, upward, completely closes the open- 
ing. — See Throat. 

From the above slight sketch, the general 
reader may derive some idea of the import- 
ant organs of respiration. To recapitulate : 
situated at the base of the tongue, and pro- 
tected from injury by the cartilage of the 
epiglottis, is the larynx, constricted in the 
centre and ending in the trachea, or wind- 
pipe, which, descending in front of the neck 
into the chest, divides into the right and 
left bronchi ; these, entering their respective 
lungs, divide and subdivide, till the minute 
branches enterthe air-cells, on the thin walls 
of which the blood circulates in a network 
of veins, and undergoes purification by ab- 
sorption of the oxygen of the atmosphere, 
while it frees itself from carbonic acid and 
watery vapour. 

The act of respiration is partly involun- 
tary — that is, goes on (as during sleep) 



LUN 



339 



LUN 



independent of any exercise of the will : it 
is, however, as all know, capable of being, 
to a certain extent, controlled by the will ; 
this being, doubtless, a necessary adjunct to 
the power of the utterance of sound. The 
process of respiration is essentially effected 
by means which enlarge the capacity of the 
chest. These means are the various muscles 
attached to the ribs, and which, by elevating 
them, increase the diameter of the chest 
from before backward, (see Chest,) and also 
the diaphragm and muscles of the abdomen, 
which, by their downward and outward mo- 
tions, increase the capacity of the chest from 
below. The enlargement of the chest by 
these agencies, either in combined or sepa- 
rate action, has the effect of causing the air 
to rush in, or to be sucked into the chest as 
it is into a pair of bellows. If the cavity 
was empty it would rush into it; as it is, it 
rushes into the spongy distensible lungs and 
distends them — it may be, assisted in some 
degree by the action of the lungs them- 
selves. The air having been thus drawn 
into the chest by an active movement, is 
immediately thereafter expelled by a com- 
paratively passive one ; the active muscular 
movement ceasing, the ribs descend, and 
regain their position by their own weight 
and elasticity. The movements, however, 
both of inspiration and expiration, may be 
increased — "forced" — by the will; and, in 
in this case, other muscles are called into 
action, and those usually employed in the 
process are more strongly exerted. It is 
the necessity for these forced efforts in the 
asthmatic, which, after frequent repetition, 
gives the peculiar curve of the shoulders so 
often observable. The average number of 
respirations in a minute varies from fifteen 
to twenty-two in different individuals, and 
even in the same at different times. The 
end of the process of respiration — that is, 
the change undergone by the blood, in con- 
sequence of its exposure to atmospheric air 
in the lungs — has been sufficiently entered 
into in the articles Aeration — Blood — Circula- 
tion, Sfc. ; it is therefore unnecessary to re- 
peat it here. 

The passage of the air into and through 
the lungs gives rise to certain definite 
sounds perceptible to the attentive ear, ap- 
plied closely to the outside of the chest. 
These sounds vary but slightly in healthy 
individuals ; consequently, any deviation 
from them is indicative of disease, experi- 
ence furnishing the link which enables the 
physician to pronounce upon the nature of 
the disorder, from the nature of the sound, 
or from its entire absence, which latter con- 
dition occurs, either when the lung is ren- 



dered so solid by diseased action, that air 
cannot penetrate its tissue, or when it is 
condensed, or pressed together by the pre- 
sence of fluid within the chest. Moreover, 
it is evident that organs like the lungs, 
which, in their natural healthy state, are 
distended with air, must, when the side of the 
cavity within which they are contained is 
struck, give out a somewhat hollow sound ; 
but that, should the lung become solid, or 
the cavity be more or less filled with water, 
the sound, instead of being hollow, will be 
dull or flat. It is further evident that the 
power of conducting sound must be changed 
by the various alterations in the structure 
of the lungs, and that the voice must sound 
differently to the ear applied to the chest, ac- 
cording to these alterations. These brief 
observations will, perhaps, convey to the 
general reader some idea of the means of 
judgment, and of the principles on which 
they depend, which the physician avails 
himself of, when he goes through the — to 
the unprofessional — somewhat mysterious- 
looking process of physical examination of, 
or " sounding" the chest. 

The nax^rowness of the triangular chink 
in the larynx, through which the air passes, 
always renders disease of this organ a 
matter of anxiety and of danger, for that 
small opening cannot be obstructed for 
three or four minutes, without death en- 
suing. 

The larynx is liable to be obstructed 
from swelling of its lining membrane, either 
from inflammation or other cause, from 
spasmodic contraction of its muscles, or by 
foreign bodies accidentally introduced into 
it. It is also liable to ulceration. Inflam- 
mation of the larynx, or laryngitis, though 
comparatively an infrequent disease, is a 
very fatal one when it does occur ; it is re- 
markable from having been the cause of 
death to General Washington. Laryngitis is 
usually the result of cold ; in Washington's 
case it was caused by the snow, during a 
storm, lodging about the neck. In one case 
under the author's care, it arose from a la- 
bourer having incautiously thrown aside 
his neckerchief while warm with work, 
but at the same time exposed to a March 
east wind. The symptoms of laryngitis are 
those of general feverishness, with pain in 
the organ affected, pain on swallowing, 
hoarseness, and hoarse, dry, ringing cough; 
it is, in fact, a disease in the adult, in many 
respects similar to croup in the child, and 
even more dangerous. It is, too, an affec- 
tion which calls for the exercise of the 
most energetic and best-directed medical 
treatment as soon as it can be procured. 



LUN 



340 



MAD 



But for the same reason, it is of the highest 
importance that no time should be lost, even 
while waiting for that aid, and that some 
properly directed means should he at once 
resorted to. First, from half a dozen to 
two dozen of leeches, according to the 
strength of the patient, should be applied 
to the throat and upper part of the chest ; 
or, if leeches are not available, from six to 
twelve ounces of blood are to be taken 
from the back of the neck by cupping. Tar- 
trate of antimony, in eighth of a grain 
doses, is to be repeated at intervals of from 
one to two hours, at first, and calomel given 
in four grain doses every four hours, with 
a quarter of a grain of opium in every, or 
every second dose, should purging ensue. 
Hot bran-poultices are to be kept constantly 
to the throat, the feet put in hot water, and 
advantage may be derived from breathing 
the steam of hot water, the patient, of 
course, being kept perfectly quiet in bed. 
These measures will do all that can be done 
until the arrival of a surgeon ; he may do 
more, and possibly, if the case becomes ex- 
treme, may think it requisite to open the 
windpipe. 

Closure of the larynx, or rather of its 
narrow portion, the glottis, may be the 
result of swelling, extending to it from the 
throat. Partial chronic swelling, causing 
permanent, or at least continued, loss of 
voice, is not an unfrequent and not a dan- 
gerous affection ; and ulceration within the 
larynx, also causing loss of voice, is met 
with in consumption. 

Of the spasmodic affections of the larynx, 
that mentioned under the spasmodic croup 
of childhood is perhaps the most charac- 
teristic, but the researches of Dr. Marshall 
Hall make it evident, that in the nervous 
convulsive diseases, such as epilepsy, spas- 
modic closure of the larynx takes place, 
and that in aggravated cases, relief — by 
proper hands — may be given by the opera- 
tion of opening the windpipe. [This point 
is by no means settled, and there is con- 
siderable evidence to prove that it does not 
afford relief except temporarily.] When 
death does occur from any of the causes 
mentioned, it is by suffocation, or "as- 
phyxia," just as if the person had been 
drowned or hanged. It may also take place 
in consequence of foreign bodies, either 
getting wedged in the larynx itself, or in 
the gullet behind it ; when, if of large size, 
they act by their mechanical bulk and com- 
pression. Foreign bodies are usually drawn 
into the larynx itself, in consequence of the 
person, often a child, laughing or crying 
while the substance or fluid is in the mouth. 



As all know, even the smallest crumb or 
drop of fluid getting into the larynx, or as it 
is popularly called, " going the wrong way," 
immediately, in consequence of the irritation 
of the extremely sensitive lining membrane 
of the organ, causes violent cough, and per- 
haps choking spasm. If the foreign body is 
large, those symptoms are severe in a corre- 
sponding degree, and may, by their severity, 
prove the patient's safety, by expelling the 
offending substance. Should this not be 
effected, and if it is too large to pass 
through the larynx, death must inevitably 
and quickly ensue ; sometimes, however, the 
body passes through the larynx into the 
bronchi, as happened in the well-known in- 
stance of the half-sovereign in Mr. Brunei's 
case. When this occurs, the more severe 
suffocative symptoms subside, but irritating 
cough continues, with the constant risk of 
driving the foreign body back into the 
larynx. In such cases, unprofessional per- 
sons can do little or nothing, and unless 
proper surgical assistance is quickly pro- 
curable, there is much chance of a fatal ter- 
mination. It would always be right, how- 
ever, for some person to pass the forefinger 
as far back in the throat as possible, under 
the chance that the obstruction might be 
within reach ; and also to adopt the reme- 
dies for choking laid down under article 
Gullet. 

The various inflammatory affections of 
the air-tubes, such as Croup, Bronchitis, 
Catarrh, Influenza, &c. &c. are treated of 
under their separate heads ; inflammation 
of the lungs falls under article Inflamma- 
tion; and other diseases of the respiratory 
organs, such as Consumption, Asthma, &c. 
&c. are assigned to distinct articles in the 
Dictionary. 

Refer also to Aeration — Blood — Chest — 
Circulation, $c. §c. 

LUXATION.— A dislocation.— See Dislo- 
cation. 

LYMPH.— The fluid contained within the 
lymphatic or absorbent vessels. — See Ab- 
sorbents. The term is also applied to limpid 
exudations from the body, such as vaccine 
lymph, adhesive lymph, &c. 

MACE — The outer covering, or, in bota- 
nical language, the " arillus," of the nut- 
meg, and one of our pleasantest and most 
generally used spices, may, when taken too 
largely, produce determination of blood to 
the head, and intellectual disturbance. The 
characteristic properties of mace depend 
upon an essential oil. — Refer to Nutmeg. 

MADEIRA.— Of this much frequented 
and most important resort for invalids, Sir 



MAD 



341 



M AL 



James Clark thus speaks : — Madeira has 
been long held in high estimation for the 
mildness and equability of its climate : in 
which respect it will well bear comparison 
with the most favoured situations on the con- 
tinent of Europe." 

Compared with the best of these, it is 
warmer during the winter, and cooler during 
the summer ; there is also less difference 
between the temperature of the day and that 
of the night, between one season and an- 
other, and between successive days. It is 
almost exempt from keen, cold winds, and 
enjoys a general steadiness of weather to 
which the continental climates are stran- 
gers. During the summer, the almost con- 
stant prevalence of north-easterly winds, 
especially on the north, and the regular sea 
and land breezes on the south side of the 
island, maintain the atmosphere in a tem- 
perate state. The sirocco, which occurs 
two or three times, at most, during the 
season, and then continues only for a few 
days, (seldom more than three,) sometimes 
raises the atmosphere in the shade to 90°. 
With this exception, the summer tempera- 
ture is remarkably uniform — the ther- 
mometer rarely rising above 80°. In con- 
sequence of the regular sea-breezes, the 
heat is not so oppressive as that of the 
summer in England often is. Close, sultry 
days are little known in Madeira, and there 
is neither smoke nor dust to impair the pu- 
rity of the atmosphere. Such, indeed, is 
the mildness of the summer at Madeira, 
that a physician, himself an invalid, who 
resided for some time on the island on ac- 
count of his health, doubted whether the 
season was not more favourable to pulmonary 
invalids than the winter. 

* * * "The spring at Madeira, as at 
every other place, is the most trying season 
for the invalid, and will require even there 
a corresponding degree of caution on his 
part. In March, winds are frequent; and 
April and May are showery;" but Sir 
James adds — " On the whole continent of 
Europe there is no place with which I am 
acquainted where the pulmonary invalid 
could reside with so much advantage during 
the entire year as in Madeira." 

MADEIRA WINE— Is one of the strong 
dry wines, and contains from twenty to 
twenty-two per cent, of spirit. It gene- 
rally contains more acid than either port or 
sherry. 

MADNESS.— See Insanity. 

MAGNESIA— One of the alkaline earths, 

is largely used in medicine, in the form of the 

pure or calcined magnesia ; also in the form 

of the carbonate, and of bicarbonate, which 

2d2 



latter, being soluble, constitutes the fluid 
magnesia of the shops. In combination 
with sulphuric acid, it forms sulphate of 
magnesia, or Epsom salts. — See Epsom Salts. 

The principal use of magnesia is as an 
antacid in acidity of the stomach and bowels ; 
it at the same time — provided it meets with 
acid — acts as a gentle aperient ; it is often 
combined with rhubarb, Epsom salts, &c. 
The effectual manner in which magnesia 
neutralizes acid in the stomach, and thereby 
relieves heartburn and other uneasy sensa- 
tions, has probably been the reason for its 
extensive use, and certainly for its abuse 
among dyspeptics generally, whereby much 
evil has resulted ; for there is no question, 
that the continued use of magnesia as 
an antacid greatly impairs the digestive 
powers. Moreover, if used in the form of 
calcined magnesia, or of carbonate, should 
it not encounter sufficient acid in the ali- 
mentary canal to convert it into a soluble 
aperient salt, it is apt to accumulate, and, 
if taken regularly and largely, to collect 
into and form concretions in the bowels. 
On this account, persons who will take 
magnesia habitually, ought to be careful to 
clear out the bowels thoroughly, at intervals, 
by means of a dose of castor-oil ; the same 
rule being observed with regard to children, 
if magnesia is given regularly to them. 
These remarks do not apply to the com- 
paratively pleasant and efficient preparation 
of the bicarbonate, or fluid magnesia, which 
has greatly, and with advantage, supplanted 
the other preparations. 

Fluid magnesia, in doses of from half an 
ounce to two ounces, may be taken either 
alone, or in milk — the latter mode being 
convenient for children ; or it may be given 
as an effervescing draught, with lemon- 
juice. It has been already observed, that 
magnesia only acts as an aperient when it 
meets with acid ; the author has found a 
dose of magnesia, taken after the garden 
rhubarb used as food, act very well as a 
gentle aperient. 

Of the solid preparations, Hemy's [or 
Husband's of Philadelphia] calcined mag- 
nesia is the best. Some kinds of magnesia, 
when kept for a time mixed with water, are 
apt to form a solid mass. 

Refer to Children — Indigestion — Piles, §c. 

MAGNETISM, ANIMAL.— See Mesmer- 
ism. 

MALARIA.— See Ague. 

MALE FERN.— See Fern. 

MALIC ACID.— The peculiar acid of the 
apple. 

MALIGNANT*— A term applied medically 
to various diseases when they assume a fa- 



M AL 



342 



MAS 



tally severe, or intractible form, such as ma- 
lignant sore-throat, &c. 

MALT LIQUOR.— See Ale and Beer and 
Porter. 

MAMMA. — The female breast — See 
Breast. 

MANNA — Is the saccharine exudation 
from a species of ash-tree, and is chiefly 
brought from Sicily and Southern Italy. 
Flake manna is the variety used in this 
country, but it is not employed by any 
means to the same extent as formerly. It 
is gently aperient, but as two ounces are 
requisite for a close, it is likely to disorder 
the stomach. There are many good substi- 
tutes. 

MARASMUS — Wasting — Atrophy. — 
See Atrophy. 

MARMALADE.— The well-known pre- 
serve, made from the Seville orange, is by 
some regarded as a stomachic. 

MARRIAGE.— The religious and lawful 
union of the sexes. Various observations 
go to confirm the fact that the married 
state is conducive both to health and to 
prolongation of life ; thus it has been ascer- 
tained, that married women at the age of 
twenty-five have, on an average, thirty-six 
years of life before them, while unmarried 
women of the same age have not, on the 
average, more than between thirty and 
thirty-one years ; that in men, the mortality 
between the ages of thirty and forty-five 
amounts, on the average, to eighteen per 
cent, in the married, but to twenty-seven 
per cent, or one-third more, in the un- 
married ; and, further, that at the age of 
seventy, while there remain alive but eleven 
bachelors out of every hundred, twenty- 
seven married men out of the same number 
may be expected to reach the threescore 
and ten. 

It has also been shown from statistical 
returns, that suicide is very much more 
frequent among the unmarried than the 
reverse. On the score, therefore, of phy- 
sical and mental health, independent of 
other considerations, marriage is advisable ; 
of course its advisability, in individual cases, 
must rest on the relative position of the 
parties. Certainly, however favourable 
other matters may be, it is a great evil for 
parties to enter into the married state too 
early in life ; the female especially, if she 
commences child-bearing early, that is, 
before the age of two or three and twenty, 
cannot fail to suffer in her own constitution, 
and almost necessarily entails the acquired 
debility upon her offspring. In the case of 
those who have a family when advanced in 
life, the trial is less to their own constitu- 



tions, but should the father be aged, the 
children are not likely to be strong. The 
reader is further referred to articles Disease, 
Hereditary, §c. for information respecting 
the influence which the health and constitu- 
tion of the parent exerts upon that of the 
offspring. 

As regards physical and mental develop- 
ment, it is an undoubted fact, that the 
mixture of races, or at least of families 
totally unconnected with each other, tends 
greatly to elevate the standard of both. 
It has been remarked by Humboldt and 
others, that in South America, the progeny 
of the negro and of the native Indian are 
greatly superior to the progenitors on either 
side; the superiority of the Caribs to other 
American Indians has been ascribed to 
their latitude in intermarriage with the 
surrounding tribes ; and it is well known 
that the Anglo-Saxon attributes the posi- 
tion of his race in the vanguard of progress, 
to the mixture of blood which has taken 
place, as a necessary consequence of the 
successive occupations of Great Britain by 
different races. 

MARROW— Is the fatty matter which 
fills up the centre of the shaft of the long 
bones. As an article of diet, it possesses 
the same nutrient properties as the fats 
generally. 

MARSH-MALLOW — Is found on the 
continent, and frequently in England, in 
marshes near the sea ; it bears pale bluish- 
red flowers on the upright stem ; the leaves 
are heart-shaped, cut at the edges, and, like 
the stem, are covered with soft, hairy down. 
The whole plant is mucilaginous, but the 
root is the part chiefly used ; four ounces 
may be put into six pints of water with two 
ounces of raisins, and the whole reduced 
one-third by boiling ; the mucilaginous 
decoction thus obtained is to be strained 
through calico before use. 

Marsh-mallow is much more used in 
France and Spain than it is in this country, 
not only in decoction, but also as lozenge, 
and syrup ; it is, undoubtedly > a good de- 
mulcent, but probably not superior to linseed 
or pearl barley. 

The leaves of the common roadside mallow 
are often used in England by the poor, under 
the name of marsh-mallow, as an addition 
to fomentations ; it is, perhaps, needless to 
add, it is a very useless one. 

MASTICATION.— The act by which the 
food is, or ought to be, reduced to a soft 
mass before swallowing, by the action of 
the teeth, and by admixture with the saliva. 
The importance of the proper performance 
of this act has been pointed out in article 



MAT 



343 



ME A 



" Indigestion." It has even been suggested, 
that the average of life at the present time 
exceeding that of former periods is partly 
due to the improvements in dentistry, ena- 
bling the aged to masticate their food more 
perfectly. 

Refer to Digestion — Indigestion. 

MATERIA MEDICA, (Medical Mate- 
rials.) — Refer to Medicines. 

MATICO — Is the term applied to the 
leaves of one of the pepper tribe, a native 
of South America ; the drug has recently 
been introduced as a powerful astringent in 
cases of bleeding ; the leaves, especially, 
being lauded as a certain remedy in obstinate 
bleeding from leech-bites. The author has 
not found, in his own trials of it, that 
niatico possesses any advantage over other 
astringents, and that which he used came 
direct from the importers ; [and such is the 
experience of others.] 

MAW-WORM.— See Worms. 

MEALS. — See Breakfast, Dinner, &c. 

MEASLES — Is one of the eruptive fevers, 
which most persons go through once in a 
lifetime, and generally during childhood ; 
the disease usually occurs as an epidemic, 
and is contagious. The first symptoms of 
measles are those of a feverish cold ; there 
is shivering, headache, loss of appetite, and 
perhaps vomiting ; the eyes look red, and, 
as well as the nose, furnish increased watery 
discharge ; there is hoarseness and cough. 
On the fourth day of the disease, or in from 
seventy to eighty-four hours after the first 
symptoms of sickness have shown themselves, 
the peculiar eruption of measles begins to 
appear, generally about the forehead, then 
on the neck and arms, and thence extends to 
the trunk and extremities ; at first the erup- 
tion shows only in red points, not unlike 
flea-bites, but these soon enlarge into rather 
broad, slightly purplish, crescent-shaped 
spots, which are just perceptibly elevated 
above the skin. At this period, the skin is 
hot, there is a good deal of general fever, 
with thirst, and much hoarse cough, with 
quickened breathing. After remaining out 
about four days, the eruption — first, of 
course, on the face — begins to decline, and 
by the seventh day it has generally disap- 
peared, leaving the skin slightly roughened, 
followed by separation of the cuticle in 
small scales. 

Measles, however, does not always follow 
the same regular course ; there may exist 
the constitutional symptoms without erup- 
tion ; but a more common variety is the 
characteristic eruption without any consti- 
tutional affection. This, however, affords no 
protection from future attacks of the disease. 



Again, measles may prevail, either as a very 
mild disease, scarcely requiring treatment, 
or it may be as a most malignant and fatal 
epidemic. The principal danger in ordinary 
measles arises from the affection of the chest, 
especially in very young children, many of 
whom die from this cause, particularly if 
the epidemic happens to occur during the 
prevalence of cold winds in spring, and if 
the children, as often happens among the 
poor, are insufficiently attended to. When 
measles occurs in its malignant, or putrid 
form, it becomes a fearfully fatal malady, 
carrying oft numbers of children, in spite of 
the best-directed treatment. 

In any case of measles, the safest plan is, 
of course, to have medical attendance ; very 
many parents, however, in the humbler 
classes, when the prevailing epidemic is 
mild in character, take the matter in their 
own hands, and do little more than keep 
their children in bed for a day or two, if 
they do even that. There is no question 
that a mild attack of measles will get well 
without any treatment ; but in even the 
mildest, ordinary care to guard against cold 
should be observed, this being, of course, 
requisite in proportion to the season of the 
year. If the attack be a smart one, the per- 
son should be kept in bed and moderately 
warm, allowed to drink freely of diluent, 
and especially of demulcent drinks, such 
as barley-water. The diet should consist 
of milk and farinaceous matters ; cooling 
fruits and such-like may be allowed, the 
bowels at the same time being attended to, 
but not purged. Should the eruption of 
measles seem tardy in coming out, or come 
out small or insufficiently, or, after having 
shown itself, should it disappear again 
suddenly, and before the time of its regular 
decline, danger must be apprehended ; the 
warm-bath is at once the safest and the 
best remedy ; the child being kept in the 
water — temperature 98° — from ten to twenty 
minutes, according to age. In addition to 
this, to a child five years old, a drachm or 
teaspoonful of spirit of mindererus should 
be given in a little sweetened water every 
two or three hours, and warm drinks freely 
administered at the same time. A very per- 
nicious practice prevails, especially in the 
country, among the poor, of giving children 
stimulants, "to bring out the eruption," 
and also in the course of the disease ; in Scot- 
land, whiskey is given ; in England, cowslip 
wine is the most generally employed stimu- 
lant; [and in the United States, saffron, 
tansy, and catnip teas are often resorted 
to, with nearly always evil results, as 
they increase the fever. Warm gruel is much 



M E A 



344 



ME A 



safer.] It is perhaps scarcely necessary to 
add, that none but the most ignorant and 
prejudiced could he guilty of so dangerous 
a practice. In England there seems to he 
a popular prejudice in favour of the virtues 
of the cowslip in measles, and when the wine 
is not used, it is very common to find the 
infusion, or tea of the "cowslip pips" or 
flowers, given ; this, of course, is perfectly 
innocent, and may he permitted. When the 
feverish symptoms in measles run high, it is 
commonly in connection with the chest-affec- 
tion ; in such cases, from four to six grains 
of ipecacuanha powder and half a drachm 
of carbonate of potassa are to be made into 
a mixture with three ounces of water, and 
of this, a dessertspoonful given to a child 
of five years of age every four or five hours ; 
in milder cases, ten or fifteen drops of ipeca- 
cuanha wine are to be given in the same 
way. Should symptoms of inflammation 
within the chest show themselves, as often 
happens if the child has been permitted 
to take cold, (see Inflammation,) they must 
be treated as directed in the article on the 
subject; but in all such cases a medical man 
should be called. It must always be borne 
in mind, that measles do not bear much 
lowering treatment, and that blisters are apt 
to prove dangerous — a bran-poultice being 
always a preferable application. An idea 
prevails, that persons affected with measles 
cannot be kept too hot ; this is often a 
source of much mischief. Cold certainly is 
to be avoided; but free ventilation, with 
a moderate temperature, (see Bedroom,) is 
always the most advantageous. When mea- 
sles assumes a malignant or putrid form, 
the case must be considered as eminently 
dangerous. In this form the eruption is 
dusky and purple, or rather, livid, the patient 
extremely depressed, and the tongue dry and 
black looking. Medical assistance as soon 
as possible is, of course, indispensable, and 
even then the hope of saving life is but 
small. Nourishing meat-broth, wine, or 
warm wine whey must be given frequently, 
and those measures resorted to which are 
recommended under typhoid fever. 

The convalescence from measles requires 
much care, if the weather is at all cold, for 
the disease leaves a susceptibility to inflam- 
matory chest-affection for some time. In 
children of weak constitution, measles, like 
the other eruptive fevers, is apt to leave 
a tendency to discharges from the ears, to 
weakness and redness of the eyes, &c. 

Refer to Inflammation — Catarrh, §c. 

MEASURES.— Two kinds of measures are 
used by the apothecary for smaller quanti- 
ties of fluid ; these are the drop or minim 



measure, (fig. xcvii.,) and the ounce mea- 
sure, (fig. xcviii.) 

Fig. xcvii. 




Tig. xcviii. 

The drop measure is, or ought to be, 
cylindrical, as represented. It is graduated 
or marked with divisions equal to five or 
ten minims each, and may be made for 
sixty minims or one fluid drachm only, or 
for one hundred and twenty minims or two 
fluid drachms, or for a greater quantity. 
A minim measure for sixty drops will be 
sufficient for domestic purposes. A minim 
by measure contains a larger quantity of 
fluid than a drop ; the latter, too, is liable 
to vary in bulk according to the nature of 
the fluid, and of the lip of the phial or vessel 
from which it falls ; on these accounts, it 
would be desirable that the measured minim 
only should be used, but as the measure 
glass itself must necessarily be frequently 
wanting, the drop is a more generally ap- 
plicable mode of division. When the doses 
of drops, of any medicine, are measured in a 
minim glass, one-fourth ought to be allowed 
for the greater bulk of the minim ; that is, 
if the dose is twenty drops of laudanum by 



ME A 



845 



MED 



drop, by minim measure it should be only 
fifteen. 

The fluid ounce measure-glass [called "a 
graduate" by the apothecaries] is graduated 
as represented, (fig. xcviii.,) on the right side 
of the perpendicular line into fluid drachms, 
and on the left side into fluid ounces. It may, 
of course, be made of any size, from one 
ounce upward. 

The other fluid measures used by the apo- 
thecary in England and Scotland are the pint, 
■which contains twenty fluid ounces, and the 
gallon, which contains eight pints : in Ireland 
the pint is only reckoned at sixteen ounces ; 
[and the same is the practice of apothecaries 
in the United States.] The following table 
of the apothecaries' fluid measures, also 
shows the initial letters, by which, for the 
sake of brevity, these measures are distin- 
guished in prescription : — 
Fluid. Symbol. 

One gallon C = 8 pints. 

One pint = 20 ounces. 

One ounce ^ = 8 drachms. 

One drachm 5 = 60 minims. 

One minim m 

Besides these regular measures, there are 
a variety of less accurate modes of measure- 
ment for medicine, used on account of their 
convenience ; these are, the teaspoon, equal 
to about one fluid drachm ; the dessertspoon 
to double, and the tablespoon to four times 
that quantity, or to half an ounce. The 
wineglass generally holds about two fluid 
ounces, the teacup about one ounce more ; 
the breakfastcup and tumbler about half 
a pint each. These irregular modes of 
measurement, however, are not only incon- 
venient, but they may, at times, be of 
serious moment. Spoons and glasses must 
vary greatly in size ; what the poor call a 
"meat-spoon" and consider a tablespoon, 
barely equals an ordinary dessertspoon in 
calibre : again, one person will fill a spoon 
till it runs over, another scarcely more than 
half, so that in one way or another, it is 
a great chance whether the patient gets 
the quantity the medical man orders. To 
remedy these evils-, glasses marked in table- 
spoonfuls, and porcelain measures (fig. xcix.) 
made only to hold a certain quantity, have 
been manufactured, and are certainly con- 
venient when at hand. But by far the 
most certain method of apportioning the 
doses of fluid medicine, is by means of the 
moulded graduated bottles now largely 
used; these being marked in fourths, sixths, 
eighths, &c. and the medicine being pre- 
scribed in these proportions, there is no 
further trouble ; no spoon is required — a 
great saving to silver, which is apt to be 



Fig. xcix. 




stained — and the medicine is poured directly 
into the cup from whence it is drunk. These 
graduated bottles are now beautifully made 
by the York Glass Co., [England,] and are 
not higher in price than plain ones. A few 
of them would be found convenient in most 
houses. 

MEAT.— See Beef— Flesh— Muscle— Mut- 
ton, $c. 

MECONIUM. — The dark, olive-green 
discharge from the bowels of a newly-born 
infant. 

MEDICINES.— Under this head will be 
included all that would come under the 
more correct designation of Materia Medica. 
This term, which literally means medical 
materials — -that is, the various agents used 
in the practice of medicine — may appear 
somewhat technical in a popular work, but 
it is the most conveniently comprehensive 
under which to include the enumeration of 
all those agents, whether medical or sur- 
gical, which may be used domestically. It 
is unnecessary here to give more than an 
enumeration, the agents themselves being 
sufficiently treated of in the various arti- 
cles devoted to them, either classified or 
individually. The following list is meant to 
include whatever, either in the way of me- 
dical or surgical materials, an intelligent 
emigrant, in a remote district, might, with 
reasonable care and ordinary common 
sense, safely employ ; thus constituting a - 
domestic materia medica, in its widest 
sense. At the same time it must be evi- 
dent that, however desirable this latitude 
may be for the circumstances supposed, it 
is by no means requisite for those who are 
placed with greater facilities for procuring 
proper professional assistance ; neither is 



MED 



346 



MED 



it recommended that they should take ad- 
vantage of it as a whole, but that each 
should select whatever may appear most 
suited to their own circumstances. The 
articles in the list to which the asterisk is 
prefixed are such as may most readily be 
dispensed with in most instances. Of 
course, the list includes but a portion of the 
medicinal remedies mentioned throughout 
the work at large ; neither does it include 
other agents used in medical treatment, 
such as heat, cold, &c. 

A list of the most generally useful domestic 
medicines : — 

*iETHER — Either chloric or sulphuric. To he kept in 

a stoppered hottle, tied over with hladder, or with 

sheet gutta-percha.— Chloric aether, see Appendix. 
Aloes — In the form of the simple drug. 
Alum — Burnt, in powder. 
* Ammonia — The carbonate of ammonia, to he kept in 

a wide-mouthed, stoppered, or well-secured bottle. 
Ammonia. — The compound spirit of ammonia, cr sal- 

Tolatile, to be kept in a stoppered bottle. 
Ammonia— The acetate of ammonia, or spirit of min- 

dererus. 
Antimony— The tartrate of antimony, or tartar emetic. 
Antimony— In the form of James's Powder, [or Tartar 

Emetic] 
. * Arnica — The tincture. 
*Bismuth — Nitrate of, in powder. 
*Borax— In powder. 
#Columbo — Boot, and powder of root. 
*Camphor — In bottle. 
Cantharides — Or Spanish blistering fly. In the form 

of the common blister plaster, or in the form of 

blister tissue, or of blistering fluid. 
Castor-oil. 

*Catechu — The simple drug. 
Chalk— Prepared. 
*Chamomtle Flowers. 
Chlorine — Disinfecting powder, Collins's ; or solution 

of chloride of lime, Beaufoy's. 
Cinchona Bark— The simple drug, or in the form of 

quinine. 
*Confection — Aromatic, in powder. 
Cotton Wadding — In sheets. 
Cream of Tartar. 

Creasote — In stoppered bottle, about two drachms. 
Copper — Sulphate of— blue vitriol. 
Diachylon Plaster — Adhesive plaster ; but not spread 

if going to a warm climate. [That made in the 

United States, and put up in rolls in a tin case, 

will keep in any latitude.] 
Dill-water— For infants. 
Extract of Henbane. 
*Galls — Whole, or in powder. 
Gentian Root. 
Ginger. 

*Gum Arabic — In mass and in powder. 
Ipecacuanha — In whole root, and in powder. 
*Iron— Sulphate of— green vitriol. 
Iron — Tincture of muriate of, " tincture of steel." 
* Jalap — Powder. 
Lead — Acetate, sugar of. 
*Lemon-juice — Bottled, if for a sea voyage. 
*Linseed Meal. 
Magnesia — Calcined or fluid. 
Magnesia — Sulphate of— Epsom salts. 
Mercury — Chloride — Calomel. 
Mercury — With chalk — gray powder. 
*Mercury — Red precipitate. 

*Muriatic Acid — Spirit of salt, in stoppered bottle. 
Mustard — In powder, in close canister. 
*Myrrh — Tincture of. 

#Nitric Acid — Aqua-fortis, in stoppered bottle. 
*Orx— Camphorated. 



Opium — In powder. 

Opium — Compound tincture, with camphor — Paregoric. 

*Opium — In the form of Battley's solution, a small 

quantity, or in the form of muriate of morphia. 
Opium — In the form of laudanum. 
Pells — Either in powder, ready mixed for making up, 

or made up with a small addition of glycerine to 

keep them soft, and kept in stoppered bottles. — 

Blue pill in the mass, in a well-covered pot. 
Pills — Compound colocynth pill. 

Compound colocynth pill, with calomel. 
Compound colocynth pill, with blue pill. 
Compound rhubarb pill. 
Compound expectorant pill. — See Pills. 
Potash — Bicarbonate, in powder. 
Potash — Nitrate of— saltpetre, in powder. 
*Potash — Solution of—" liquor potassse," in stoppered 

bottle. 
Powders — Compound. 

Compound chalk, with opium. 
Compound powder of ipecacuanha and 
opium — Dover's powder. 
Rhubarb — In root, and powder of root. 
Rhubarb — Tincture of. 
Scammony — In powder. 
*Squill — In tincture. 
Senna — Leaves. 
Silver — Nitrate of, or lunar caustic in stick mould, in 

a bottle, or with gutta-percha holder. 
Soda — Bicarbonate, in powder. 
*Spirit of Wine. 
Spirit of Sweet Nitre. 
Sulphuric Acid— Oil of vitriol, diluted to medicinal 

strength, and kept in stoppered bottle. 
*Tartaric Acid. 
*Turpentine — Spirit of. 
Zinc — Sulphate of, white vitriol. 

[Before purchasing any of these, the 
reader would do well to consult an intelli- 
gent druggist, or a physician.] 

To the above medicines, or such of them 
as are selected, it will be requisite to add a 
set of scales with apothecary's weights ; a 
couple, at least, of "graduated" glass-mea- 
sures ; a Dutch tile ; a bone spatula, and one 
or two iron spatulas or palette knives ; a fil- 
tering funnel or tun-dish, and a moderate- 
sized mortar and pestle of Wedgewood ware. 
The above may be said to be the necessary 
articles of the domestic laboratory, and it 
is advisable that they and the medicines 
should be included in a chest or box pro- 
perly constructed for the purpose. Where 
expense is not too great an object, strong, 
glass-stoppered bottles will be found the 
best receptacles for the various medicines, 
wider mouthed ones being used for the 
pills and powders, and narrow ones for 
fluids. In addition to the above requisites, 
the following will be found convenient addi- 
tions for all, but especially in the case of emi- 
grants: — A measure graduated for doses; a 
few bottles of various sizes, from half a pint 
downward, graduated, that is, marked into 
parts, such as fourths, sixths, &c ; phial- 
corks ; filtering or blotting paper; a few cut 
papers for powders ; a glass rod for stirring. 

The above-mentioned articles may and 
ought to be included in a thoroughly fur- 
nished medicine-chest; and those who 



MED 



347 



MED 



■would be completely equipped, should also j 
provide the surgical materials mentioned 
below. All these, however, add to the ex- 
pense ; and as there are many persons, 
-whether emigrants or others, who either 
cannot or do not wish to incur the cost of 
providing so amply, but yet who would de- 
sire to keep beside them a stock of the 
most efficient medicines, and those most 
likely to be required on emergencies, an 
emigrant's medicine-chest has been manu- 
factured by Mr. Hooper, of Pall Mall, London, 
[and by all others in all large cities,] which 
is calculated to contain, in the most com- 
pact form, a stock of selected medicines, 
with the means of dispensing them, such as 
scales, measures, &c. Mr. Hooper's chest is 
entirely constructed of j apanned tin, this ma- 
terial being better calculated to resist the 
effects of climate, and the attacks of insects, 
than wood, and at the same time occupying 
much less space ; indeed, the entire chest 
measures barely eight inches in length, and 
five in width, and the same in depth, and is 
to be sold stocked, at a cost of 30s., which 
will place it in the power of most. 

A complete medicine-chest, in the full 
sense of the word, cannot certainly be pro- 
vided when the object is to furnish one fitted 
with selected medicines, of the best quality 
— more essential than quantity or great 
variety — at such a moderate price as will 
make it generally accessible ; but, of course, 
those who can afford it, and may desire a 
more amply furnished store, can have it 
constructed on the same principle as the 
smaller and cheaper article. 

In the case of emigrants especially, the 
author would advise those who are provid- 
ing a medicine-chest, to make themselves 
well acquainted, previous to purchasing, 
with the probable requirements of the cli- 
mate and situation to which they are re- 
moving, or which they are likely to pass 
through ; thus, for instance, quinine would 
be a much more indispensable article for the 
settler in some parts of the United States, 
where ague prevails, than for the Australian 
emigrant ; or sulphate of zinc, for eye-wash, 
would be an omission not to be supplied in the 
medicine-store of the voyager upon the Nile ; 
or, as another example, persons going to hot 
climates must not take their adhesive plas- 
ters ready spread, [unless in canisters.] By 
reference to the articles on the individual me- 
dicines mentioned in this work, the requisite 
information on these points will be gained: 
it is unnecessary, therefore, to detail it here. 

To the surgical department belong — lint 
and old linen ; oiled silk or oiled calico, or 
thin sheet gutta-percha ; bandages ; scis- 



sors; pins; goldbeater's leaf, &c. Instra ■ 
ments, properly so called, (see Instruments,) 
must entirely depend upon the contingent 
circumstances, present and probable, and 
upon the inclination of the individual. 
Indeed, so much depends upon these, that 
it is impossible to lay down any uniform 
system of domestic materia medica ; but it 
is trusted that the foregoing enumeration 
will be some guide in the selection. At the 
same time, the author would strongly advise 
parties, either resident in England, or 
going abroad, to avail themselves, when 
possible, of the aid of a medical friend, or 
adviser, when furnishing the domestic labo- 
ratory. They will thus be put in the best 
way of getting what they want, good of its 
kind ; this is essential, for the money had 
better be kept in the pocket than wasted 
upon cheap and worthless drugs : they 
will, too, have some guarantee that when a 
good price has been given, a good article 
has been procured. — See Drugs. Further, 
although there are certain general remedies 
which none can err in providing, there may 
be others more especially adapted, either to 
the constitutional tendencies of the indi- 
vidual, or family, or, in the case of emi- 
grants, to the nature of the climate, and of 
its peculiar diseases, to which they are 
about to remove. These are points on which 
a medical man only can give proper advice; 
and few are so friendless as not to be able 
to get it ; indeed, the author knows well 
that none need want advice on these points ; 
the members of the medical profession will 
always give, and give it freely, under such 
circumstances. This article is little more 
than an enumeration of our domestic reme- 
dies, the plan of the work rendering it 
necessary that the information connected 
with each should be given under the indi- 
vidual heads, and to these the reader is 
referred in particular, as well as to such 
articles as Bedroom — Dressing — Drugs, A,*c. 
Indeed, the reference may be said to extend 
to the work at large. 

In accordance with the plan laid down 
at the commencement, whenever doses of 
medicine are given, they are, unless it is 
otherwise specified, such as are suitable for 
an adult ; the following table is generally 
considered a sufficient guide in the appor- 
tionment of the doses to the different ages: 

For an adult — 
Suppose the dose to be 1, or 1 drachm.... 3 i 
Under 

1 year the dose will be j^ = 5 grains... gr.v 

2 " i = 8 grains gr.viii 

3 |- =10 grains... gr. x 

4 " £ =15 grains., gr.xv 



MED 



348 



MED 



Under 

7 years the dose will be |- == 1 scruple... 9 i 
14 " J = J drachm... £fs 

20 " § = 2 scruples.. ^ii 

21 to 60 years 1 drachm.. .5 i 

Above sixty — that is, in old age — the 

dose gradually diminishes. 

Although the above table is, and may be, 
accepted as an average rule, it must not, 
by any means, be adopted as an invariable 
one in practice, without reference to the 
constitution, state of health, &c. of the in- 
dividual. A strong child at three years of 
age may require, and may tolerate better, 
a much stronger dose than a weaker or 
weakly one two years older. Moreover, in 
the case of many aged persons, purgative 
medicines especially will often require to 
be used as actively as in the young. Again, 
in such a medicine as opium, the propor- 
tions given in the table would give rather 
large doses for children, while, on the 
othor hand, in the administration of mercu- 
rials, such as calomel or gray powder, they 
would reduce them too greatly. These ob- 
servations are made, as qualifications to 
what some might regard, from its being in 
the tabular form, as a complete guide in all 
cases. . The variations are of less conse- 
quence, as sufficient information respecting 
dose is always given in the place or article 
in which it is directly requisite. 

As a general rule, women require smaller 
doses of medicine than men ; and at the 
same time, it is always requisite to keep in 
view the peculiarities, periodical and other- 
wise, of their constitutions; and in the case 
of matrons, the possibility of pregnancy. It 
is better to avoid the use of strong purga- 
tives, and of astringents, during the healthy 
menstrual period. In some cases, all re- 
laxing remedies, such as warm bathing of 
the feet, and diaphoretic medicines, are 
inadmissible during the same event. Tem- 
perament, in all cases, requires to be con- 
sidered in the administration of medicine. 
See Temperament — Diathesis, Sfc. 

There is some art — and a good deal 
depends upon it — in administering medi- 
cines properly, not only to children, but to 
adults. It is a very common popular 
saying, that " doctors do not give sugar- 
plums," and verily, unless it be the homoeo- 
paths, they do not. At the same time, 
much may be done to lessen the nauseous- 
ness of many drugs ; the methods are 
generally pointed out when the medicines 
themselves are treated ; the following do 
not occur under any regular head. The 
aromatic waters, such as peppermint, cin- 
namon, &c. are as much disliked by some 



as they are liked . by others ; their addition 
to medicines may, therefore, generally — ■ 
unless they are given as carminatives — be 
left to choice ; as a rule, they do not render 
the medicine more palatable. The same 
observation generally applies to sugar and 
syrups ; in cough-medicines and the like, 
sweetness may be agreeable, and an advan- 
tage, but in the case of a nauseous medicine, 
sweetening it only renders it more sickly 
to most patients. From his own experience, 
the author can testify that the fewer addi- 
tions made to the essential medicine — what 
physicians call the " basis" — the better. 
In the case of children, bulk is always an 
objection to be guarded against, as much 
as consistent with utility. The fact is 
perhaps not sufficiently realized practically, 
that one most efficient method of avoiding 
the taste of nauseous medicine is to blunt 
for a time the acuteness of the nerves of 
taste : nothing does this so well and agree- 
ably as the essential oil of orange or lemon 
peel. A small piece of the rind of either 
of the above fruits chewed, just/ before and 
immediately after swallowing the dose, is 
very efficacious. 

The nature of the medicine, and its form, 
should, in some degree, bear a connection 
with the periods of the twenty-four hours. 
Tonic remedies generally, are better taken 
before evening ; the time for taking purga- 
tives should, in some degree, depend upon 
their nature. Unless for some special pur- 
pose, liquid purgatives, such as castor-oil, 
senna, salts, &c. which, like liquid medi- 
cines generally, exhibit their action quickly, 
should not be taken late in the evening, 
when their action will probably disturb the 
night's rest. Pills and powders, on the 
other hand, which are slower in their ac- 
tion, may be, and generally are, taken at 
night. Although medical men order some 
medicines to be taken upon a full stomach, 
for special purposes, the generality are 
better taken when the stomach is empty, or 
nearly so ; tonics, purgatives, astringents, 
&c, particularly. In the first place, they 
are not so likely to interfere with the pro- 
cess of digestion, and in the second, their 
proper action is more readily and effectually 
manifested. 

In conclusion, it might be thought by 
some, that more of what medical men call 
prescriptions, and the public, recipes, might 
have been given in this article, or through- 
out this work generally. But the author 
trusts that before this, the principle of his 
system of "safe domestic medicine" has 
been manifested; that it is not to furnish a 
set of nostrums, one "good for" this com" 



MED 



349 



MED 



plaint, and another "good for" some other, I 
to be used without reason why or where- 
fore. Such a system of blind popular 
quackery is truly mischievous, and very far 
apart from the intelligent management of 
disease, modified more or less, according to 
circumstances, and which is based upon a 
true, even though a popular, knowledge of 
the functions and requirements of the human 
body as well as of the constitution, disorders, 
and accidents to which both are liable. 
Under such a system, no series of nostrums 
and mixed recipes is requisite ; its safety 
and its efficiency rest, in the first place, 
upon the correctness and intelligent under- 
standing of the anatomical and physiolo- 
gical knowledge, as far as it goes ; upon the 
clear appreciation of the causes and nature 
of disease and accident, as far as they can 
be popularly explained; and lastly, upon the 
simplicity of the means of alleviation or of 
cure, which can be legitimately pointed out. 

The term "medicine" is usually given to 
the substance in its prepared state ; in its 
crude condition it is more generally called 
a drug. — See Drugs. 

The prepared forms of medicines are — 

Cataplasm, or poultice. Mixture. 

Cerate. Ointment. 

Confection. Pill. 

Decoction. Plaster. 

Distilled water. Powder. 

Enema, or Clyster Spirit. 

Extract. * Syrup. 

Infusion. Tincture. 

Liniment. "Wine. 

Metallic salts. 

Medicines are also divided according to 
their actions, as follows : — 

Antispasmodics. Errhines. 

Astringents. Escharotics. 

Antacids. Excitants. 

Demulcents. Expectorants. 

Diaphoretics. Narcotics. 

Diluents. Purgatives. 

Disinfectants. Refrigerants. 

Diuretics, Sedatives. 

Emetics. Sialagogues. 

Emmenagogues. Tonics. 

Epispastics. 

For explanation, refer to the articles on 
the above subjects. 

Refer to articles on medicines individu- 
ally and classified — Measures — Filter — Scales, 
Sfc. 

MEDICINE. — The science and practice 
of medicine is, in its highest and worthiest 
sense, the practical application of many 
sciences to the investigation of the number- 
less diseases and disorders to which the hu- 
man frame is liable, and to their removal, 
2E 



as a result of that investigation, either by 
the direct action of medicine, properly so 
called, by medicine as an assistant simply to 
the natural tendency toward health, or by 
other means which exercise a beneficial in- 
fluence over the health of the body. To 
exercise well and truly this noble art is, 
perhaps, the most difficult task in which a 
man can engage ; but it would seem also 
to be the easiest channel through which 
the ignorant knave can gull his fellow-men. 
That it is so, however, cannot be laid to the 
charge of the science of medicine, but is 
the consequence of the thorough ignorance 
respecting the nature and requirements of 
their own bodies and constitutions in which 
people, hitherto, have been for the most part 
content to rest ; an ignorance which, strange 
to say, has been too often favoured by mem- 
bers of the medical profession, who seem to 
have laboured under a morbid dread lest 
a patient should have the least rational idea 
of the nature of his own malady, or of the 
means — medical and otherwise — requisite for 
its removal. The effect of this mystery has 
been, in the eyes of the ignorant, to place 
the educated physician in many instances 
on the same level as the charlatan — more 
particularly in cases requiring long and 
slow treatment. In a case admitting of 
rapid and successful cure, by the well-di- 
rected efforts of scientific treatment, even 
the most ignorant can see and, in some de- 
gree, appreciate the educated skill which has 
afforded the striking result. But should 
the case prove to be a necessarily tedious 
one — its progress slow, perhaps uncertain, 
ebbing and flowing — the patient and the 
patient's friends, unconscious of the nature 
of the case, and of the difficulties to be 
overcome, see nothing, perhaps, but mys- 
tery in the treatment; looking upon the 
curative powers of medicine as exerted in 
some undefined curative effect upon the 
disease. On seeing first one medicine pre- 
scribed, and then another, they probably 
attribute the changes to the endeavours of 
the physician to "hit the complaint," while 
he is only making those changes requisite 
in every case of continued disease, to meet 
the varying and varied symptoms which 
arise ; and when, by the exercise of patient 
skill, the disease is cured, the last medicine 
reaps the credit of the whole ; and if the 
patient has been whimsical, very probably 
the last doctor gets the full credit for that 
which was really effected by a predecessor 
in attendance. 

Now, while it is evident that the entire 
treatment of such cases may have been con- 
ducted on the most scientific, rational, and 



MED 



350 



M E M 



conscientious principles, to an ignorant or 
prejudiced patient — and there are many 
such — or to one kept in ignorance, the 
■whole is unintelligible, quite as much so as 
the quack nostrum, as far as the method of 
cure goes. And, perhaps, if the physician 
be a conscientious man, holding out far less 
brilliant prospects of speedy cure, the quack's 
promises and lies carry the day against the 
physician's well-considered, and, perhaps, 
guarded opinion ; for the simple reason 
that the patient is without any true rational 
idea of the structure of his own frame — of 
the requirements of his own constitution — 
of the nature and tendencies of his malady, 
and, lastly, of the objects and intentions 
which regulate the necessary treatment, 
and direct its aim. 

Quackery and deception, in connection 
with the treatment of disease, never will 
and never can be extinguished by legal 
enactment — they flourish on ignorance alone. 
It may be said that the higher and edu- 
cated classes in this country are the chief 
supporters of quackery, legal and illegal, 
patent and secret, and undoubtedly they 
are — because they are ignorant — ignorant 
of the simplest laws which regulate the 
working of that frame, so fearfully and won- 
derfully made, in which God has placed 
them to dwell on earth. 

It is a reproach often brought against 
medical science and practice, that it is "so 
uncertain," so full of doubt, so liable to 
error: if persons would but reflect for a 
moment, it would be apparent that this un- 
certainty must in some degree be insepa- 
rable from a science which is not one of order, 
but of disorder ; unlike chemistry, astronomy, 
and the other exact sciences, medicine has 
to deal with that which is regulated by no 
fixed laws, but varies with the constitution, 
the habits, circumstances, and numberless 
other contingencies connected with the indi- 
vidual whose constitution, on the other hand, 
has its own peculiar susceptibilities to the 
action of remedies. These considerations 
will show why medicine must be to some 
amount uncertain ; but with this admission, 
it is contended, that its skilful practice is 
capable of conferring the most extended be- 
nefit on suffering humanity. If medicine is 
yet uncertain, it is far less so than it has 
been, and every day is making it more exact. 

The practice of medicine or treatment of 
disease may be classed under the two divi- 
sions of Empirical and Rational. The 
former is rather the result of experience 
and experiment than of reasoning, and ad- 
ministers medicine which is known to remove 
certain symptoms, or sets of symptoms — 



constituting a disease — without any rational 
ground for the administration of the cura- 
tive agent beyond the fact of its being 
known from experience to act beneficially 
in such cases. Rational medicine, on the 
other hand, looks less at the symptoms than 
at the causes, and endeavours to ground its 
treatment upon the observations after death, 
and upon microscopical, chemical, and other 
examination. The most efficient practitioner 
will probably be he who neglects neither 
method. 

Refer to Diagnosis — Disease, §c. 

MEGRIM — Is a species of nervous head- 
ache affecting only one side of, or one de- 
fined spot on the head, and is generally the 
result of debility. The immediate attack 
of megrim headache may be relieved by 
the application of flannel or sponge, soaked 
in hot water. The tendency is to be re- 
moved by the improvement of the general 
health and strength, by good diet, air, and 
exercise, and by the use of bark, iron, and 
other tonics. 

MELON. — The well-known pleasant but 
indigestible fruit. 

MEMBRANE— In its purest form, is a 
thin expanded substance or pellicle, in which 
no trace of structure can be detected under 
the highest powers of the microscope; in 
this state it is now known as "primary" or 
"basement" membrane. Membrane, how- 
ever, may be constituted also, either of flat 
cells or of interlaced fibres. The surfaces of 
the serous or mucous membranes are spread 
over with a layer of minute cells, which are 
concerned in, and adapted to the functions 
of the particular membrane they cover; this 
layer is called the epithelium of the mem- 
brane, and resembles, in situation and pur- 
pose, the epidermis or cuticle which is spread 
over the skin. 

Refer to Skin. 

MEMORY— The mind's record of the past, 
is, we have every reason to believe, impe- 
rishable. The power to recall what has 
been imprinted on its, to us, mysterious 
tablets, may not be always at command, but 
all know that it is more so at one time than 
another ; and medical men not unfrequently 
meet with cases of disease, in which the me- 
mory of long-forgotten knowledge is again 
opened up ; the scenes, the thoughts, and 
the language and words of the first child- 
hood pass again through the mind of the 
second ; the thoughts and feelings of later 
times are unremembered, and the Greek 
exercise or Latin poem of the school-room 
are once more gone over correctly, by those 
to whom they have been unknown tongues 
for years. This resuscitation, as it were, 



MEN 



351 



MEN 



of memory, as the effect of disease, is not 
less remarkable than its loss ; in many in- 
stances, under the same influence, one man 
will remember numerals but forget letters, 
another the reverse ; one can only recall the 
last syllables of words, a second stops short 
after repeating the first. Still more remark- 
able are the cases of double memory or con- 
sciousness, several of which are on record. 
In these, either in consequence of some 
acute disease, or mental shock, all memory 
seems to be swept away ; the mind is left a 
perfect blank, and education, even in adults, 
has to be commenced anew. In such cases, 
the individual has gone on for some time 
acquiring the simplest rudiments of know- 
ledge, when, all at once, the old memory 
has returned, and with it all its mental 
stores, blotting out, apparently, the new; 
and this alternation of these two singular 
states of mind has occurred again and again. 
Loss of memory, exhibited either with re- 
spect to things that have hitherto been well 
remembered, or in unwonted difficulty in 
the acquisition of new ideas, must, unless 
well accounted for by advanced age, be re- 
garded suspiciously, as the possible result 
of incipient cerebral disorder — it may be, of 
a tendency to insanity. 

MENORRHAGIA.— See Menstruation. 

MENSTRUATION.— The monthly peri- 
odical discharge, the "catamenia," is one 
of, if not the most important of the facts 
connected with female health. 

Commencing, usually* in this country, be- 
tween the ages of thirteen and fifteen, its 
recurrence in health — except during preg- 
nancy and nursing — is generally extended 
for a period of thirty years. It needs not to 
dwell upon the necessity for the mainte- 
nance of the regular and sufficient develop- 
ment of this function during those thirty 
years of life. Females are generally suffi- 
ciently aware of it, although sometimes, in 
carelessness or wilfulness, they neglect the 
temporary self-restraint it imposes. 

It is a foolish error, or neglect, not un- 
common with mothers, to omit all mention 
of the occurrence of this event to their 
daughters : the consequence is, that the 
symptoms which usually precede it are 
ignorantly unattended to, and, it may hap- 
pen, the development of the function is 
checked by imprudences which a little in- 
formation might have prevented. More- 
over, the unexpected appearance of the 
period is apt to excite much alarm, and the 
mental agitation, or other causes, may at 
once check a natural and healthy proceed- 
ing ; it need scarcely be said, with how 
great probable injury to health. Mothers 



or female guardians should always forewarn 
those committed to their charge, and put 
them on their guard against those exposures 
to cold and fatigue, to mental excitement, 
or abuse of purgative medicines, which may 
interfere with the natural relief. There is, 
of course, considerable variation as regards 
the amount of the menstrual discharge, and 
also in the period of its continuance. The 
one is in this country from four to five 
ounces, and the other from three to five 
days on the average. 

Climate, temperament, habits, &c. all ex- 
ert much influence over the function in dif- 
ferent individuals, or even over the same 
individual at different times ; but these 
variations may all fall within the limits of 
health, and do not require interference ; 
and, although in the majority of instances 
the function is established before the six- 
teenth year, it may, coincidently with per- 
fect health, be delayed two or three years 
longer. Generally, however, the delay, or 
non-development of the menstrual function, 
if not owing to structural deficiency, or to 
mechanical obstruction, is owing to some 
deep-seated constitutional defect, such as 
is usually distinguished as "chlorosis" or 
" anaemia." — See Ansemia. In any case, 
medical advice is requisite to give those 
proper directions for the improvement of 
the general health and strength, which 
are necessary, or to investigate the cause, 
whatever that may be, of so important a 
deficiency. 

After the first appearance of menstrua- 
tion, it is not uncommon for the second to 
be delayed for a considerable period, with- 
out the health in the least suffering : after 
its full establishment this can scarcely be 
the case. During the menstrual period, 
there is almost always some amount of irri- 
tation of the system, at least of an in- 
creased susceptibility to external impres- 
sions, and very often of increased tendency 
to hysterical affections. These facts always 
require to be kept in mind in the treatment 
of disease, and care taken that this does not 
interfere with the natural discharge, which, 
often in itself, proves no slight relief; indeed, 
there exists so strong a prejudice on this 
point among females themselves, that they 
will voluntarily stop a course of medicine 
at the time of their period. As well known, 
menstruation is generally absent during 
suckling. Its occurrence and recurrence, 
while this is going on, should be a signal for 
weaning, for not only is the double drain 
most hurtful to the maternal constitution, 
but the milk undergoes alteration, becomes 
more serous and less nutritious. 



MEN 



352 



MEN 



Menstruation may be interfered with by 
causes from without, which check its de- 
velopment, and throw it, as it were, back 
upon the system ; or by causes from within, 
generally incipient disease, such as con- 
sumption or general debility. In the former 
case, the stoppage is of the active, in the 
latter, of the passive character. In either 
case, the term " amenorrhoea" is applied to 
the condition by medical men. 

When menstruation in a healthy female 
is checked by external causes, such as cold, 
the whole system exhibits symptoms of op- 
pression. There is probably fever, much 
headache, torpor, pain in the back, loins, 
&c. ; these symptoms being aggravated, 
and perhaps mixed up with hysteria, on the 
return of each menstrual period. In such 
cases, relief is best afforded by those mea- 
sures which tend to relieve the overloaded 
system. Free purgation by some of the 
more active pills, such as compound colo- 
cynth, or compound rhubarb, with or with- 
out calomel or blue pill, senna, jalap, &c. 
will be found of service. Effervescing 
draughts of carbonate of potassa and tar- 
taric acid may be tolerably freely taken. If 
there is much complaint of headache, or of 
pain in the lower bowels, leeches in the 
groins, or cupping at the bottom of the 
back will do good. But these must be used 
in the interval, not just at the return of 
the period, at which time, immersion of the 
feet and legs in hot mustard and water 
and hot hip-baths will be most serviceable, 
the latter at the full heat of 98°, and re- 
peated nightly for a few times, the patient 
remaining in for twenty minutes. Until 
the restoration of the function the diet 
should be reduced, especially as regards 
animal food and stimulants, and walking 
exercise regularly taken for a considerable 
time every day. 

In Amenorrhoea, or suppressed menstrua- 
tion from constitutional causes, the reverse 
of all these measures recommended above 
will probably be requisite. In such cases, 
the secretion is not thrown back upon the 
constitution, but the constitution, from 
some cause, has not power to bring it for- 
ward. It is evident, then, that remedial 
measures must not be so much directed to 
the inducement of the function, as to the 
amendment of the debilitated constitution 
and improvement' of the general health. 
For these purposes, the plan recommended 
under article "Ansemia" will be generally 
applicable, and to that the reader is re- 
ferred. 

In any case of suppressed menstruation, 



medical attendance should be procured if 
possible, but especially so in the last- 
mentioned form, when the secretion ceases 
without any appreciable cause, and the con- 
stitutional powers seem to be impaired. In 
such cases, the threatening of some disease 
of debility is to be dreaded, which may, if 
detected early, be nipped in the bud. It is 
repeated, in such cases a medical examina- 
tion cannot be too soon submitted to. More- 
over, the distinction between suppressed 
menstruation with overfulness, and that 
dependent upon debility, is not always 
clearly defined. Such cases call for the 
most careful exercise of educated judgment. 
In cases of suppressed menstruation, the 
chance of pregnancy is, of course, to be 
kept in view. Many mistakes have been 
made on this point. — See Pregnancy. The 
time of life is, of course, to be considered, 
and the possibility of the secretion disap- 
pearing at an earlier age than common. 

In some cases of suppressed menstruation, 
what is called a vicarious or compensating 
discharge is sometimes established from the 
nose, the ears, the lungs, the stomach, &c. ; 
sometimes from an open ulcer. 

Painful menstruation, " dysmenorrhoea," 
is very common both among married and 
single, chiefly those of an irritable consti- 
tution, and of indolent habits. It causes 
much suffering: the subjects of it are less 
likely to become mothers, and often mis- 
carry. As regards the cure of this painful 
disorder, it is not a matter for the unpro- 
fessional, it is generally tedious and dif- 
ficult, or it may be unattainable, even in the 
best hands. For the relief of the paroxysms 
of pain, much may be effected. Dr. Ashwell 
says, " Let the patient, on the first premo- 
nition of pain, commence the use of the 
hot bath at 96° or 98°, and ordinarily re- 
main in it for a half or three-quarters of 
an hour, repeating it three or four times in 
the twenty-four hours, and always guard- 
ing against the effects of cold, by keeping 
in a hot bed, so long at least as to allow 
the skin to resume its natural temperature. 
When the pain is very severe, the bath may 
be continued until faintness is induced; 
and if it be inadequate for this purpose 
then half a grain of ipecacuanha or fifteen 
drops cf antimonial wine may be exhibited 
every hour." Opiates give relief; five 
grains of Dover's powder may be given 
twice or three times in the twenty-four 
hours, or ten drops of laudanum, or seven 
or eight of Battley's solution at the same 
intervals. Anodyne suppositories (see Sup- 
pository) are often of much service, or small 



MEN 



353 



MEN 



■warm clysters, containing ten or fifteen 
drops of laudanum ; castor-oil being used 
if an aperient is requisite. 

In the slighter cases of difficult and pain- 
ful menstruation, the hot bran poultice may- 
be substituted for the hip-bath. 

Profuse menstruation, or menorrhagia, 
like internal hemorrhages, may be either 
of an active or passive character. Many 
varieties of the affection are recognised, but 
it will be sufficient here to consider it under 
the above two general heads. Those ad- 
vanced in life are, as a general rule, most 
subject to the disorder. Constitutional ten- 
dency and the influence of climate both 
exert so much influence upon the freedom 
of the menstrual discharge, that they must 
not be lost sight of in the consideration of 
cases of menorrhagia. What in one person 
would be excessive, may be only natural in 
another, and the usual amount in a warm 
climate would be accounted profuse in a 
cold one. Profuse menstruation of an active 
character is most apt to occur in persons 
of full habit of body ; and in such cases, 
within certain limits, may be considered, 
and allowed to go on, as a salutary relief. 
When, however, it becomes so free as to 
tell distinctly upon the strength, medical 
assistance should be procured, and in the 
event of the case being a severe one,_blood 
and clots being passed away in quantity, 
treatment similar to that recommended 
under the head of "Abortion" should be 
resorted to till proper aid can be obtained. 
Females liable to these attacks of profuse 
menstruation, if of full habit of body, ought 
in the interval to submit themselves to 
medical treatment. Animal food must be 
taken sparingly, stimulants avoided, early 
rising practised, and active exercise taken 
during the day, the bowels being attended 
to by cooling saline aperients. A teaspoon- 
ful of Epsom salts, with fifteen drops of 
dilute sulphuric acid, taken every morning 
in half a pint of water, will form a most 
suitable dose. Continued and repeated active 
menorrhagia may end in the passive form. 

Passive menorrhagia is most general in 
persons of debilitated constitution, in whom 
every drop of blood is of consequence, and 
in whom the continued weakness resulting 
from the disorder is very apt to lay the 
foundation of consumption, and other dis- 
eases of debility. Such persons ought always 
to be under the care of a medical man. In 
the event of a sudden attack, means very 
similar to those employed in the active form 
are to be at once resorted to, the strength 
being supported by strong animal broths, 
and, if there is much exhaustion, by stimu- 
2e 2 23 



lants. In such cases, the oxide of silver, 
as recommended by Sir James Eyre, in 
one-third and half-grain doses, is extreme- 
ly useful, but must be given under medical 
sanction. In the interval, these cases will 
require a strengthening tonic treatment, 
animal food and broths freely, wine or 
malt liquor, bark and mineral acids, or 
"tincture of steel," in fifteen-drop doses, 
twice a day. It is repeated, there are so 
many modifications and varieties, both of 
cause and effect, in cases of menorrhagia, 
that medical advice cannot be safely dis- 
pensed with, and should be resorted to as 
soon as practicable. 

The decline of menstruation usually oc- 
curs, as already noticed, about thirty years 
after its first establishment. The period is 
(and always is) regarded by females them- 
selves, as a critical era in their lives. With 
the cessation of menstruation the capability 
of conception also ceases. Such an im- 
portant change cannot take place without 
causing some constitutional disturbance ; 
indeed, women themselves seem to think it 
a matter of necessity that they must have 
illness at this period. This is probably going 
too far ; many do get over the change with 
comparatively trifling indisposition, and 
much of the disorder that does occur may 
be traced to luxurious and artificial modes 
of life ; perhaps, also, to privation and over- 
work. However, disorder at the " change 
of life" is sufficiently common to make it a 
matter of expediency in all cases, of neces- 
sity in many, that the health should be 
carefully watched, and any symptoms of 
disease at once attended to. As might be 
expected, irritations of the nervous system, 
hysterical, hypochondriacal, and even ap- 
proaching insanity, are apt to occur ; still 
more frequently, disorder, indicative of 
plethora, or overfulness of blood, such as 
headaches, or apoplexy, spitting of blood, 
piles, &c. ; or the individual becomes corpu- 
lent. Lastly, cancerous diseases not unfre- 
quently show themselves for the first time at 
the cessation of the menstruation. Mode- 
ration in diet, particularly in the use of 
animal food and stimulants, regular and 
sufficient exercise, strict attention to the 
state of the bowels by means of the com- 
pound colocynth pill alone, or with blue 
pill, or by senna, castor-oil, or saline pur- 
gatives, are means which may safely and 
with benefit be carried out ; on the occur- 
rence of actual disorder or disease, medical 
aid should be sought at once — any sudden 
attack being attended to according to its 
nature,' and under the directions given for 
its management in the proper place. 



MER 



854 



MER 



Refer to Abortion— Hemorrhage— -Pregnan- 
cy, Src. 

MERCURY — Quicksilver — The well- 
known metal, fluid at ordinary tempera- 
tures, furnishes some of the most important 
agents used in medical practice. Of these, 
it will be sufficient to notice its preparations 
in the form of blue pill and of gray powder, 
of calomel, and of "red precipitate," and 
of blue ointment. Corrosive sublimate, 
although a preparation of mercury used by 
medical men as a medicine, will only be 
noticed here with reference to its poisonous 
properties. 

Quicksilver itself has been used in medi- 
cal practice not as a medicinal, but as a 
mechanical agent, in obstruction of the 
bowels ; as much as a pound being ad- 
ministered at once, under the idea that its 
mere weight in passing through the bowels 
would overcome the stoppage. The prac- 
tice has been almost abandoned. 

In the forms of blue pill and of gray 
powder, mercury, according to some, exists 
merely in a state of minute division, but is 
most generally thought to be in a state of 
low oxidation. The former of these pre- 
parations is made by rubbing up metallic 
mercury in certain definite proportions, with 
conserve of roses and liquorice-roo.t powder, 
until the mercury disappears, or, as it is 
often expressed, is "killed," the entire 
mass assuming the well-known grayish-blue 
colour. Gray powder is similarly made 
by rubbing the mercury with chalk. These 
two forms are mild, but effective and 
most useful preparations ; the blue pill for 
adults, the gray powder for children, or 
where very gentle action only is required, 
it being milder than blue pill. It should 
be remembered in giving gray powder, that 
if given in preserve or treacle, the acid, 
meeting with the chalk, gives rise to effer- 
vescence. 

Calomel is a compound of mercury and 
chlorine, and is a much more powerful pre- 
paration than either of the above. It occurs 
in lumps, but is generally met with and 
sold in the form of a heavy white powder 
with a slight tinge of yellow. It is often 
adulterated. 

Red precipitate is an oxide of mercury, 
and should be in the form of brilliant red, 
somewhat glistening scales. It is often 
adulterated with red lead, which has a much 
duller appearance. 

Corrosive sublimate, like calomel, is also 
a compound of mercury with chlorine, but 
with a larger proportion of the latter ; hence, 
in chemical language, calomel is known as 
the chloride of mercury, and corrosive sub- 



limate as the bichloride. Calomel has also 
been called the submuriate, and corrosive 
sublimate the muriate. These terms are 
apt to create confusion, and might occasion 
dangerous mistakes, as the corrosive subli- 
mate, except in minute doses, is a virulent 
poison. It is better, for medicinal purposes, 
to adhere regularly to the old and perfectly 
distinctive names of calomel and corrosive 
sublimate. 

The medicinal uses of mercurial prepara- 
tions are, perhaps, more numerous than 
those of any other single agent in the mate- 
ria medica ; for while, in itself, a mercurial 
acts as an alterative, as a purgative, as a 
stimulant, or as a powerful constitutional 
remedy, according to the mode in which it is 
given, it appears, when conjoined with other 
remedies, to merge its action in theirs, 
quickening and strengthening that of the 
drug to which it is adjoined. With the diu- 
retic it tends to the kidneys, with the dia- 
phoretic it increases the determination to the 
skin, while to the purgative it gives more 
energetic action. Not the least remarkable 
and valuable property of mercury is its 
power of controlling or of subduing inflam- 
mation. In many cases, it is often all that 
the practitioner can trust to ; hour after hour 
he pushes on the mercurial, in the assur- 
ance thSt if he can get the constitution, 
however slightly, under its influence, the 
disease will succumb. This effect of mer- 
cury is more particularly manifest in inflam- 
mations affecting the eye, such as iritis, in 
which, as through a glass, the whole process 
is to be witnessed ; and it is such a cura- 
tive effect, as he in this case witnesses, that 
gives the physician confidence that, in cases 
where he cannot see, similar desirable re- 
sults follow the action of the drug upon the 
constitution of his patient. 

The administration of mercury in various 
diseases being noticed when the diseases 
themselves are treated of, the reader is re- 
ferred to the proper articles. 

The constitutional affection, by means of 
mercury, known also as mercurialism, or 
ptyalism, or "salivation," is not a state to 
be lightly induced, and without good rea- 
son, by a medical man ; never by an unpro- 
fessional person, except in an extreme and 
acute case. The first symptoms of the 
constitution being affected by mercury, or 
of approaching salivation, is a sense of ful- 
ness and tenderness of the gums ; the teeth 
feel, as it were, elongated, and the person 
cannot bite any firm substance, such as a 
crust, as well as usual ; coincident with 
these symptoms, the breath acquires a 
peculiar fetor, which, once smelled, cannot 



ME It 



355 



MER 



be forgotten, and the gums, if examined, 
are seen to be slightly swollen, and of rather 
a purple hue. If the medicine be now 
stopped, or given only in very small quan- 
tity, the constitutional indications do not 
become more developed, nor, indeed, does 
it serve any good purpose that they should 
be so ; but if the medicine be gone on with 
as usual, the gums become much more 
swollen and tender, the tongue and glands 
around the jaws inflame and swell, and 
there is continued flow of fetid saliva from 
the mouth. At the same time, there is 
much constitutional irritation — mercurial 
fever, as it is called — and, altogether, the 
individual under the action is in a most 
miserable condition. It is by no means 
requisite for the good effects of a mercurial 
course, to be developed, that the influence 
of the medicine should be pushed thus far, 
neither is it desirable ; all that is requisite 
is, that the gums should give indication of 
the constitution being affected. At the 
same time, in some individuals, any consti- 
tutional affection by mercury appears to 
involve this violence of action. Indeed, 
there are some constitutions so susceptible 
of the action of the medicine, that the 
smallest dose cannot be taken without its 
producing free, or even violent salivation. 
Such cases are among the most vexatious 
which it falls to the lot of a medical men to 
encounter. He orders, perhaps, a mild, 
ordinary dose of some mercurial, and finds 
it has produced salivation, injuring the 
patient, and probably entailing days — it 
may be weeks — of discomfort. It is only 
experience of the fact which can point out 
the individuals to whom this, accident may 
happen ; but, having once occurred, it 
ought always to be kept in mind, and any 
person thus liable, having occasion to 
change their medical attendant, the fact 
should be communicated at the very first 
interview. Unfortunately, but little can 
be done to cut short, or even alleviate 
greatly, a course of mercurial salivation : 
cold, of course, is to be avoided, the alum- 
wash for the mouth, or tincture of myrrh, 
or camphorated spirit in water, used to rinse 
the mouth, afford some relief. A lotion 
made with two drachms of chloric ether, to 
eight ounces of water, is also serviceable, 
and diminishes the fetor ; a solution of chlo- 
ride of soda, in the same proportions, will 
have the same effect. A few leeches may be 
applied under the jaw, and saline aperients, 
such as Seidlitz powders, or Epsom salts, 
largely diluted, may also be given with ad- 
vantage, if the patient can swallow them, 
and is not in a very reduced state. The 



excitation of mercurial action must alwaj^s, 
as much as possible, be avoided in scrofulous 
constitutions ; in such, mercury seldom 
acts as beneficially as in others. Mercurial 
action is not unfrequently induced by persons 
continuing to take, inadvertently, aperient 
pills, which contain small doses of the 
medicine. When these are prescribed by a 
medical man for a temporary occasion, warn- 
ing should always accompany the prescrip- 
tion. 

When mercurial preparations are given 
in small doses, they exert an inappreciable, 
or what is called "alterative" action, in 
improving the quantity and quality of vari- 
ous secretions. For this purpose a grain 
of blue pill, or a couple of grains of gray 
powder, may be given twice in the twenty- 
four hours. Of ail the organs on which 
mercurials exert their effects, the liver is 
most obviously affected ; small alterative 
doses stimulate gently the flow of bile, and 
improve its quality if impaired ; larger 
doses stimulate more actively, bringing 
down the bile freely, and carrying it 
through the bowels with a purgative action. 
This is more obviously the case when the 
liver has been in an overloaded condition : 
then, a dose of mercurial, even a small one, 
opens, as it were, the flood-gates, and the 
rapid descent of bile, often in an acrid con- 
dition, causes diarrhoea with severe griping. 
When mercurials are given with other me- 
dicines not purgatives, it is generally in 
doses which will not purge, for should that 
occur, the desired action is interfered with. 
When mercurials are given in frequent and 
not very small doses, either in inflammatory 
cases, or for the purpose of affecting the 
constitution, it is usual to combine with 
them small quantities of opium, a quarter 
of a grain in each dose, to check the pur- 
gative effect, or, as it is expressed, to pre- 
vent the mercury from running off by the 
bowels. 

As an alterative, the doses of mercurials 
are, of blue pill one grain, gray powder two 
grains, calomel half a grain ; as a purga- 
tive, blue pill from five to eight grains, gray 
powder six to ten grains, calomel three to 
five grains. When mercury is given to act 
specially upon the liver, it is better given 
according to the Abernethy plan — that is, 
uncombined at night, and followed by a 
dose of liquid purgative, [citrate of mag- 
nesia,] black-draught, castor-oil, or the like, 
in the morning. In this way the mercury 
is able to exert its full effect upon the liver, 
whereas, if combined with a purgative at 
first, it is hurried through the bowels too 
quickly to do this. 



MEE 



356 



MIC 



In some persons, mercurials produce a 
state of great nervous irritation ; in others 
they cause deadly sickness and faintness. 
Children generally bear mercurial medi- 
cines well, in doses -which are large when 
compared with those of adults. It is almost 
impossible to salivate a child — indeed, in 
most cases it is quite so. The stools occa- 
sioned by the purgative action of mercurials, 
especially in children, are generally of a 
dark olive-green. 

Poisoning may be occasioned by any of 
the preparations of mercury, but corrosive 
sublimate is the most frequent agent of the 
class by which it is produced. This sub- 
stance occurs in the form of a heavy crys- 
talline powder, and has a strong metallic 
taste. Three grains would be a dangerous, 
if not a fatal dose. Corrosive sublimate 
can scarcely be swallowed without the 
strong taste being quickly perceived ; very 
shortly, violent pain in the bowels, suc- 
ceeded by vomiting of stringy phlegm 
mixed with blood, comes on, the bowels 
act violently, and if the patient is not re- 
lieved, collapse or sinking is followed by 
death. Of course, in such a case medical 
assistance should be got with all speed ; but 
fortunately the most effectual antidotes are 
generally within easy reach. These are the 
white of eggs given mingled with a little 
water, or if this cannot be had at once, 
thick flour and water, or milk ; free vomit- 
ing being at the same time encouraged by 
ipecacuanha, if at hand, or by a feather in 
the throat. The white of egg must not be 
given too freely ; for, if in excess, the good 
effects of a sufficient smaller quantity are 
neutralized. If the quantity of the poison 
given be known, the white of one egg may 
be given for every three grains. Accidental 
poisoning, even by the mildest of the mer- 
curials, may arise in consequence of violent 
constitutional affection, owing to peculiar 
susceptibility. Such cases are most fre- 
quent in children, and are usually accom- 
panied with severe affection of the mouth, 
and mortification of the cheeks, gums, &c. ; 
they generally occur in weak constitutions, 
and the best antidotes are wine, strong 
animal broths, bark, or quinine, with two- 
drop doses of muriatic acid every six or 
eight hours. Such cases must be put under 
medical superintendence. 

Slow poisoning by mercury is apt to occur 
in those who are much in contact with 
the metal in their daily occupations — 
such as looking-glass silverers, &c. They 
become liable to a peculiar shaking or mer- 
curial palsy, which compels them to aban- 
don their occupations ; the same symptoms 



occur in those employed in quicksilver 
mines. 

Mercurial, or blue ointment, is prepared 
in a somewhat similar way to blue pill or 
gray powder. — See Ointments. 

A sulphuret of mercury constitutes the 
well-known pigment, vermilion. 

Powders containing gray powder, calomel, 
&c. and indeed, heavy powders generally, 
should either be simply placed on the 
tongue, or given in some thick vehicle ; 
but a teaspoonful of milk answers very 
well for the administration of gray powder 
to children. Calomel in a thin liquid, such 
as tea, &c. sinks at once to the bottom, 
and probably is not swallowed. — Refer to 
Plummet's Pill. 

MESENTERY— Is a broad fold of the 
"peritoneum," or covering membrane of 
the bowels, by which the small intestines 
are connected with the posterior part of the 
abdomen and retained in their place. The 
mesentery contains the mesenteric lym- 
phatic glands, &c. — See Digestion. 

METASTASIS.— The shifting of diseased 
action from one part of the body to another, 
the portion deserted being left free from 
disease. This occurs in rheumatism, in 
gout, in mumps, &c. &.C. 

MEZEREON. — The root-bark of the 
Daphne mezereon, a shrubby plant found 
in shady woods, which flowers in February. 
It is rarely used as a purgative and diapho- 
retic. The berries are poisonous. 

MIASMA. [Miasm]— See Ague. 

MICROSCOPE.— This well-known instru- 
ment, which enables us to examine struc- 
tures far too minute to be even visible to 
our unassisted vision, has done, and is 
doing much every day, to render the prac- 
tical applications of medicines more exact. 
Many of the conditions of the urine are 
appreciable only by the aid of this invalu- 
able instrument. The nature of tumours, 
often a matter of serious import, when 
their removal by surgical operation is the 
question, is determined by it, in many cases, 
in a way that no other means of discrimina- 
tion could admit of. Many other instances 
might be cited ; in fact, a medical practi- 
tioner cannot now be considered to avail 
himself of every resource of his calling un- 
less he uses the microscope. In medico- 
legal investigation it proves of the highest 
service ; stains which, without the use of 
the microscope, could only be doubtfully 
distinguished, are by it so exactly discri- 
minated as to afford foundation for sworn 
evidence. As a rational and highly in- 
structive means of amusement, every family 
should possess a microscope. 



MID 



357 



MIL 



MIDRIFF.— The diaphragm.— See Dia- 
phragm. 

MILIARY. — An eruption, consisting of 
numerous very minute vesicles, which is 
apt to appear intermixed "with other erup- 
tive diseases, but particularly in cases 
where persons have been perspiring very 
much, or kept too hot in illness. Miliary 
eruption on the skin used to be very com- 
mon in women after childbirth, in times 
when it was the custom to keep them much 
too hot, and to stimulate. — See Skin. 

MILK — The nutrient fluid secreted by 
mammiferous animals for the sustenance 
of their young, through the agency of the 
peculiar " mammary" glands provided for 
the purpose, is the only material through- 
out the range of organization prepared by 
nature expressly and solely for food. More- 
over it contains within itself all that is 
requisite in food to maintain in health and 
to build up the frame of a living animal. 
The milk of animals generally is charac- 
terized by certain general properties and 
constituents, although it varies much in 
the proportions of the latter it contains. In 
this article, attention must be confined to 
the peculiar nature of the milk of the hu- 
man female, and to that of the cow: "ass's 
milk" has been already noticed. When 
milk is examined under the microscope it 
is found to consist of numberless minute 
spherical globules, which are suspended or 
float in a serous fluid. From these glo- 
bules, which are of various sizes, milk de- 
rives its opaque whiteness ; consequently, 
when it is diluted with water, and the fluid 
increased in proportion to the globules, the 
rich whiteness of pure new milk is de- 
stroyed, and the liquid assumes a more or 
less bluish or semi-transparent appear- 
ance. These globules consist principally 
of the oleaginous, fatty, or creamy portion 
of the milk, but they also contain curd or 
caseine. This constituent, however, chiefly 
exists in a state of solution, in the serous 
or fluid portion of the liquid, along with 
the sugar and salts, chiefly phosphates of 
lime and magnesia, with potash, and a 
small proportion of iron. 

Thus, we have milk consisting of — 

Cream, its oily or fatty constituent, in 
the form of globules, which are suspended in 

Water, which holds in solution, 

Curd or caseine, in combination with salts, 

Phosphate of lime, and of magnesia, with 
potash and iron, and also, 

Sugar of milk. 

The latter ingredient is not present in the 
milk of carnivorous animals as long as they 
are fed on flesh solely, but appears if they 



are made to eat a portion of vegetable food. 
In the milk of the cow, the proportions of 
curd, of cream, and of sugar, that is, of the 
caseous, oleaginous, and saccharine ingre- 
dients are about equal. In human milk, 
the saccharine and oleaginous constituents 
are proportionally greater than the curd. 
This milk is less opaque and thinner in ap- 
pearance than cow's milk, and is most 
nearly approached in composition by that 
of the mare and ass. 

Fresh milk is alkaline, has an average 
specific gravity of 1-030, and when good, is 
at first perfectly homogeneous. After stand- 
ing, the light oily particles separate and 
float in greater or less proportion at the top 
of the fluid, in the well-known form of 
cream. If the milk be kept some time, 
(more quickly in a warm situation,) lactic 
acid is formed by a process of fermentation, 
and the curd separates, souring or curdling 
taking place. Various modes and instru- 
ments have been employed for testing the 
quality of milk as to richness, &c. The 
addition of a small quantity of carbonate 
of soda to milk retards its souring and 
curdling, if it be requisite to keep it longer 
than usual. 

The very general fraud practised [especi- 
ally in the large towns] of diluting milk sold 
to the public with water, has recently called 
forth a very useful and low-priced little in- 
strument, (fig. c.,) called the "Milk Tester," 

Fig. c. 




the invention of a Mr. George, by which the 
purchasers can at once detect, not only 



MIL 



358 



MIL 



whether water has been added to milk, but 
in what quantity the addition has been 
made. The printed directions issued with 
the instrument are as follows : — 

" Place the instrument in water, and drop 
on the rings until it floats at the line of the 
W, (water, )* then place it in the milk to be 
tested, and its quality will be at once shown. 
For instance, should the instrument float at 
3, the mixture would be composed of three 
parts milk, and one water ; at 2, half and 
naif; at the 1, one part milk, and three 
water. Should the instrument float at 
any point between the divisions, it must 
be allowed for accordingly; for instance, 
should it float between the M and the 3, 
the milk would be three and a half, to a 
half water ; between the 3 and 2, two and 
a half milk to one and a half water, and so 
on." 

The addition of a graduated glass which 
would show the amount of cream contained 
in the milk tested would much increase the 
value of the instrument. 

The instruments are sold wholesale at No. 
2 Adelphi Arcade, Strand, London, [but 
may be found at most of the opticians or 
philosophical instrument makers in the 
United States.] 

The milk which is first secreted (formed) 
after the birth of the young, varies from 
any that succeeds it, particularly in pos- 
sessing a purgative property, which acts 
beneficially upon the bowels of the off- 
spring. In the cow, this first, or "green" 
milk, or " colostrum," is very nutritive, and 
contains much curd of a peculiar nature, 
which is coagulable by heat, like the albu- 
men of egg. On this account, it is used in 
the country parts of England, under the 
name of "beastings," for making a kind of 
custard pudding. The first milk, or colos- 
trum, of the human female, is thin and 
serous looking. This first milk or colos- 
trum, in animals generally, if examined 
under the microscope, exhibits an intermix- 
ture of larger and different globules from 
those of ordinary milk. 

It is, perhaps, needless to remark, that 
the nutritive properties and wholesomeness 
of the fluid depend, upon the health of the 



* In weighting the instrument with rings, in the 
first instance, it may be observed that it is not at all 
necessary that it should float exactly at the line of the 
W, for let it be either a little over or under it, if an 
equivalent allowance be made for it, in its immersion 
in milk, the result must be -correct. The instrument 
should be splashed into the water, or moved briskly 
about in it, to detach any air-bubbles that may have 
adhered thereto, the ivory wetted, and the tester al- 
lowed to take its position of equilibrium before the 
floating point be remarked. 



being or animal by which milk is afforded. 
In the case of mothers, therefore, who are 
decidedly unhealthy, or the subjects of any 
disease, scrofulous or otherwise, it is better 
for their offspring that they should not be 
nursed by them. And even in the case of 
the healthy mother, this secretion is so 
liable to be affected and deteriorated by ir- 
regularities in diet, by emotions of the 
mind, and by medicine taken, that the 
greatest care, as all mothers well know, is 
requisite to prevent such causes and effects 
being accidentally originated. — See Children 
— Nurse, §c. 

Cow's milk is so largely used as an article 
of diet (see Food) that its purity and good- 
ness, especially in large towns, become a 
matter of much importance. The following 
remarks on the subject, from the Lancet 
Sanitary Commission, are valuable. The 
specimens of milk examined were procured 
from milk-sellers in various parts of London. 

" From an examination of the table drawn 
up, it appears that, out of twenty-six sam- 
ples of milk submitted to analysis, 

"1st. That twelve were genuine. 

"2d. That of these, two showed a de- 
ficiency of cream. 

" 3d. That eleven were adulterated. 

" 4th. That this adulteration consisted in 
all cases of water, the percentage of which 
varied from ten to fifty per cent, or one- 
half of the article. 

" 5th. That in no case was chalk, size, 
gum, sheep's brains, or any of the other 
substances occasionally used for the adulte- 
ration of milk, detected." 

These results are more favourable than 
might have been anticipated, from the belief 
generally entertained respecting the gross 
adulterations to which milk, as alleged, has 
been so constantly subject. 

In addition to the modifications which milk 
undergoes in the hands of the dealer, there 
are those due to the condition of the animal. 
The pasturage, the supply of water, and the 
temperature, all influence the state of the 
milk as regards quality and nutritive power. 
Its wholesomeness depends upon the period 
after calving — milk not being in good condi- 
tion for three weeks or a month after this 
occurrence — upon the health of the cow, 
upon its food, and upon the condition of the 
place in which it is kept. It is notorious, 
that in many large towns, and in London espe- 
cially, [and in New York,] the mode in which 
extensive dairies of cows are, or have been 
lodged and fed, is disgusting — most un- 
wholesome for the animals, and, therefore, 
for those who use their milk — very many of 
the cows being diseased, consumptive, and 



MIN 



359 



MON 



stimulated to the last with fermenting brew- 
ers' grains. 

As an article of diet, milk is for the gene- 
rality of persons most wholesome, for chil- 
dren especially, of whose food it ought to 
form in some mode or other a large propor- 
tion : less heating than animal food, it is 
equally nutritious. — See Children. 

Some persons, both children and adults, 
find new milk too rich, but can take it after 
the oily cream has been removed by skim- 
ming, or if it is diluted with water, or boiled. 
The addition of from one-third to one-half 
lime-water, will often cause milk to sit more 
lightly on the stomach. 

When milk is taken largely without other 
food, there is risk of the formation of a mass 
of solid indigestible curd in the stomach, 
which may cause much uneasiness, and at 
times, in children, even alarming symptoms. 
Its expulsion by vomiting is the usual means 
of relief. Some persons cannot take milk 
without suffering from stomach disorder 
and headache ; and others, who suffer from 
chronic chest affections, find its use aggra- 
vate the symptoms. It need scarcely be 
added, that except in these peculiar cases, 
milk, and milk preparations, form one of 
the most valuable resources in the dietetic 
treatment of the sick. Many invalids de- 
rive much benefit from the use of milk 
warm from the cow in the early morning. 
In some cases, a small quantity of black 
pepper, or a teaspoonful of rum or brandy, 
is added to the teacupful of milk with ad- 
vantage. 

The whey, which is the serous portion of 
the milk, freed from the curd and a portion 
of the cream, is light, nutritious, and ape- 
rient, and is perhaps too much neglected as 
a beverage ; the same remark applies to 
buttermilk, which is freed from the cream, 
but retains the curd. 

Those who desire more information on 
the subject of the above article, will find 
much in the Reports in the Lancet for Sep- 
tember 13th, 1851, and for the two following 
weeks. 

Refer to Breast — Cheese — Children — Cream 
—Food, $c. 

MIND — The immaterial part of our ex- 
istence — exerts so marked, so powerful an 
influence over the conditions of our bodily 
health, that it makes the tone of the mind 
a weighty consideration in forming an opi- 
nion respecting the ultimate issue of many 
cases of disease. Under such articles as 
Faith, Homesickness, Hope, Fear, &c. the 
subject has been entered into as far as con- 
sistent with our limits. 

MINERAL ACIDS— See Acid. 



MINERAL WATER.— See Water. 

MINIM. — See Measure. 

MINT. — The mints constitute an exten- 
sive tribe of plants, well known for their 
powerful essential oils. Three species of 
mint are used in medicine — peppermint, 
pennyroyal, and green or spear-mint. Of 
these, the first is at once the most energetic 
and the most extensively used as a stimu- 
lant and carminative, either in the form 
of its essential oil, of its distilled water, of 
its spirit, or most generally of all as a 
lozenge. Peppermint-water is taken in 
doses of one or two fluid ounces ; oil of 
peppermint, of from two to five drops on 
sugar ; of the spirit, a teaspoonful may 
be taken at once. A very powerful medi- 
cinal peppermint lozenge is made, which 
is extremely useful where the medicine is 
required. 

Refer to Carminatives. 

MISCARRIAGE.— See Abortion. 

MIXTURES — Are medicinalcompounds in 
the fluid form. They may be simply com- 
posed of various liquids mingled together ; 
they may be solutions, or they may contain 
insoluble powders, as in the case of chalk 
mixture, iron mixture, &c. In the latter 
cases the addition of gum or of gum muci- 
lage, is useful to prevent the powder sub- 
siding as rapidly as it otherwise will do ; 
but as it will not prevent this altogether, 
care should always be taken to shake up 
the sediment in any liquid medicine. In 
mixtures which are likely to be kept for 
some time, especially in warm climates, all 
saccharine matters should be excluded, to 
avoid fermentation ; if this precaution is 
neglected, the bottles will certainly be 
burst. In forming mixtures with light pow- 
ders especially, such as magnesia, ipeca- 
cuanha, &c. and indeed with any powders, 
it must be done in a mortar, adding at first 
only a very small proportion of fluid. If 
much water is used at first, the mixture can 
never be completely and properly effected. 

Refer to Medicines. 

MOLES — Or, as they are often called, 
"false conceptions," have seldom, if ever, 
any connection with an impregnated con- 
dition of the womb, and arise from causes 
quite apart from this state. The popular 
idea that these formations are the result of 
conception requires correction, for it might 
lead to most erroneous and distressing as- 
persions on character. 

MOLES ON THE SKIN.— See Mothers'- 

MARK. 

MONKSHOOD.— See Aconite. 
MONOMANIA.— A species of insanity- 
disordered or erroneous persuasions of the 



MON 



360 



MOT 



mind on one subject. The disease may 
occur either as acute or chronic, and take 
any form — suicidal, homicidal, &c. and may 
lead to incendiarism or theft, to religious 
melancholy, or to the most absurd ideas and 
acts. 

Refer to Insanity. 

MONTHLY DISCHARGE. — See Men- 
struation. 

MORBUS COXARIUS.— See Hip-Joint 
Disease. 

MORPHIA.— See Opium. 

MORTARS and PESTLES— Are instru- 
ments used for triturating, bruising, re- 
ducing to powder, &c. the different medi- 
cinal substances. They are made of various 
materials — iron, brass, marble, glass, Wedge- 
wood ware, &c, the last being by far the 
most generally useful, and quite sufficient 
for all domestic purposes, at least in this 
country. In emigrant life, an iron mortar 
might be found useful. The Wedgewood 
mortar is generally made of the form of 
those seen in the apothecary shop. The 
pestle has its head made of the same mate- 
rial as the mortar, and is fitted to a wooden 
handle. The mortars with which medicine- 
chests are fitted are generally too small, and 
are only suitable for mixing powders, &c. ; 
there should therefore be added to the domes- 
tic laboratory a larger size — one capable of 
holding about a pint will be most convenient. 
The great advantage of the Wedgewood 
mortar is, that while much stronger than 
glass, it is not, like marble or metal, acted 
upon chemically by different agents. It may, 
however, be broken, if struck sharply with 
the pestle. The pestle is used in the mortar 
sometimes with a beating or hammering 
action; but more generally it is used to 
grind or triturate, while firmly grasped. 
For simply mingling powders, a lighter 
hold by the forefinger and thumb is quite 
sufficient. 

MORTIFICATION, or Gangrene, or 
Sloughing — Is the death of a portion of the 
living body occurring after violent or pecu- 
liar inflammation of the part — the appear- 
ance of the mortification varying according 
to the structure affected. A part in which 
inflammation is likely to terminate in mor- 
tification is hot, painful, tense, and hard; 
the colour of the skin, at first dark and 
angry -looking, becomes mottled, and the 
surface exhibits blisters filled with dark 
fluid ; at this time the previous heat giving 
way to a temperature lower than natural, 
and the pain diminishing ; at last the part 
shrinks, becomes of a dirty gray or ash- 
colour, and exhales a fetid odour. Coin- 
cident with these local symptoms, if the 



mortification be extensive, or situated in 
an important part, the constitution exhibits 
signs of collapse ; the face is pinched, cold, 
moist ; the pulse quick and feeble ; the 
tongue brown ; the mental faculties de- 
pressed or disordered; the natural func- 
tions are performed involuntarily ; and hic- 
cup is a very frequent accompaniment. 

Some parts are more prone to mortifica- 
tion than others ; but in all, impeded or 
deficient circulation of blood is the origin- 
ator. This may be caused by weakness of 
the body generally, by weakness of the cir- 
culation of a part, such as occurs in para- 
lysis, by impediment to the current of blood 
through the vessels large or small, by press- 
ure on a main branch, as by a tumour, or 
on one spot, as occurs on the back, in per- 
sons confined by exhausting disease, and by 
intense cold or heat, which destroys the tex- 
tures, or by the use of unwholesome grain, 
(see Ergot of Rye, &c.) It may also occur 
from intense inflammation in persons of full 
habit of body. In the event of an inflamed 
part showing symptoms of mortification, if 
a medical man has not been in attendance, 
he ought to be called without delay. In the 
mean time, warm poultices may be applied, 
those made of oatmeal and bran are often 
useful ; but the best applications, if pro- 
curable, are the chloride of soda or chloride 
of lime solution, diluted in the proportion of 
a quarter to half an ounce of the solution to 
half a pint of water, and used warm as a 
lotion ; at the same time, the strength must 
be supported with wine, strong meat-broths, 
&c. and rest procured by means of opium. 
— See Opium. When a mortified or slough- 
ing part of the body is separating, its loose 
and dead portions are usually cut away 
with scissors, to diminish the fetor ; poul- 
tices facilitate the separation, and after it 
has taken place, simple water-dressing will 
generally be found most suitable. — See 
Dressing. 

Refer to Inflammation, Sfc. 

MOTHERS'-MARK.— The term is applied 
to stains, moles, and other marks, vascular 
and otherwise, with which a child is born, 
and for which many fanciful causes are 
assigned. The most important mother's- 
marks are the vascular nsevi. — See Chil- 
dren, page 110. 

MOTHER. — See Child-bed — Children — 
Hereditary — Nurse, &c. 

MOTION, and MOTOR CHANGE.— 
Movement in the living body is the result 
of contraction of the muscles, or at least 
of the muscular fibres, either voluntarily or 
involuntarily; this contraction, whenever 
excited, giving rise to expenditure of the 



MOU 



361 



MUS 



substance of the acting fibres, or in other 
words, to metamorphosis of some of the ele- 
mentary constituents of the fibres, chiefly by 
combination with the oxygen of the arte- 
rial blood. This metamorphosis, which there 
is reason to believe is an essential of the 
process, is what is meant by motor change. 
— See Animal Heat — Blood — Food, Sfc. 

MOUTH. — The cavity which contains the 
tongue and teeth, in which is performed 
the important process of mastication, and 
by means of which articulate sound is 
formed, is enclosed by the lips and cheeks, 
by the upper and lower jaws, by the soft 
palate and tonsils, by the "fauces" gene- 
rally, and by the mucous membrane, 
stretching from the tongue to the lower 
jaw. It is further surrounded by the sali- 
vary glands, which supply its moisture, and 
which open by the ducts into various parts 
of its cavity. The portions of the mouth 
are liable to different diseases. These, along 
with other necessary information, are de- 
tailed in the individual articles. 

Refer to Aphtha — Palate — Saliva — Throat, 
$c. 

MOXA. — A means of counter-irritation, 
derived from, and long practised in the 
East. The true moxa is a soft woolly sub- 
stance, procured from the leaves of a species 
of mugwort, which is made into a cylinder, 
and burnt down upon the skin, causing a 
deep eschar. 

MUCILAGE.— A thick semi-fluid, formed 
by the solution of gummy or starchy mat- 
ters in water — such as mucilage of gum aca- 
cia, arrow-root mucilage, &c. — See Gum, §c. 

MUCOUS MEMBRANE— Is a membrane 
which lines certain portions of the body, 
and which is itself covered on the surface 
with an "epithelium" of flattened cells, and 
from which is secreted the thick viscid se- 
cretion named mucus. — See Mucus. There 
are two great systems of mucous membrane : 
the one which lines the mouth, nose, eyes, 
throat, bronchi or air-tubes, and is also con- 
tinued down the gullet, and through the 
stomach and bowels to the vent ; the other, 
the genito -urinary membrane, which lines 
the kidneys, bladder, &c. 

The affections to which mucous mem- 
branes are subject, are sufficiently entered 
into under such articles as "Catarrh," 
"Diarrhoea," &c, when the diseases of the 
parts they line are treated of. 

MUCUS — Is the thick, somewhat viscid, 
glairy secretion, formed on the surface of 
mucous membranes. Examined under the 
microscope it is seen to contain numerous 
round granular particles or globules, simi- 
lar to those which are contained in pus or 
2F 



matter. When a mucous membrane is in- 
flamed, its secreted mucus becomes thin 
and acrid, as all know it does in a cold in 
the head, which is simply inflammation of 
the mucous membrane lining the nostrils : 
when the inflammation is more intense, or 
of a peculiar character, the mucus secretion 
is apt to be converted into a purulent one. 

Refer to Pus. 

MUMPS. — A contagious epidemic disease, 
which consists of inflammation of the sali- 
vary "parotid" glands, situated on either 
side of the lower jaw. It commences with 
more or less fever ; shortly, swelling at the 
angle of the jaw appears, and spreads gra- 
dually to the face and neck in the vicinity 
of the gland, causing much difficulty and 
pain when the jaws are attempted to be 
opened : on the fourth or fifth day, the 
swelling begins to subside. Little treat- 
ment is required, beyond confinement to 
the house, and the administration of some 
simple purgative. The patient is compelled 
to live on slop diet, from the impossibility of 
mastication ; but if the person be delicate, 
good broth may be allowed. Hot fomenta- 
tion and bran poultice to the swelling will 
give some relief, and if the pain and swell- 
ing are very severe, a couple or three leeches 
may be applied to each side. Mumps is a 
disease quite devoid of danger, unless, as 
has occasionally happened, though rarely, 
the inflammation becomes suddenly trans- 
ferred to the brain or testicle. 

MURIATIC ACID, or Hydro-chloric 
Acid, or " Spirit of Salt." — See Chlorine. 

MUSCLES and MUSCULAR FIBRES. 
— The muscles, properly so called, are the 
fleshy portions of the animal frame, by 
means of which the various movements of 
the body are effected ; in fact, all flesh is 
muscle devoted to this purpose. The mus- 
cles are composed of bundles of fibres bound 
together by cellular tissue, and these fibres 
can be divided and subdivided under the 
microscope, until the "ultimate fibre" of 
muscle is .arrived at; this ultimate fibre 
containing within it other "minute cylin- 
drical particles." These fibrillse are marked 
with transverse lines, and constitute the 
striated muscular fibre in contradistinction 
to the non-striated fibre, which composes 
the muscular coat of parts such as the 
alimentary canal, which are not under the 
control of the will. The muscles are at- 
tached to bones, &c. for the purposes of 
movement by means of tendons. They are 
largely supplied with' nerves, (see Nerves,) 
and also with arterial blood, on the free cir- 
culation of which, indeed, the motor change 
of their elementary constituents, and, con* 



MUS 



362 



MUS 



sequently, their power of action, depends. 
When an animal has been goaded or hunted 
into a state of nervous and feverish excite- 
ment, and killed, the muscular fibres are 
left in such a condition as to be unwhole- 
some for food, and quickly become decom- 
posed and putrefied. Had the powers that 
be, been more cognizant of this fact, and of 
the influence it might exert upon their own 
health, Smithfield would not have stood so 
long. 

Refer to Beef — Flesh — Food — Motor Change 
— Tendons, §c. 

MUSHROOMS. — The fungus tribe, to 
which mushrooms belong, contains a large 
proportion of poisonous members, and even 
those which are usually considered edible 
are not always above suspicion in this 
country. In France, Russia, &c. many 
species of fungus are used, commonly and 
largely, as food, and are very nourishing, 
as they approach in some degree animal 
matter in constitution^ Those who gather 
mushrooms for food should be very certain 
that they know what are mushrooms, and 
this will be best learned from those who are 
practically acquainted with the matter ; it 
may be added, that even real mushrooms 
which grow under trees are generally con- 
sidered unwholesome, and also those in 
which the process of decay has commenced. 
Dr. Christison says, " The poisonous fungus 
has an astringent styptic taste, and, per- 
haps, also a disagreeable one, but certainly 
a pungent odour." After poisonous fungi 
have been eaten, there is generally giddi- 
ness, dimness of sight, and debility, if the 
symptoms appear quickly ; but if they are 
delayed they are more generally those of 
irritation, vomiting, purging, and pain. In 
a case of poisoning by fungi, treatment simi- 
lar to that recommended for "belladonna" 
will be the best in the absence or during 
the delay in the arrival of a medical man. 
— See Belladonna. 

MUSSEL.— See Fish, &c. 

MUSTARD.— Black and white' mustards 
are plants which grow wild throughout 
Europe, but are cultivated for use ; they 
are often confounded with the common 
charlock. Black mustard has smooth seed- 
vessels which grow close up to the stem, and 
contain reddish-black seeds. White mus- 
tard has tough seed-vessels, which spread 
away from the stem and contain yellow 
seeds. The seeds of the black mustard are 
more pungent than those of the white, but 
the two are very commonly mixed in the 
manufacture of the common '^ flour of mus- 
tard;" this is formed by crushing and 
pounding the seeds, and sifting. The sharp, 



burning acridity of black mustard depends 
upon a volatile oil, which, however, does 
not pre-exist in the seeds, but is formed 
on the addition of water. There is, per- 
haps, no article in domestic use more largely 
adulterated than mustard. The following 
result of the investigation of the Lancet 
Sanitary Commission sufficiently illustrate 
the extent and nature of the fraud ; these 
show — ■ 

"1st. That genuine mustard, whatever 
be the price paid for it, is scarcely ever to 
be obtained. 

"2d. That the whole of the forty-two 
samples — bought in London — submitted to 
examination, were adulterated. 

"3d. That the adulteration practised in 
every Ease was the same in kind, varying 
only in degree, and consisted in the ad- 
mixture of genuine mustard with immense 
quantities of wheaten flour, highly coloured 
with turmeric." 

Mustard, when used in moderation as a 
stimulating condiment, is wholesome. Its 
principal use in medical practice is in the 
well-known mustard-plaster, or cataplasm, 
as a counter-irritant. This application is 
made in various ways : when speedy ener- 
getic action is required, it is best obtained 
by mixing good fresh mustard with water, 
as for the table, and spreading on calico or 
paper. It is well to interpose a piece of 
thin gauze or muslin between the mustard 
and the skin ; this does not in any way in- 
terfere with the action of the application, 
and prevents portions of the mustard ad- 
hering to the skin, and irritating it, after 
the removal of the cataplasm. Some per- 
sons erroneously mix the mustard with vinegar, 
thinking to render its action stronger : this 
is a mistake, as it has the reverse effect. 
Others mix with one-third or one-half flour, 
or bread crumb, which modifies the power 
of the remedy, and is all very well when 
modified and longer-continued action is de- 
sirable, not unless. The usual length of 
time a mustard-plaster can be borne is from 
twenty minutes to half an hour, and even 
in this time it often produces blistering. 
It always leaves for some time a deep red 
mark on the skin, a fact not to be forgotten 
in the case of females. When mustard- 
plasters are applied to any one in a state of 
insensibility, they should be removed within 
the half-hour; if allowed to remain, should 
the person recover, troublesome ulceration 
may be the result. 

From their familiarity and accessibility, 
mustard-plasters are apt to be applied some- 
what too indiscriminately, both domestically 
and professionally, and in many cases where 



M UT 



163 



NAU 



a hot bran poultice would be much more 
soothing and beneficial. They often cause 
much irritability, and if applied near the 
I where inflammation is going on, as 
in the case of the throat, seem rather to 
aggravate than to relieve. In the case of 
a lady under the author's care, the appli- 
cation of a mustard-plaster to the lower 
part of the spine gave rise to effects re- 
sembling those produced by the inhalation 
of laughing gas. 

As an internal remedy, mustard is a safe 
and effectual emetic, in doses of one, two, 
or three teaspoonfuls in six or eight ounces 
of water. The seed of the white mustard, 
swallowed whole in tablespoonful doses, 
was, some years ago, in much vogue as a 
stomachic remedy, but is now little used. 
It probably produced any benefit it effected 
by its mechanical action upon the aliment- 
ary canal. 

Refer to Counter-irritation. 

MUTTON — When tender, is the meat best 
adapted for invalids and persons of weak 
digestive powers. The best mutton chops 
are those cut out of the centre of a leg. 

Refer to Broiling — Cookery — Food, S,'C. 

MYRRH — Is a gum resin, the product of 
a tree native to Arabia, Abyssinia, and the 
countries bordering on the shores of the Red 
Sea. from which the drug is chiefly brought. 
Myrrh is a stimulant expectorant, and enters 
into different medicinal compounds. 

The tincture of myrrh forms one of the 
most agreeable washes in affections of the 
mouth, in the proportion of half an ounce 
of tincture to half a pint of water • and a 
few drops upon the tooth-brush is a most 
excellent habitual application in cleansing 
the teeth, especially if the gums are weak 
or spongy. 

N^EYUS. — See Mothees'-mark. 

NAILS. — The nails, like hair, may be re- 
garded as prolongations from the epidermis, 
or outer skin. They are formed of flattened 
cells containing horny matter, and spring 
from a fold or matrix in the true skin, about 
two lines in depth. At the bottom of this 
groove or fold there are numbers of pa- 
pillae, or little vascular points, from which 
the nail is developed, and is continually 
being pushed forward by the addition of 
new matter to its root. At first the nail is 
thin, but it acquires thickness in its pro- 
gress forward, by the addition of new layers 
of cells to its under-surface, these cells 
being also formed by papillce, which like- 
wise serve to retain the nail in its place. 

Nails are apt to be cast off after injury, 
but the principal and most troublesome 



' affection to which they are liable, and 
particularly the nail of the great toe, is 
■■' ingrowing" — that is, ulceration, formed 
by the edge of the nail, and constantly kept 
up by the irritation which produced it in 
the first instance. There are many pallia- 
tive methods of treating this affection, such 
as the use of caustics, scraping the nail 
away, &c. ; but perhaps there is no certain 
mode of treatment, but the thorough removal 
: of the entire half of the nail up to the root, 
on the offending side. This, of course, 
requires to be done by a surgeon. The 
appearance of the nails is often indicative 
of constitutional tendency, particularly the 
long curved nail of the consumptive. 

Refer to Skin. 

NAPHTHA.— The term is now applied to 
the transparent colourless fluid obtained by 
distillation from petroleum, a bituminous 
[ substance, formed probably by the action 
of heat upon beds of coal. Naphtha has 
been recently lauded as a remedy in con- 
sumption, but it is not much in use. 

NARCOTICS — Are medicinal agents 
which diminish the activity of the nervous 
system, produce sleep, and in most instances 
relieve pain, but which also are capable, if 
given in small repeated doses, of exciting 
the nervous system ; by this they are distin- 
guished from the class of medicines named 
sedatives. The class of narcotics also in- 
cludes anodynes. The only narcotics in any 
way admissible in the domestic materia 
medica are — 

Camphor, 

Hemlock, 

Henbane, 

Hop, 

Lettuce, 

Opium, 

Strammonium. 

Refer to separate articles. 

NAUSEA — Or the sensation of sickness, 
or of inclination to vomit, is best known 
from individual experience of the sensation. 

Although the feeling of nausea itself is 
referred to the stomach, and may be due to 
causes connected with that organ simply, it 
also very frequently originates in disorder 
in other and distant parts of the body, a 
fact which often constitutes it a valuable 
symptom. Causes which act directly upon 
the brain are among the most frequent 
originators of nausea, and there is every 
reason to believe that the sensation from 
which the term is probably derived — sea- 
sickness — is primarily excited in the brain 
itself. As all know, a blow on the head 
occasions nausea and vomiting ; severe 
injuries in other parts of the body, such as 



N AV 



364 



NEC 



a dislocation, also occasion sickness by- 
acting indirectly upon the stomach ; the 
nausea of pregnancy is another example of 
this sympathetic nausea. Disgusting odours 
are instances of the same thing. The action 
of drugs of an emetic character must be 
accounted for by their influence on the 
nervous system, for they act equally "well 
as nauseants, if injected in solution into the 
veins, as if they were swallowed. Lastly, 
the presence of indigestible food, or of bile, 
&c. in the stomach itself, will also cause 
nausea, which may also be produced by 
simple over-distension of the organ by gas 
or fluid. The instances given Qf sympa- 
thetic nausea will explain how it comes to 
be a valuable guiding symptom in the in- 
vestigation of disease. Incipient or ad- 
vanced affections of the brain ; gall-stones ; 
stone in the kidney ; disease of the womb ; 
pregnancy, and many other conditions of 
various organs, giving rise to the sensation 
of nausea, or to actual vomiting. 

The complete relaxation of the nervous 
system which occurs in an individual under 
the influence of nausea, renders its existence 
favourable to the performance of certain 
operations upon the body, such as a reduc- 
tion of a dislocation, or of a rupture. It is, 
therefore, the practice of surgeons to induce 
it artificially — as by the administration of 
tartar emetic — for the above ends. The 
means of relief in nausea, and its very fre- 
quent accompaniment, vomiting, must, of 
course, depend upon the cause. When 
dependent upon brain affection, remedial 
measures are of but little service, but in 
this, as in other cases, may be resorted to. 
Effervescing draughts, with lemon-juice, 
will often be extremely useful. Creasote is 
effectual, especially in sea-sickness. — See 
Creasote. A teaspoonful of magnesia in 
a glass of sherry has been found a good 
remedy, but one which is inadmissible in 
head affections ; a mustard-plaster to the 
pit of the stomach may be used with advan- 
tage. When the nausea is thought to be de- 
pendent upon the presence of bile or other 
matters in the stomach, it is soonest relieved 
by exciting vomiting, which is generally 
easily effected, either by means of lukewarm 
water alone, infusion of chamomile, or at all 
events by a small dose of ipecacuanha. 
After the stomach has been cleared, effer- 
vescing draughts will be at once grateful 
and beneficial. 

Refer to Effervescing, fyc. 

NAVEL. — See Child-bed, Children, &c. 

NECK — The bond of connection between 
the head and the trunk of the body, is per- 
haps the most important region of the 



frame ; certainly it is so in a surgical point 
of view, on account of the numerous import- 
ant parts it comprises. The figure, (ci.,) 

Fig. ci. 




which represents a transverse section of the 
neck, will best show the position of the 
chief vessels, &c. 1, 1 is one of the ver- 
tebrae of the neck, in front of which, some- 
what flattened, as at rest, lies the oesopha- 
gus, or gullet, (2 ;) and anterior to this, the 
windpipe (3 ;) on either side are placed the 
great vessels of the neck ; these are the 
great, or "carotid arteries," (4, 4,) and 
close to them — indeed, included within the 
same covering or sheath — the internal jugu- 
lar veins, (5, 5.) All these parts, besides 
nerves, glands, the external jugular veins, 
and the muscles of the neck, are included 
within the surrounding skin, (6, 6.) The 
"thyroid gland," (7,) which becomes en- 
larged in swelled neck, or bronchocele, (see 
Bronchocele,) lies in front of the windpipe. 

Diseases which affect the parts situated 
about the neck, such as its glands, &c. fall 
to be considered under other heads, and 
need not be enlarged upon here ; and under 
such articles as Hanging, Gullet, which 
also includes Choking, Artery, &c. will be 
found information concerning the accidents 
to which this region and its parts are liable. 
There remains, however, for consideration, 
the effect of mechanical impediments to the 
circulation of the blood in the neck, con- 
nected either with clothing, or with those 
muscular movements of which the part 
under consideration possesses so wide a 
range. Some persons, particularly those 
with short necks, or with tendency to apo- 
plexy, epilepsy, &c. are much more liable 
to be affected than others, by any thing 
which, even for a very short time, checks 
the free flow of blood through the veins, 



NEC 



365 



NEK, 



downward, from the head ; find such per- 
sons ought to be especially careful that 
nothing they wear about the neck becomes in 
the slightest degree tight, not simply when 
the face is looking straight forward, but 
when it is turned from side to side. It has 
occurred, that a person liable to head attacks 
has fallen down insensible, in consequence 
of the simple fact of turning the head 
rather more to one side than usual, and thus 
giving a little extra tightness to a shirt- 
collar. It is well known, too. that the 
tight stock of the soldier has been the cause 
of numerous apoplectic and other affections, 
in consequence of its effect in compressing 
the large vessels of the neck. A similar 
caution is requisite with regard to children. 
Accidents have occurred in consequence of 
nurses and others tying too tightly (a very 
common practice) the strings of the night- 
cap, which, perhaps, become still more 
tightened by some movement during sleep. 
From a similar cause arises the danger 
which men incur from sleeping, without 
unfastening the usual clothing about the 
neck ; apoplexy may result. But not only 
may head affections result from tightness 
around the neck externally; it may, in those 
predisposed, be the effect of the action of 
the muscles alone ; these, if the head is 
turned strongly to one side, exert strong 
pressure upon the veins and impede the 
flow of blood, damming it up toward the 
head. On this account, persons who are 
liable to overfulness of blood, ought to be 
on their guard against such sudden move- 
ments. 

"Wry neck is caused by the undue perma- 
nent contraction of one or more of the 
muscles on one side of the neck. It is 
remediable by a surgical operation. A dif- 
ferent form of wry neck, or, at least, of an 
affection closely resembling it, is the result 
of paralysis of the muscles on one side, 
permitting those on the other to draw the 
head toward their own side. Stiff neck is 
the result of rheumatic affection of the 
muscles. 

NECROSIS.— Death of a portion of bone. 
— See Bone. 

NERVOUS SYSTEM and NERVES.— 
The possession of a system of nerve tissue 
is one chief distinction between the animal 
and the plant ; the latter exhibits no trace 
of it, and even in some of the lowest tiibes 
of the former, which are scarcely distin- 
guishable from vegetables, it has hitherto 
been undetected. Where a nervous system 
does exist, it is always found to be com- 
posed of two parts, one of which is white 
and opaque in appearance, and when exa- 
2f2 



mined under the microscope, presents a tu- 
bular or fibrous structure ; the other is of a 
reddish gray colour, and semi-transparent, 
and consists of cells or vesicles filled with 
granular matter. The presence of these 
two forms of nervous substance seems es- 
sential to the working, so to speak, of the 
apparatus. In the larger nervous masses, 
such as the brain, the distinction is very 
palpable, as any one may verify who will 
take the trouble to examine the brain of a 
sheep. The opaque white nerve matter 
forms the larger proportion of the brain, 
spinal marrow, and nerves ; the gray is 
more sparingly distributed, and is evidently 
the apparatus in which the nerve force is ge- 
nerated, the tubular substance acting the 
part of the conductor. This is more apparent 
when the latter is thrown into the form of 
the nerves, or # cords of nervous matter, 
which are distributed throughout the body. 
These nerves, at their origin, are connected 
with the gray substance, with the vesicles 
of which their fibres are intermingled. 
"Where this intermingling takes place, an 
enlargement, or, as it is named, a "gan- 
glion" is formed. In the lower tribes of 
animals, in which the nervous system is 
simple in a degree corresponding with the 
simplicity of their structure, these " gan- 
glia," resembling knots upon the nerves, 
are all they possess in lieu of a brain. But 
as the scale is ascended toward man. we 
find the nervous system become much more 
highly developed, and the nerve substances 
collected or aggregated into masses, which 
are carefully protected from all external 
injury, and from which the nervous cords, 
or conductors, or, as they are usually called, 
"nerves," proceed to all parts of the body, 
each being enclosed within its own proper 
sheath, and dividing and subdividing, to be 
distributed to every portion of the frame, 
although to some, such as the ends of the 
fingers, lips, &c. their branches are more 
liberally allotted than to others. 

In man, the great nerve masses are di- 
vided into the brain, or cerebrum, (fig. cii. 1, 
1.) the little brain or cerebellum, (2, 2,) the 
medulla oblongata, (3,) the ganglia of the 
special senses, (4.) These parts are all con- 
| tained within, and protected by the hard, 
bony skull. Continued from the medulla 
i oblongata at 5, there is the spinal cord, or 
j marrow, which is contained within its own 
I special canal carried through the bodies of 
j the vertebrae of the spine, and thus most 
effectually guarded. The annexed figure 
I represents the base or under side of the 
• brain. The brain, (see Brain,) which ia. 
| man and the higher animals constitutes so 



NEK 



366 



NEE 



Pig. cii. 




large a mass of the nervous system, is it- 
self destitute of sensation ; for it may be, 
and after accidents often is, cut, without 
the individual — although perfectly conscious 
— having the slightest sense of pain. Nei- 
ther does its presence appear necessary to 
the continuance of the mere animal life of 
the body ; for if — as has been proved by ex- 
periment — the brain of such an animal as a 
rabbit, be gradually and carefully removed, 
the animal still continues to live, and to 
perform the various functions of animal 
life. 

The brain is undoubtedly the organ upon 
•which the manifestations of will, intelli- 
gence, memory, &c. depend, and by which 
the conscious mind of man or animal is 
linked with the processes and actions of the 
body, by means of other portions of the 
nervous system. 

The cerebellum, or little brain, is be- 
lieved to be endowed with the function of 
regulating in unison and harmonizing the 
various muscular movements. The me- 
dulla oblongata is connected with the pro- 
cesses of respiration, mastication, swallow- 
ing, &c, and on the due performance of 
which the preservation of life depends. 

The ganglia of the special senses develop 
the powers of sight, smell, taste, &c; and 
lastly, the spinal cord appears to be most 
essentially connected with animal life, par- 
ticularly with the powers of locomotion, in- 
dependent of the conscious mind of the in- 
dividual, possessing in itself powers of sen- 
sation unconnected with the brain. These 
powers are exhibited in what are called the 
''reflex" nervous actions; that is to say, 
supposing — as sometimes occurs from in- 
jury, or is done for purposes of experiment 
in animals — the spinal cord is severed at 



any point, all sensation, all power of the 
will over the parts of the body below the 
line of severance is totally lost; but yet 
irritation, such as the prick of a pin, to 
such a part as the foot, will cause the leg 
to be retracted — evidently showing that the 
sensation excited by the pin was felt, so to 
speak, by the spinal cord through one set 
of nerve fibres, and "reflected" from it 
again through another ; causing contraction 
of the muscles of the limb — independent 
either of the sense or will of the individual. 

From the various masses within the head, 
nine pairs of nerves proceed ; from the 
spinal cord or marrow, thirty-one pairs ; 
the former passing out at various holes in 
the skull, the latter between the vertebrae. 

In addition to the nervous system above 
described, there is the sympathetic, or gan- 
glionic system, situated chiefly on the inside 
of the spinal column, and characterized by 
the possession of distinct separate ganglia 
and nerves, which are connected with the 
great nervous system on the one hand, and 
with the viscera of the organic functions, 
such as that of digestion, &c. on the other. 

As the diseases and disorders of the nerv- 
ous system are treated of under other 
heads, such as Paralysis, Delirium, $c., they 
require no further mention here. 

Refer to Neuralgia. 

NERVOUS DISEASE, or Nervousness 
— Is a term usually applied to an indefinite 
affection — a mixture of mental and bodily 
disorder and irritability, generally the pro- 
duct of weakness. The active countryman, 
the hunter, and those who take much exer- 
cise in the open air, do not suffer from the ir- 
ritability, or nervousness, which attacks the 
sedentary — those who exhaust the brain by 
too great mental exertion, or the body by 
dissipation. Females are much more liable 
to nervous disorder than males, independent 
of hysterical affection, which constitutes 
one of the most marked phases of the ma- 
lady, and many of the remarks on which 
apply to the present subject. 

In nervous disorders there is usually 
great susceptibility to external influences, 
and at the same time mental emotions, whe- 
ther of joy or grief, fancied or real, exert 
much influence over the body and its func- 
tions. The heart palpitates, the hand trem- 
bles, the face flushes under the most trivial 
excitement. Much of this is undoubtedly 
due to constitutional timidity ; but it is 
also notably increased in debilitated states 
of the constitution, and those who have 
never been what is called "nervous," are 
apt to become so in some particular condi- 
tions of impaired health. The affection, 



NET 



367 



NEU 



is indeed, very nearly akin to hypochon- 
driasis ; it is essentially a disorder of weak- 
ness, and is relieved by -whatever increases 
temporarily or permanently the power of 
the nervous system. The temporary relief 
to nervous sensations which is afforded by 
alcoholic stimuli, is very apt to lead those 
who suffer from them to put too much trust 
in, and to resort too habitually to the use 
of those palliatives — a practice which must 
be followed by pernicious consequences ; 
sometimes, too, opiates are habitually made 
use of, and are no less injurious. 

Undoubtedly, when properly employed, 
alcoholic stimuli, and even opium, are valu- 
able in the treatment of nervous disease, 
but they must never be substituted for more 
permanent means of invigoration, particu- 
larly regular and sufficient exercise in the open 
air, on foot or horseback, good nourishing 
diet, with a sufficient amount of animal 
food, and attention to the bowels and the 
state of the skin. The producing cause, 
whether excessive mental exertion, seden- 
tary employment, late hours, or excess of 
any kind, must of course be modified as 
much as possible. The shower-bath is 
often recommended, and often useful in 
these affections, but some persons cannot 
bear the shock ; when this is the case, the 
cold or tepid douche down the back does 
much good, particularly if there be any 
tenderness of the spine on pressure, a fact 
which should always be investigated in those 
who suffer much frqm nervous disease : it 
very commonly exists and is overlooked. 
When the tenderness is at all marked, it 
will require special treatment by counter- 
irritation, &c. ; but this, as well as the treat- 
ment of aggravated cases of nervous disor- 
der, will be best managed under the care of 
a medical man. In addition to the regula- 
tion of the bowels by the warmer purga- 
tives, or by clyster, quinine and the prepa- 
rations of iron are the most generally use- 
ful remedies ; tincture of valerian, sal-vo- 
latile, and stimulant carminatives may be 
used as palliatives during an aggravated at- 
tack, but should be sparingly resorted to. 

Refer to Hysteria — Indigestion, £c. 

NETTLE.— The common nettle belongs 
to a tribe of plants which includes the fig, 
the hop, and others used as food, and is 
itself eaten when cooked, as a wholesome, 
almost as a medicinal article of diet, in some 
parts of the country. It is diuretic. The 
fresh juice of the nettle has been highly 
recommended in cases of internal hemor- 
rhage, particularly from the lungs and 
womb. The dose, one teaspoonful three 
times a day — Refer to Hemorrhage. 



NETTLE RASH.— See Skin. 

NEURALGIA — Literally, pain in a nerve 
— is also known as "rheumatism of the 
nerve," or "tic doloureux." It is perhaps 
one of the most painful affections to which 
the human body is liable. Inmost instances 
the pain is the only symptom ; in some it is 
accompanied with marked constitutional or 
local ailment. The exact nature of neu- 
ralgia is obscure ; probably the one effect, 
pain in the nerve, may arise from various 
causes; it is certain that some of the most 
intractable cases have been connected with 
diseased growth of bone in different parts 
of the head or face, especially about the 
canals through which the nerves pass ; 
other severe cases have been found to de- 
pend upon irritation excited by foreign 
bodies acting upon some of the nerve 
branches ; decayed teeth are not unfre- 
quently connected with the disease. The 
most general seat of neuralgic pain is in 
the head or face ; but the fingers, the chest, 
the abdomen, &c. may any of them consti- 
tute its site. When the great nerve of the 
leg is affected with neuralgia, the disorder 
is known as "sciatica." 

The pain of neuralgia is described as a 
"plunging," darting pain of the most in- 
tense and agonizing kind ; but, except in 
long-continued cases, there is no external 
mark — no redness, swelling, or heat, to in- 
dicate the disorder to others. After a se- 
vere attack of neuralgia the skin is often 
left tender, and when the pain has recurred 
frequently, exquisitely tender swelling of 
the part has been known to come on. The 
access of the pain is usually sudden, its 
remission equally so, and it is generally 
periodical in its attacks : it is suspended 
during sleep. The suddenness of the pain, 
its character — often compared to severe 
toothache — the absence of inflammatory 
symptoms, and its periodical returns, suffi- 
ciently mark the disease. 

The exciting causes of neuralgia are, 
especially, damp and cold, or damp alone, if 
combined with malaria, such as cause ague ; 
exposure to currents of cold air, especially 
if the individual is heated, frequently origi- 
nates the disease : in this way railway 
travelling has proved a fertile source of 
neuralgic affection. Debility of constitution 
renders the individual much more suscepti- 
ble to those and other exciting causes ; it 
has often, too, been traced to anxiety of 
mind. 

Some sudden attacks of neuralgic pain 
in various parts of the body have been 
traced to temporary stomach disorders, such 
as superabundant acid, and have disap« 



NEU 



368 



nig 



pcared as soon as the cause has been 
rectified. 

The severe pain which attends neuralgia, 
quickly drives the sufferer to seek medical 
advice ; and without doubt, the safest plan 
is to have the exciting cause of the affection 
detected if possible, and as soon as possible 
obviated, before the disease has become 
fixed. If the person is resident in a climate 
or situation likely to excite it, some change 
should, if possible, be made ; this will pro- 
bably be most beneficial if the removal be 
to a dry, warm air ; but should disease 
have commenced in a cold, dry district, 
change to a moist, humid, but warm one, 
will probably offer most advantage. If dis- 
order of the digestion exists, it must of 
course be rectified, (see Indigestion;) after 
that, if the disease still continues, quinine, 
given in one or two grain doses every six 
or eight hours, will most probably be of 
service. Carbonate of iron, in from half 
drachm to drachm doses, is a most useful 
remedy, especially in weak constitutions ; 
but these are constitutional curative mea- 
sures which will be most safely trusted to 
medical hands. Blisters behind the ears, 
or at the back of the neck, are often valu- 
able aids in the treatment of facial neural- 
gia. The late Sir Charles Bell is said to 
have found the following most successful in 
some cases of obstinate neuralgia, probably 
caused by disorder of the alimentary canal : 
— One to two drops of croton-oil is mixed 
with one drachm of compound colocynth 
pill, and of this one-twelfth, or five grains, 
is given at bedtime, along with ten grains 
of compound galbanum pill. The remedy 
is more suited to persons of strong habit of 
body than to the weakly. 

During the paroxysms of agonizing pain, 
any thing which will, or is likely to relieve 
should be tried, even in the absence of a 
medical man. A sponge or piece of flannel 
dipped in boiling water and applied as hot 
as it can be borne over the site of the pain, 
will often allay its severity, or remove it 
altogether. Opium internally may be given 
in very severe cases, or rubbed on the part. 
Chloroform applied to the affected part by 
means of a piece of lint soaked in it, is a 
very successful application, and should be 
tried if it can be procured. [Aconitia made 
into an ointment in the proportion of one 
grain to the drachm of lard, and then well 
rubbed in, will also be found to be very effec- 
tual.] Lastly, the author can say from his 
own experience, that the Pulvermacher elec- 
tric chain will, in some cases, confer speedy 
relief. Leeches are sometimes of use. 

Earache is a form of neuralgia distin- 



guished from inflammatory earache ending 
in abscess, by the neuralgic characters al- 
ready described. It is of course treated as 
neuralgia. 

Refer to Nerves — Sciatica, §c. 

NEUTRAL SALTS— Are compounds of 
an acid and an alkali, in which the two 
constituents completely neutralize one an- 
other ; the resulting compound having nei- 
ther acid nor alkaline properties. 

NIGHT. — The period of darkness conse- 
quent upon the absence of the sun's rays, 
is one which unquestionably exerts consi- 
derable influence over the states and health 
of the human body. The effect of light 
upon the body, and the injurious, conse- 
quences of its withdrawal, has already been 
treated of, and to that article the reader is 
referred for information ; also to articles, 
Early Rising, Breakfast, Sleep, §c. With 
the exception of certain animals, fitted by 
their constitution for nocturnal activity, the 
majority, including man, are evidently in- 
tended by Providence to rest and sleep 
during the hours of darkness ; animals 
governed by instinct do so ; uncivilized 
man for the most part does so ; but the 
member of a civilized community neces- 
sarily requires in some degree to modify 
these things, and is endowed with the capa- 
bility of doing this, within certain limits, 
without injury to health ; if these limits are 
exceeded, he suffers. 

It is often asked, "Is it not the same 
thing whether I sleep in the day or the 
night, so as I get enough ?" It is not the 
same thing. Independent of the argument 
that the natural laws of our constitution 
can never be infringed with impunity, and 
that man cannot, without injury to health, 
spend those hours in sloth and sleep, dur- 
ing which he ought to be active under the 
sanative influence of diffused daylight, ex- 
perience has long testified that during the 
night many sources of disease act more 
energetically upon those exposed to them. 
One often recorded experiment sufficiently 
illustrates the fact. The colonels of two 
French cavalry regiments had to move their 
respective corps a considerable distance 
during the hot weather. One, thinking to 
avoid the heat of the day, moved his regi- 
ment during the night only ; the other fol- 
lowed the reverse plan. The latter, at the 
end of a week or ten days, arrived with his 
men and horses well, while the other had 
many laid up with sickness. 

As, however, in northern countries in 
winter, the term of daylight is too consider- 
ably curtailed, and the hours of darkness 
too prolonged to permit of their all being 



Nia 



869 



NIT 



spent in sleep, it becomes a question which 
portion of the latter may be most advan- 
tageously devoted to wakefulness, under the 
influence of artificial light. Experience 
has proved, that to rise early and spend 
the morning hours by artificial light, is not 
by any means so salutary a custom as to 
add to the latter part of the day by the 
same means. This is probably, in part, 
due to the greater activity of the nervous 
system in the after part of the day, causing 
the absence of the stimulus of the sun's 
light to be less felt. 
.Refer to Sleep. 

NIGHT-BLINDNESS— Is a species of pe- 
riodical "amaurosis" to "which some persons 
are liable, probably in consequence of the 
retina having become exhausted by expo- 
sure to too great a light during the day. 
The affection prevails chiefly in southern 
climates. It requires proper medical treat- 
ment. The glare of the midday sun should 
be avoided. 

Refer to Amaurosis — Eye. 

NIGHTMARE.— See Sleep. 

NIGHTSHADE.— See Belladonna. 

NIPPLES.— The nipple of the female 
breast is chiefly composed of tubes which 
give passage to the milk. During preg- 
nancy, and at childbirth, it ought to be- 
come more prominent and increased in size; 
but sometimes, from the pernicious pressure 
of the stays in early life, it has become so 
imbedded in the breast that it cannot be 
developed ; consequently, when the time of 
suckling arrives, it is perfectly impossible 
for the infant to seize it. This is a state 



may be covered with collodion.] — See Cate- 
chu. Various substances, such as cow's 
teats, prepared nipple shields, &c. have 
been used to cover the nipple in such cases, 
but they do not answer well, and it requires 
a very strong child to draw the milk through 
them. If the nipples are harsh and dry on 
the surface, glycerine will probably be 
found of more service than catechu ; and if 
they do not heal up under these or similar 
applications, the child must be kept from 
sucking for a short period, the breasts being 
emptied by other means, and the milk thus 
drawn given to the child. 

The late Sir Astley Cooper's favourite 
lotion in sore nipples was composed of bo- 
rax one drachm, spirit of wine half an 
ounce, and water (soft) sufficient to make 
up the half-pint lotion. 

Refer to Breast — Childbed, $c. 

NITRATES— Are salts, such as nitrate of 
potassa, (saltpetre,) of which nitric acid is 
one of the components. — See Potassa. 

NITRIC ACID, or Aqua-Fortis— Is one 
of the most powerful of the mineral acids, 
and is strongly corrosive. It is obtained 
from saltpetre by distillation with oil of 
vitriol. Pure nitric acid is composed of 
nitrogen and oxygen gases, in the propor- 
tion of one of the former to five of the latter, 
and should be colourless. It is usually met 
with in the shops of a light straw colour, 
and contains water. 

Nitric acid is used externally by sur- 
geons as a caustic, or rather as a corrosive. 
Internally it is employed as a tonic, espe- 
cially in some forms of dyspepsia and liver 



of things which often gives much trouble, disorder ; the dose is from two to eight drops 



causes the individual much pain and suffer 
ing, and not unfrequently lays the founda- 
tion of abscess of the breast. When this 
condition of the nipple exists, every effort 
should be made during the time of pregnancy, 
to get it into a better and more prominent 
state, by means of the glasses adapted to 
the purpose, or by suction exerted by the 
mouth of an adult: after childbed, the same 
means should be assiduously practised. 
The greatest suffering, however, connected 
with the nipple during nursing, is in con- 
sequence of its becoming excoriated and 
chapped. This may be greatly prevented, 
if, during the latter months of pregnancy, 
trouble be taken to bathe the nipples night 
and morning with a mixture of brandy and 
water, one part of the former to three -or 
four of the latter. When the nipples are 
inclined to become sore from nursing, which 
is generally within the first fortnight, the 
best, and indeed almost a certain remedy, is 
the tincture of catechu, [or of galls, or they 



well diluted with water. Diluted nitric acid, 
composed of one part of the common com- 
mercial acid, and nine parts of water, is 
used as more convenient than the strong 
acid. Of this, the dose is from twenty to 
thirty drops. 

Poisoning by nitric acid, or aqua-fortis, 
sometimes occurs, and must be treated in a 
manner similar to that recommended in 
poisoning by muriatic acid, under the article 
" chlorine." 

NITROGEN GAS— Is one of the element- 
ary gases, important from its forming nearly 
four-fifths of our atmosphere, and from its 
numerous combinations. — See Ammonia — 
Azote — Nitric Acid, §c. 

The existence of nitrogen in animal mat- 
ters was formerly thought to constitute one 
great distinctive mark between them and 
vegetable substances, but this idea is now 
known to be erroneous. Certainly, the 
abundant presence of nitrogen in the con- 
stituents of the animal kingdom is truly 
24 



NIT 



370 



NOS 



characteristic, compared with its more 
sparing amount in vegetables ; but it is 
more than probable that animals, in the 
first instance, derive the greater part of their 
nitrogen from vegetables, "which constitute 
the medium for its conveyance to them from 
the inorganic kingdom. 

Kefer to Aliment — Blood — Food, #-c. 

NITRO-MURIATIC ACID, or A W-Re- 
GiA — As it has been called from its power 
of acting upon gold, is used in medicine 
as a tonic, and it is a very valuable one. 
It may be prepared sufficiently well by 
mingling equal measures of nitric and 
muriatic acids in their undiluted condition, 
and allowing them to stand for a few 
minutes before water is added. The dose 
is from four to eight drops, well diluted in 
water. 

NITROUS, or Nitric Ether, or Sweet 
Spirit of Nitre — Is prepared by the action 
of nitric acid upon alcohol. It is one of 
our most valuable diuretics, being also sti- 
mulant and diaphoretic, and is much used 
domestically as a remedy in common colds, 
&c, and to increase the flow of urine. The 
dose is from half a drachm to a drachm and 
a half, given either in water or gruel. 
When badly made, or too long kept, sweet 
nitre is apt to contain much acid, which may 
cause pain at the stomach. The fact may 
be known by the ether effervescing with 
carbonate of soda. 

NOCTURNAL DISCHARGES— [Seminal 
Weakness] — Of seminal fluid are apt to 
cause much uneasiness and physical debility 
in those, generally young men, who are the 
most frequent subjects of them. Unless 
very excessive, there is no reason that they 
should be regarded in the almost morbid 
way they often are. Abundant exercise, 
cold bathing, either general or local, and 
where there is not much debility, the disuse 
of alcoholic stimuli, the avoidance of what- 
ever may tend to excite the secretion in 
question, and the use of the tincture of mu- 
riate of iron, in ten or fifteen drop doses 
twice or thrice a day, will, in most cases, 
effect a cure. It is of great importance, 
along with these measures, to keep the bow- 
els perfectly open; andfor this purpose, gentle 
salines, senna, castor-oil, sulphur and mag- 
nesia, from half a drachm to one drachm 
of each for a dose, in milk, or cool clysters, 
are preferable to pills which contain aloes. 

In such cases, one caution is of the high- 
est importance, Avoid the advertising quacks. 
The painfully nervous state of the mind in 
those who suffer from the above affection, 
render them most timidly credulous, and 
this fact is made use of by designing knaves, 



first to frighten, by attaching exaggerated 
importance to every slight symptom, and 
then to fleece those they have thus gulled. 
Persons who are affected with the disorder 
in question, by confiding in some medical 
man may speedily be relieved. 

NODE — Is an enlargement of a bone, 
caused by inflammation of the bone itself, 
or of its covering "periosteum;" the shin 
bone is very liable to the disease, often in 
consequence of venereal affection. While 
active inflammation of the part is present, 
perfect rest, leeches, fomentations, poultices, 
and other remedies, internal and external, 
recommended in inflammation generally, 
may be' used, and afterward blisters. A 
medical man should be called in. 

NOISE in the EARS.— See Ear. 

NOLI-ME-TANGERE— Lupus.— SeeSKiN, 
Diseases of. 

NOSE. — The organ of smell is so situated 
above the mouth, that by it the odour of 
whatever is put into the latter must be per- 
ceived in the first instance. The visible 
portion of the nose is chiefly made up of 
bone at the upper part or bridge, of carti- 
lage at the expansive nostrils. The internal 
portion of the nose consists of a cavity — 
which communicates with the throat, at 5 
fig. ciii. — formed in the bones, which are 

Fig. ciii. 




expanded in such a manner as to offer a wide 
extent of the membrane (fig. ciii. 1) on which 
the nerves of smell (2, 3) are distributed, 
to the action of the air bearing the odorife- 
rous particles. The two nostrils are sepa- 
rated from each other by a bony cartilagi- 
nous "septum," or division ; they are lined 
by the mucous membrane which secretes the 
peculiar mucus of the nose. This mem- 
brane is continuous with that of the eyes, 
through the canal or " lachrymal duct," 
(see Eye,) which conveys the superabundant 
tears into the nostril ; it is also continuous 



NOS 



371 



NUR 



with that of the throat. As might he ex- 
pected, the nose, from its position, is much 
exposed to accident. 

Fracture of its hones is not uncommon, 
and, like other accidents to the organ, is 
liable to be followed by much bleeding. If 
the nature of the accident is indicated by 
the alteration in shape and mobility of the 
parts, &c, the nose may, if a medical man 
is not at hand, be restored somewhat to 
shape, by a bystander, the fingers on the 
outside being assisted, if requisite, from 
within, by means of a firm quill, or piece 
of wood covered with lint, passed up the 
nostril. After the displacement has been 
rectified, the person should be kept perfectly 
quiet, the injured parts covered with cloths 
clipped in cold water, and, if the habit of 
body is full, a sharp purgative administered, 
for the possibility of the inflammation ex- 
cited extending to the brain must not be 
forgotten. 

Bleeding from the Nose. — See Hemorrhage. 
The nose, like the ear, is very liable to be 
made by children the receptacle for any 
thing that will pass into it ; beans, buttons, 
stones, or the like. A few minutes before 
commencing this article, the author was 
called upon to extract a considerable piece 
of tobacco pipe, which a child had pushed 
up the nose almost out of sight. When the 
articles introduced swell, by absorption of 
moisture, there is often considerable dif- 
ficulty in their extraction. Sometimes they 
have been in the nose^ unnoticed, for days or 
weeks, and are not discovered until inflam- 
mation of, and perhaps discharge of matter 
from, the lining membrane attracts attention, 
a reason, when such symptoms occur in a 
child, for always examining the nose for the 
presence of foreign bodies. The extraction 
of a foreign body from the nostril is always 
best done by a surgeon : others are very apt 
to make the matter worse by pushing the 
foreign body farther in. If, however, cir- 
cumstances render it desirable to attempt 
the extraction without waiting, it must be 
done by means of the flat end of a probe, or 
of a bodkin, bent about the eighth of an inch, 
nearly at right angles with the rest of the 
instrument, which bent end being carefully 
passed beyond the body, must be used as a 
hook to draw it out. Sometimes, when the 
foreign body is not very far in the one nos- 
tril, if that on the opposite side be closed, 
and the child can be made to blow forcibly 
through the other, the obstruction will be 
shot out. 

The lining membrane of the nose is liable 
to become inflamed and ulcerated. In a 
mild case, washing with warm water — if ne- 



cessary, by means of a syringe — containing 
a little carbonate of soda in solution, will 
be of service. It is a common popular error 
to suppose that the nose communicates with 
the brain : it is sufficient to remark that it 
does not. 

NOSOLOGY. — The scientific classification 
of diseases. 

NOSTALGIA.— See Home-sickness. 

NOSTRUM.— See Quackery. 

NOURISHMENT.— Refer to Aliment- 
Digestion — Food, &c. 

NURSE — for Children. — The subject of 
wet-nursing, and the objections to it, have 
already been alluded to under article Chil- 
dren. When a wet-nurse is absolutely neces- 
sary and resolved upon, the selection is best 
left to the medical man, who will endeavour 
to procure one whose confinement was as 
nearly as possible at the same time as that 
of the mother whose child she is to nurse ; 
he may at the same time avail himself of 
the aid of the microscope in examining the 
milk, if there is much power of choice. The 
following characteristics of a good wet-nurse 
are laid down by M. Devergie, who, in 1838, 
had the responsibility of choosing a nurse 
for the infant Count of Paris. "A good 
nurse should be from twenty-five to thirty 
years old, strong in constitution, full-chested, 
of sanguine, lymphatic temperament, brown- 
haired, having white healthy teeth and well- 
coloured lips. She should have pyriform 
breasts with well-formed nipples, and with- 
out too much development of veins. The 
milk drawn into a spoon should be white, 
with a slight bluish tint, its taste saccha- 
rine ; it should not be too thick." In scru- 
tinizing, however, the physical qualifications 
of a wet-nurse, it is of the highest import- 
ance that the mental ones — disposition, 
temper, &c. — should not be overlooked ; 
for, independent of the influence which may 
be exerted upon the infant by the psychical 
qualities of the being from which it draws 
its first nourishment, we know that the 
emotions of the mind always do affect the 
milk in some peculiar way, and cause in- 
jury to the child — nay, death itself from 
convulsions has been the consequence to an 
infant whose mother had, shortly before 
nursing it, given way to violent passion. 
The late Sir Astley Cooper held the opinion 
that the anxiety of a mother for her child 
during teething, by acting on the milk, 
gave it an aperient, and, therefore, a salu- 
tary property. Again, all nurses well know 
how much the quality of their milk is af- 
fected either by food or medicine ; and this 
is another reason why a wet-nurse should 
be selected, if possible, who is likely to have 



NUB, 



372 



NUT 



sufficient self-control to regulate her diet. 
The difficulty in this is one, at least, of the 
objections to wet-nurses, especially if kept 
in the houses of their employers, where they 
are tempted with unaccustomed and richer 
food and drink. 

The return of menstruation, in a nurse, 
is always an objection, although perhaps 
not an absolute one, if merely an occasional 
occurrence ; the child, however, should be 
withdrawn from the breast during the pe- 
riod, and managed as if nursed by hand, 
(see Children,) the breasts being kept duly 
emptied by artificial means. — See Child-bed. 
In the event of slight indisposition in a 
nurse, the same plan may be pursued. 
Perhaps no diet is more suitable for a 
wet-nurse than one which embraces a large 
proportion of milk and farinacea, with a 
moderate proportion of animal food ; and 
much mischief is often done to both nurse 
and infant, under the idea that an extra 
allowance of stimulant is required during 
nursing, from the very first. Strong, healthy 
women require it not, and are better with- 
out it; some derive much benefit from a 
moderate allowance of malt liquor, after 
the first two or three months, while others, 
who are deficient in vital and digestive 
power, require it from the very first. Per- 
haps nothing can show more strongly than 
these facts, which are well known to every 
medical man, the folly of laying down any 
fixed rule respecting the use of alcoholic 
stimuli by mankind generally. Medicines 
taken by the nurse may be so directed as to 
benefit the child, particularly such aperi- 
ents as castor-oil, senna, &c. Saline aperi- 
ents and acids generally cause griping in 
the infant. 

With respect to nurses who have the 
charge of children in the nursery, it is suffi- 
cient here to remark, that good health, at 
least, should be insisted upon, particularly 
if the children sleep with them. 

Refer to Breast — Child-bed — Children — 
Milk, $* 

Nurses fob, the Sick. — Really good sick- 
nurses, who understand their business, are 
difficult to meet with, especially in the coun- 
try ; and it is to be lamented, when it is 
considered how much of the success of the 
best-directed treatment depends upon its 
being carried out and seconded by good and 
judicious nursing. A very young nurse is 
not desirable, and, perhaps, few are fit for 
the office under thirty years old ; but a very 
old one is still more objectionable, when the 
infirmities, and often the irritabilities, of 
age have come on : after sixty this is too 
often the case. 



It is sufficiently obvious that those whose 
duty it is to wait upon the sick, to suffer 
the necessary confinement, loss of rest, and 
other depressing influences, should them- 
selves have health as good as possible, and 
be possessed of strength and stature suffi- 
cient to enable them to give all requisite 
aid in lifting, &c. Activity, and order, and 
cleanliness, both in their own persons and 
about those they wait upon, are indispen- 
sable. All bad habits, such as snuffing, 
smoking, and it, perhaps, must be added 
drinking, are insuperable objections ; like- 
wise the habit or necessity of making un- 
usual noises, such as humming, or habitual 
cough. Neither should nurses be great 
talkers : some patients are much annoyed 
with the garrulousness of their attendants. 
A nurse ought to be a light sleeper, awake 
to the slightest call or movement, and no 
snorer — a light mover about a room. 

A good and obliging temper is, of course, 
highly desirable ; equally so, sufficient good 
judgment in the management of the whims 
and peevishness of the sick, and to direct 
any little conversation into proper chan- 
nels, avoiding all narrations of previous 
experiences, which are very apt to be in- 
dulged in. 

Some amount of education is absolutely 
necessary — especially the ability to read 
writing. Without it the most serious mis- 
takes may and have occurred. 

In enumerating the qualifications of a 
good nurse, it is not expected that all these 
are to be found combined and in perfec- 
tion in one or every individual, but some 
approximation, at least, to them should be 
attempted. Of course, in addition to the 
natural qualifications, experience in the 
management of the sick is more or less 
requisite, and the more skilled the nurse 
in the performance of the needful opera- 
tions of the sick-room, of course the more 
valuable. While laying down the qualifi- 
cations for good nurses, one word may be 
said to those who employ them. If active, 
cheerful attendance is required, it must not 
be forgotten that this is almost physically 
impossible, if a nurse be kept day after day, 
and night after night, confined in a close 
sick-room. Even if averse to it, both for 
her own sake, and for that of the patient, a 
nurse ought to be made to go out in the 
open air for exercise, for at least an hour 
in the day. There are few cases which will 
not admit of some member of the family 
taking her place for that time. 

Refer to Bed — Bedroom, §c. 

NUTS. — See Chestnuts — Filberts, &c. 

NUTMEGS— Are the produce of a tree 



NUX 



373 



CEDE 



resembling the pear-tree, which is a native 
of the islands of the Indian Archipelago ge- 
nerally, but its cultivation has been much 
circumscribed by the narrow policy of the 
Dutch. The nutmeg is the kernel of the 
fruit, which is about the size of a peach, 
and is enclosed in a shell, over which is 
spread the arillus, which is the mace of 
commerce. — See Mace. The properties of 
the nutmeg depend upon a fragrant essen- 
tial oil which it contains. This is some- 
times partially extracted by heat, and the 
nuts afterward sold as fresh ones, being 
covered with powdered lime. This cover- 
ing with lime, however, is also sometimes 
resorted to simply to prevent the attacks 
of insects. 

Nutmegs, as articles of diet, possess the 
advantages and disadvantages of spices ge- 
nerally. 

Refer to Mace — Spices, §c. 

NUX VOMICA— Is the seed of a tree— 
the strychnos nux vomica, a native of India 
and the neighbouring countries. Its active 
principle is strychnine, one of the most en- 
ergetic poisons known, though a valuable 
remedy in proper hands. 

Strychnine is now much used for destroy- 
ing vermin, and occasionally proves fatal to 
the human subject by design or accident. 
The symptoms produced in poisoning, either 
by nux vomica or by strychnine, come on 
quickly, in the form of violent spasms, af- 
fecting the entire muscular system, and 
death ensues from sp.asni of the muscles of 
the chest producing suffocation. Emetics 
in the first instance, cold affusion, and, per- 
haps, stimulants, may be used in such cases, 
but there is no known antidote. Medical 
assistance should be procured without delay. 

OAK BARK — Is a powerful astringent, 
and may be used for the same purposes as 
others of the class. For domestic use, it 
has the advantage of generally being easily 
procurable. It is used in the form of de- 
coction, made by putting from an ounce to 
an ounce and a half of oak bark into a quart 
of boiling water, and boiling down one-half. 
In relaxed sore-throat it is a useful gargle, 
[and in tender nipples it forms an excellent 
wash.] 

Refer to Galls. 

OATS — As an article of diet, are generally 
ranked next after wheat as regards nutri- 
tive power, the latter holding the first place 
in consequence of its containing a larger 
amount of gluten ; in some respects, how- 
ever, the oat is the superior grain. — See 
Grains. The oat is most largely used in 
Scotland; the seed is there "kiln-dried, 

2 a 



stripped of its husk and delicate outer skin, 
and then coarsely ground," in which state 
it constitutes "Scotch oatmeal." It may 
be thought that the cheapness of the oat 
might prevent its meal being adulterated, 
but in the recent examination of the subject, 
by the Lancet Sanitary Commission, it was 
found, that -much of the oatmeal sold in 
London is adulterated with barley-flour, a 
much less nutritious article of diet. In 
England oatmeal is chiefly used for making 
gruel, (see Cookery ;) but the meal, or rather 
oat-flour, prepared in England, is of very 
inferior quality to the Scotch, and even when 
meal is made professedly in imitation of the 
Scotch preparation, it is a very poor substi- 
tute. In Scotland, oatmeal is most largely 
employed for the well-known "porridge," 
which constitutes the breakfast of a great 
proportion of the population, and almost 
universally of the children of all classes ; 
and except, perhaps, for a few persons, a 
more wholesome one could not be found. 
In a few individuals, the use of oatmeal 
causes heart-burn, and occasionally sick- 
ness, and, of course, must then be abandon- 
ed. One of the most beneficial properties 
of the oat, especially in the form of the 
Scotch meal, is its aperient power ; in many 
children, the use of oatmeal porridge for 
breakfast will entirely correct a tendency 
to constipation. The proper method of 
making oatmeal porridge is, to have the re- 
quisite quantity of water boiling upon the 
fire, and to sprinkle the meal into it from 
the hand, stirring constantly, not only at 
the time, but during the twenty minutes 
that the mixture should be boiled. Suffi- 
cient salt for seasoning is to be added 
during the process. In Scotland the stirrer 
is generally made of wood. When the mix- 
ture is boiled sufficiently, it must be poured 
into a saucer or soup-plate, till it is suffi- 
ciently cool. It is generally eaten with milk, 
but buttermilk, treacle, or beer are also 
used. A pint of water, and a tea-saucerful 
of oatmeal, will make a good soup-plateful 
of porridge. When oatmeal, coarsely pre- 
pared, is too largely used, especially in a 
dry state, it may cause concretions in the 
bowels, (see Concretions,) but this effect never 
follows its proper moderate employment. 

Refer to Grains — Groats — Poultice, fyc. 

OBESITY.— See Fat. 

OBSTETRICS.— The art of midwifery.— 
See Childbed. 

OCCIPUT.— The back part of the head. 

OCCUPATION.— See Artisan. 

CEDEMA — Is the term applied to the swell- 
ing caused by the effusion of serum into the 
cellular tissue beneath the skin. — See Dropsy, 



osso 



374 



OLI 



(ESOPHAGUS.— See Gullet. 

OIL — From oleum, derived from the name 
of the olive which yields the well-known oil. 

Oils are the products of either the vege- 
table or animal kingdom. They are divided 
into fixed oils — which also include the fats 
— and volatile oils. Oils are also divided 
into drying and non-drying, according to 
their power of solidification by absorption 
of oxygen from the air. 

Fixed oils vary from the most limpid fluid 
to the hardest suet, according to the amount 
of solid or fluid fatty matter in their com- 
position ; all fixed oils, and animal fats, 
being separable into two, and often three 
different principles. One, named oleine, re- 
mains fluid at the lowest temperature ; the 
next, margarine, has a higher melting point, 
and the third, stearine, the highest of all. 
The separation — under the influence of cold 
— into oleine and margarine may often be 
witnessed in olive-oil in winter. Fixed oils 
are further distinguished by their leaving a 
greasy stain on paper, which is not dispelled 
by heat, and by their power of forming 
soaps with the caustic alkalies. 

Volatile oils are of great variety ; the 
odoriferous properties of the vegetable king- 
dom depending on their presence. These 
oils are generally limpid, should be colour- 
less, but are, for the most part, slightly 
yellow. Their taste is usually pungent. Like 
the fixed oils, the volatile oils cause a 
greasy stain upon paper, which, however, 
entirely evaporates under the influence of 
heat, thus affording an easy test of adulter- 
ation with a fixed oil, which is sometimes 
proctised. 

Some volatile oils, such as turpentine, oil 
of lemons, juniper, &c. are composed 
simply of carbon and hydrogen. Others, 
such as lavender, peppermint, &c. &c. also 
contain oxygen in addition, — camphor be- 
longs to this division, — and a third section, 
those of garlic, mustard, &c. have sulphur 
added. 

The principal fixed oils used in medicine 
are 



Almond-oil, 

Castor-oil, 

Croton-oil, 



Linseed-oil, 

Olive-oil, 

Codliver-oil. 



They all possess, more or less, aperient 
properties. Almond-oil is chiefly used as 
an external application. The reader is re- 
ferred to the separate articles for further 
information. 

Volatile oils are also used chiefly for their 
pleasant flavour, and for their stimulant 
carminative properties. They form a long 
list — amber, aniseed, bergamot, cajuput, 
camphor, cassia and cinnamon, chamomile, 



cloves, copaiva, cubebs, dill, fennel, juni- 
per, lavender, lemon, marjoram, mint, 
orange, peppermint, pennyroyal, pimento, 
rosemary, rue, savine, sassafras, turpen- 
tine, &c. 

OINTMENTS— Are greasy or unctuous 
preparations, about the consistence of firm 
butter. They are much less used as dress- 
ings in modern practice than they formerly 
were, and their number might be reduced 
with much advantage. They have been sup- 
planted by the more elegant, cleanly, and 
in every way superior, water-dressing. Oc- 
casionally, a greasy application is requisite, 
and then nothing answers better than per- 
fectly fresh lard, or sweet olive-oil, or, 
when fresh, the simple ointment, contain- 
ing spermaceti or wax to give additional 
firmness. The form of ointment for pur- 
poses of counter-irritation, inunction, &c. 
is sometimes convenient, but even this, as 
in the case of tartar emetic, might be often 
avoided. 

The ointments most likely to be useful for 
domestic practice are antimonial ointment, 
gall ointment, hydriodate of potash oint- 
ment, mercurial and red precipitate oint- 
ments, simple or spermaceti ointment, sul- 
phur ointment, and zinc ointment. 

The composition of these is given under 
the head of the active ingredient they con- 
tain. Simple spermaceti ointment is made 
by melting together spermaceti five ounces, 
white wax fourteen drachms, olive-oil twenty 
ounces, stirring continually till the mass is 
perfectly cold. 

One of the great objections against oint- 
ments is, that so many of them, if kept, 
become rancid, and thus form a most irri- 
tating application. 

Refer to Dressing. 

OLD AGE.— See Age. 

OLIVES— The product of the Olea Euro- 
pcea, or olive-tree, though used in the 
form of preserved olives, are better known 
as the source of the well-known 

Olive, or Salad-oil, which is procured 
by crushing from the perfectly ripe fruit. 
Good olive-oil is of a pale yellow colour, 
and should be almost free from either smell 
or taste. It is often adulterated with the 
inferior fixed oils. As an article of diet, 
olive-oil agrees well with many, and some 
persons find it useful as an aperient, but it 
is very weak in action. In pregnancy, how- 
ever, with irritable and yet confined bowels, 
it occasionally answers better than the usual 
castor-oil. Olive-oil is most used in medi- 
cine as an external application, both as an 
addition to ointments and as a liniment. — 
See Ammonia — Camphor, #c. 



OMB 



375 



OPI 



OMENTUM, or Caul. — A membrane, 
more or less covered with fat, which is 
spread over the intestines. It probably acts 
as a protection against cold. The great 
loading of the omentum with fat is one of 
the chief causes of the protuberance of the 
abdomen in very corpulent people. 

ONANISM. — The crime of Onan— self- 
pollution — requires no further notice here, 
than to put parents on their guard respect- 
ing their children, in connection with this 
ruinous vice, acquired at school, and in- 
dulged in, in ignorance either of its sin or 
evil consequences. Some of the most la- 
mentable instances of youthful decrepitude, 
nervous affections, amaurotic blindness, and 
mental debility and fatuity in early life, 
which come before medical men, are trace- 
able to this wretched practice. Whenever 
young people, about the age of puberty, ex- 
hibit unaccountable symptoms of debility, 
particularly about the lower limbs, with 
listlessness and love of solitude, look dark 
under the eyes, &c, the possibility of vicious 
practices being at the root of the symptoms 
should not be entirely lost sight of. [A phy- 
sician should then be at once consulted, and 
his directions strictly observed.] 

ONION and GARLIC— The former of 
these well-known vegetables may be con- 
sidered either as a condiment or as an ar- 
ticle of real nourishment. In its raw state, 
(especially the onion,) by virtue of the 
volatile oil it contains, is a powerful sti- 
mulant, but one only to be used with advan- 
tage and impunity by the owners of strong 
stomachs, who intend for the time being 
to eschew civilized society. Under this 
proviso, the onion may really, at times, 
prove of much value as a stimulant. By 
boiling, the onion is deprived of much of 
its pungent volatile oil, and becomes an 
agreeable, mild, and nutritious vegetable. 
It is less wholesome either fried or roasted, 
a portion of the volatile oil being retained, 
and empyreumatized, and thus rendered 
very irritating to the stomach. The onion 
possesses diuretic properties. A roasted 
onion, cut in half, and the centre scooped 
out, is a frequent domestic remedy applied 
to boils, with a view of hastening their 
breaking. 

Garlic is a more powerful stimulant than 
onion. When applied to the skin, either 
fresh or in a pulp, it acts like a mustard 
cataplasm. Garlic is diuretic, and'possesses 
other properties, but its abominable smell 
is quite sufficient to exclude it from use, 
when so many more efficient and agreeable 
substitutes are obtainable. 

ONYCHIA — Is a speoies of ulcer very 



difficult to heal, situated at the side of, and 
underneath the nail. It is usually depend- 
ent on general constitutional debility, which 
requires to be attended to. — See Debility — 
Tonics, §c. The -local irritation about the 
nail may be treated by poultices, and after- 
ward by the mercurial black wash, but the 
disease will probably require the attention 
of a medical man. 

OPHTHALMIA.— See Eye. 

OPINION, MEDICAL.— A medical opi- 
nion on a case of disease includes, first, the 
"diagnosis," or conclusion arrived at re- 
specting the nature of the disease ; second, 
the conclusion as to the appropriate treat- 
ment ; third, the "prognosis," or opinion 
respecting the ultimate termination of the 
case. Under the articles "Diagnosis," 
"Medicine, Science of," and " Prognosis," 
these points are sufficiently entered into. 

OPIUM — Is the milky juice, dried, of the 
seed-vessels of the common garden poppy : 
it is perhaps the most useful remedy in the 
entire list of medical agents used by man, 
and has probably given more relief to hu- 
man suffering than any physical means we 
are acquainted with. 

Opium may be procured from other spe- 
cies of poppy, but that above named is its 
regular source. The drug is chiefly col- 
lected in Asia Minor, in Egypt, and in Hin- 
dostan, but has been made in Britain. It 
is procured by making oblique incisions 
about half through the external wall of the 
unripe poppy capsule or seed-vessel, and 
allowing the milky juice to become par- 
tially dry, when it assumes a brown colour, 
and tenacious consistence ; at this stage 
the opium is generally gathered by scraping 
it off the capsule by means of a stick or 
some other instrument, by which it is trans- 
ferred to the receiving vessel — a cocoa-nut 
shell or the like ; it is then further dried, after 
which it is, in some places, packed in leaves, 
in masses of various size, or, as in Egypt, 
made into rolls or small flat cakes. Opium, 
when bought as imported, is apt to contain 
much impurity ; by far the best condition, 
therefore, in which to purchase it for direct 
use is the properly prepared powder, which 
must be kept in a well-closed bottle. The 
preparations of opium used by medical 
men are very numerous ; the most useful 
of these only will be referred to in this 
article. % 

Opium is most familiarly known in its 
action upon the human body, first, by its 
power of compelling sleep — its sedative, 
soporific, or narcotic property; and second, 
by its power of relieving pain — its anodyne 
property. These actions, however, are 



OPI 



376 



OPI 



much varied, and others are developed in 
accordance with the influence of circum- 
stances, either permanent or accidental, 
such as the dose and mode of administra- 
tion; the state of the person taking it at 
the time, whether physical or mental, his 
temperament, previous habits, &c. It is 
well known, that among the Orientals, 
opium is employed rather as a stimulant, 
as we use wine, than as a sedative, and its 
use for this purpose has very widely extend- 
ed of late years in this country. When 
taken with the above view, the dose re- 
quires to be small — that is, comparatively 
so, according to the habits of the individual 
— and if sleep approaches, it requires to be 
resisted. After this state, if it occurs in 
those who are stimulated by opium, a state 
of unusual physical, and especially of 
mental activity is excited, accompanied with 
exalted brilliancy of ideas ; after some 
hours this subsides, leaving drowsiness, in- 
activity, and low spirits. 

If, however, the dose of opium has been 
a large one, or if the individual give way 
to the inclination to sleep which follows 
even a moderate dose, heavy slumber is the 
result, varying in duration according to 
the dose of the drug and other contingent 
circumstances. Such is the more ordinary 
medicinal effect of opium ; but whether the 
effect produced be one of excited, or of se- 
dative action, pain is either modified or 
wholly subdued for the time being. When 
the effects of an ordinary dose of opium 
are passing off, most persons experience 
some amount of uncomfortable sensation ; 
dryness of the mouth, headache, low spirits, 
and sickness ; this latter symptom espe- 
cially is sometimes so distressing as almost 
to debar the use of opium in certain indi- 
viduals. 

Sometimes, opium produces neither sleep 
nor the pleasing excitement so valued by 
its votaries ; but gives rise to feverish rest- 
lessness, headache, thirst, &c. This may 
arise from constitutional peculiarity, from a 
state of previous feverish excitement, from 
the drug having been swallowed too soon 
after a meal, or from other causes. 

In whatever way it is conveyed into the 
system, whether by the stomach, by the 
skin, or by external application, &c, opium 
seems to exert its peculiar effects upon the 
brain and nervous system ; it further mo- 
difies the secretions, particularly those of 
the mucous membranes ; it checks the flow 
of bile, and powerfully constipates the 
bowels ; but it determines to the skin, and 
causes sweating. The constipating action 
of opium is sometimes one of its chief in- 



conveniences; but in those who consume it re» 
gularly, this effect generally soon passes off. 
The action of opium upon the system is in 
the first place greatly modified by custom ; 
persons who habitually take it for purposes 
of intoxication, find it necessary gradually 
to increase their dose if they wish to expe- 
rience the — to them — agreeable influence : 
such persons, when consulting a medical 
man, ought always to inform him of their 
habit; otherwise, when ordering what would 
be only a suitable dose for the generality of 
persons, he may be prescribing little more 
than a tithe of the ordinary amount con- 
sumed by his patient. It is, perhaps, need- 
less to point out that serious consequences 
might result. Again, the existence of cer- 
tain diseases, particularly of a spasmodic 
or painful character, very greatly modifies 
the power of opium over the system ; this 
is peculiarly exemplified in such diseases as 
lockjaw, &c. Persons, even, who are ordi- 
narily very susceptible to the action of 
opium, when suffering severe pain, can 
often take it in considerable quantity, with- 
out experiencing its usual effects, or, in- 
deed, any effect beyond relief to pain. Age 
is another circumstance, which, affecting 
the power of action of all medicinal agents, 
seems peculiarly to do so in the case of 
opium, its influence augmenting in a rapidly 
increasing proportion, as the earliest epoch 
of life is approached. Indeed, during the 
first two or three years of life, it is impos- 
sible to exercise too great caution in the ad- 
ministration of opium ; many accidents are 
known to ensue from its careless, or igno- 
rant, or criminal use, and doubtless many 
more there are which never come to light. 
A single drop of laudanum has been known to 
prove fatal to a young infant. Even in in- 
fancy, habit, nevertheless, enables compa- 
ratively large doses of opium to be given, 
but the most lamentable results accrue to 
the constitution, and, ultimately, death it- 
self may be the consequence. No one 
should be tempted to give opium in any 
form to a child, unless under medical sanc- 
tion, or under the pressure of some of such 
circumstances as are pointed out in various 
parts of this work, (see Children;) and 
when it must be given, it should be in the 
form of laudanum, in the most cautiously 
graduated dose. To an infant under two 
months old, one-quarter to one-third of a 
drop only should be given at once, and re- 
peated at intervals of an hour, if required ; 
and even in this way, no unprofessional 
person should venture to exceed the amount 
of one single drop of laudanum to an infant 
under six weeks old, 



0P1 



377 



OPI 



Poisoning by opium, either by accident or 
design, is a very common occurrence. The 
symptoms generally set in from half an 
hour to an hour after the drug has been 
swallowed, but this circumstance depends 
partly upon the form in which the poison 
is taken, the effects of the drug being de- 
layed longer when solid opium has been 
employed, than when, as usually happens, 
it has been its fluid preparation, laudanum. 
The symptoms are giddiness and drowsi- 
ness, from which the person may be roused 
by noises, shaking, &c; but this quickly 
passes into apoplectic stupor, with slow, 
"stertorous" [snoring] breathing; and, ulti- 
mately, if the case proves fatal, into death, 
with or without convulsions— these being 
most common in children. In addition to 
the above symptoms, the face is pale and 
ghastly, the surface cold, but may be co- 
vered with perspiration ; the urine is un- 
passed ; the pupils of the eyes are generally 
contracted ; and the odour of opium may 
possibly be detected in the breath. 

The treatment of a case of poisoning by 
opium must, in the first place, be to pro- 
cure the evacuation of the poison from the 
stomach. For this purpose a medical man 
may use the stomach-pump ; but others 
must attempt it by emetics. — See Emetics. 
If sulphate of zinc (white vitriol) be pro- 
curable, half a drachm should at once be 
given, dissolved in water ; or five grains of 
sulphate of copper (blue vitriol) in the 
same way ; or mustard or salt maybe tried 
if neither of the above are at hand ; or ipe- 
cacuanha combined with a stimulant — a 
couple of teaspoonfuls of sal-volatile or of 
brandy ; or the throat may be irritated with 
a feather. In some cases, vomiting and 
even diarrhoea occur spontaneously, and 
certainly diminish the danger. When the 
stomach has been cleared, but not be- 
fore, vegetable acids — lemon-juice, vinegar, 
cream of tartar — may be given freely ; or 
strong coffee, without either milk or sugar. 
— See Coffee. At the same time, every 
means must be used to keep the patient 
from lapsing into lethargy ; cold, or alter- 
nate cold and hot water may be dashed over 
the body ; mustard plasters used between 
the shoulders, and continual movement kept 
up. This is usually, and very properly, 
done by keeping the patient in continual 
motion for many hours between two assist- 
ants. Lastly, galvanism or electricity may 
be used, and artificial respiration kept up. 
A most remarkable case of recovery, the 
result of the persevering employment of 
these two agents — galvanism and artificial 
respiration — is recorded in the Lancet, 
2g2 



March 27th, 1852, by Dr. Herapath, under 
whose care the case occurred. 

In this case, a " small teaspoonful" of 
laudanum was given by mistake to an infant 
but thirty-nine days old, and the whole re- 
tained. The case is cited as an instance of 
how much may be done by persevering and 
well-directed efforts to save life. 

Tannin, the active principle of oak bark, 
has been recommended in opium poisoning. 
It is perhaps not much to be depended on, 
but in the absence of other remedies a 
strong decoction of the bark might be used. 
It must be remembered, that in poisoning 
by opium, partial consciousness may be re- 
stored, and yet the patient, if unattended 
to, may relapse and die. It has been sug- 
gested that many of the symptoms of poi- 
soning by opium are the result of the dry- 
ness of the lining membrane of the air- 
tubes — which is one of the invariable con- 
sequences — preventing the due oxygenation 
or purification of the blood. The fact should 
not be lost sight of, especially as it may be 
remedied by making the patient inhale steam 
freely. 

The quantity of opium required to destroy 
life may probably be stated at from four to 
five grains of solid opium as a dangerous 
dose to an adult, and from a drachm and a 
half to two drachms of laudanum, and 
upward. The average time in which death 
ensues, in consequence of poisoning by 
opium, is twelve hours ; but it may occur 
considerably earlier. 

Opium as a medicine is useful in a great 
variety of diseases, but as its employment 
is mentioned under the separate articles, it 
is unnecessary to repeat the information 
here. The most useful preparations of opium 
are — 

Opium in powder. — To be kept in a well- 
stopped bottle. Average dose for an 
adult, one grain. 
Tincture of opium, or laudanum — which 
contains one grain of solid opium in nine- 
teen minims. Average dose for an adult, 
fifteen to twenty minims, or about twenty- 
five to thirty drops. 

Of all the preparations of opium, this is 
the most generally useful and valuable, and 
the safest. Its dose may be regulated to 
the minutest proportion, and when properly 
made, it keeps well. 

Tincture of opium with camphor, or pa- 
regoric — which contains one grain of 
solid opium to the half ounce. Average 
dose for an adult, one drachm to three 
drachms. 
Compound opium powder with ipecacuanha, 
or Dover's powder — which contains one 



OPI 



378 



OKA 



grain of solid opium in ten. — See Dover's 

Powder. 
Compound opium powder with chalk — which 

contains one grain of opium in forty. 

Average dose, twenty to forty grains. 

As external applications, the soap and 
opium liniment, and the opium plaster, are 
both useful. 

There are many other preparations of 
opium used, but the above would be ample 
for the best-stored emigrant chest ; and 
therefore for any home use. Persons gene- 
rally will find it more advantageous to pur- 
chase the preparations ready made, but in 
some cases it may be requisite to make 
laudanum themselves. 

To make. Laudanum: — Take of opium, 
sliced, three ounces ; water, thirteen fluid- 
ounces by measure. Macerate the opium in 
water, in a wide-mouthed bottle, for a cou- 
ple of days, shaking up occasionally ; and 
then add twenty-seven ounces of rectified 
spirit of wine ; macerate for ten days or a 
fortnight, and filter. Of course a much 
smaller quantity may be made at once, ob- 
serving the same proportions. 

Laudanum and paregoric are best admi- 
nistered in water ; Dover's powder, or the 
compound chalk powder, in some thick sub- 
stance, such as gruel. When solid opium 
is given, it is best in the form of pill, with- 
out admixture. Laudanum is sometimes 
used as an external application, being put 
into poultices, &c: it is also used to rub 
on the gums in toothache. It must not be 
forgot, that in any of these ways, if em- 
ployed incautiously, or in excessive quan- 
tity, it may affect the system, and even 
prove dangerous. For the use of laudanum 
in clysters, the reader is referred to the ar- 
ticle on the subject. 

In addition to the preparations of opium 
above mentioned, two others require notice ; 
one of these, the valuable, though secret, 
Battley's Sedative Solution, will be found 
noticed under its special article ; the other, 
morphia, is the special sedative or narcotic 
principle of opium. Opium is a very com- 
pound body, and includes other principles, 
on some of which its stimulant and other 
powers more particularly depend ; morphia, 
therefore, being separated from these, is 
more purely sedative, and is not found so 
frequently to occasion the disagreeable af- 
ter effects which often follow the use of 
opium ; in other respects, its action and 
application are the same. 

Morphia, on account of its insolubility, 
is generally prescribed in the form of the 
more soluble acetate or muriate of morphia. 
The latter is the best and more certain pre- 



paration: dose, from a quarter to half a 
grain. The graduated morphia lozenge is a 
most effectual and comparatively agreeable 
remedy in irritable cough ; ten or fifteen of 
the lozenges may be taken in the course of 
the same number of hours. In Edinburgh, 
the same lozenge, combined with ipecacu- 
anha, is made, and is very useful in many 
cases. 

Refer to Poppy — Daily's Carminative — 
Godfrey's Cordial, fyc. 

OPODELDOC— Is an old name, seldom 
used now by medical men, applied to ex- 
ternal stimulating embrocations. The cam- 
phorated soap liniment is the form most 
usually indicated by the term, popularly. 

[OPTIC NERVE.— The nerve of vision.] 
. OPTICAL DELUSIONS— The result of 
diseased or of disordered action — are not 
uncommon. Under the term may be in- 
cluded the more obvious disorders of vision, 
such as those in which one-half of an ob- 
ject, or one-half of a word only are per- 
ceived. From this state, up to that in 
which figures of persons, either known or 
unknown, are seen, either constantly or pe- 
riodically, every form of optical delusion is 
met with. Such cases are generally con- 
nected with disorder in the head, either in 
the form of disease of the brain itself, or 
are occasioned by sympathy with disordered 
function in other parts of the body, more 
particularly the stomach. 

ORANGE. — This well-known and whole- 
some fruit is imported chiefly from the 
countries bordering the Mediterranean. The 
two varieties — the bitter or Seville orange, 
and the sweet orange — are too well known 
to require description. The perfume of the 
orange-flower is highly valued, and the dis- 
tilled water is used on the continent as an 
antispasmodic and anodyne ; it is recom- 
mended as extremely useful in hysteria, in 
doses of one or two ounces. 

In this country, the chief direct medi- 
cinal use of the orange is derived from the 
rind, which yields an agreeable, aromatic, 
stimulant bitter ; the rind of the bitter 
orange is usually ordered, but that of the 
sweet may also be used, though it is less 
powerful. A confection, an infusion, a 
syiaip, and a tincture of orange-peel, are 
all used. A very good infusion may be 
made, simply, from an ounce of the dry 
bitter orange-peel, twenty ounces of boiling 
water being poured over, the whole allowed 
to stand for twenty minutes, and then 
strained ; the addition of a quarter of an 
ounce of lemon-peel to the above quantity 
may be made with advantage. The dose, 
as a stomachic, is a wineglassful twice a day. 



ORB 



379 



OVA 



Of the sweet variety of the orange, the 
China, the Maltese and St. Michael's are 
best known in England ; the finest descrip- 
tions of the fruit have a smooth, thin, dark, 
rind. The juice of the sweet orange con- 
tains principally mucilage, sugar, and citric 
acid, and is one of the most wholesome 
vegetable juices we possess, particularly in 
the chamber of sickness ; the cellular pulp 
of the orange, however, in which the juice is 
contained, is very indigestible, and when 
swallowed, as it often is by children, is apt 
to produce disorder, passing through the 
bowels unchanged. It is a good plan, in the 
case of young children, to give the orange- I 
juice squeezed into a glass. 

ORBIT.— The cavity in the skull in which i 
the eye is placed. 

OSMAZOXE — Is the animal principle on t 
which the peculiar and agreeable flavour of 
cooked meat depends. It is most manifestly 
developed in decoctions of meat, such as 
soups, &c. 

OSSIFICATION.— The formation of bone. 
"The first development of bone is com- 
monly preceded by the formation of a car- 
tilaginous (gristly) structure, which occupies 
the place the bone is afterward to take ; 
and it has been commonly considered that 
the bone is formed by the ossification of the 
cartilage, (gristle.) This, however, does not 
appear to be the case, for none of the pecu- 
liar substance of the cartilage — chondrin — 
can be found in perfect bone." " The pro- 
cess of true bone -formation always com- 
mences in the immediate neighbomdiood of 
blood-vessels, which pass down into canals 
excavated in the substance of the cartilage ; 
the spots where these vascular canals are 
especially developed, are termed centres of 
ossification. We usually find one of these 
in the centre of the shaft of a long bone, and 
one at each end ; in the flat bones, there is 
generally one in the middle of the surface, 
and one in each of the principal projections. 
Up to the period when a bone attains its full 
dimensions, the parts which contain distinct 
centres are not connected by osseous (bony) 
union, but only by cartilage, so that they 
fall apart when this decomposes ; the pur- 
pose of this is to allow an increase in the 
size of the bone by the growth of cartilage 
between its detached portions, which car- 
tilage may give place to bony structure, 
when there is no further need of increase."* 
— See Epiphysis. 

After the formation of bone has been 
completed, the changes which take place in 
its component particles appear to go on 



: Carpenter's Physiology. 



slowly. But should injury be inflicted, either 
in the form of fracture, or as a consequence 
of disease, by which a portion of bone is 
destroyed, the formation of new bone is 
often extremely rapid, and, in the course of 
time, extremely perfect ; the new structure 
in every way resembling the old. The re- 
union of fractures by the formation of new 
bone [callus] has already been alluded to 
under article Fracture. 

As all are aware, the bones of young ani- 
mals are much more cartilaginous than those 
of older ones ; they contain much more ani- 
mal matter, which, as life "advances, dimi- 
nishes, and gives place to a larger proportion 
of mineral ingredient. It is not, however, 
in the bones alone that this tendency to 
increase of mineral deposite — ossification — 
is observed ; the body, generally, in old age, 
becomes more rigid, and bony deposite is 
found in structures that do not ordinarily 
contain it. Some structures are, however, 
much more obnoxious to this than others. 
It is matter of popular information that 
the heart is very liable to be the seat 
of ossification in advanced life. This occurs 
more especially in the structure of its valves, 
and in connection with them ; [see Heart;) 
also in the coats of the arteries which sup- 
ply its own muscular substance, a change 
which is often found to have been associated 
with symptoms of " angina pectoris." This 
tendency, however, to the deposite of bone 
about the arteries of the heart, extends 
throughout the arterial system generally, 
causing these otherwise elastic tubes to be- 
come rigid, and thus impairing the import- 
ant power they possess in health and in 
early life of assisting to propel each wave 
of blood which the heart contraction com- 
mences through the bod}'. — See Circulation. 
This change in, and enfeeblement of, the 
power of the arteries, is one great and ori- 
ginating cause of many of the diseases of 
old age. Other parts, such as those con- 
nected with the larynx, &c, are liable to 
become converted into bone as life advances. 
The subject could not profitably be pursued, 
further here. 

Refer to Bone — Cartilage — Fractures, 

OVARIUM, or Ovary — Is the recep- 
tacle in which are contained, either in plant 
or animal, the germs of the future seed or 
egg. The ovary in the human female is 
liable to a variety of diseases, such as in- 
flammation, &c, which often give rise to 
many obscure symptoms in organs appa- 
rently quite disconnected with those which 
are the primary seat of the irritation. 
Dropsy of the ovary is one of the most gene- 



vu 



880 



OXG 



ral affections of the organ ; tapping or other 
operations may be required for its relief. 

OVUM — Literally, means an egg. The 
term is generally applied to the germ of the 
future being, after it has been fertilized by 
the male ; previous to that, the term ovule 
is used. After fertilization, the ovule of 
the plant becomes the seed ; that of the 
animal, the egg, in which and from which 
the future animal is formed, either out of 
or within the body of the mother. — See Egg. 

OXALIC ACID— Is one of what are call- 
ed the vegetable acids, being found ready 
formed — in combination with potassa — in 
various plants, such as the common wood- 
sorrels, the common sorrel, the garden rhu- 
barb, &c. It is also formed in some dis- 
ordered states within the animal body, and 
is excreted in the urine, in combination with 
lime. — See Urine. Oxalic acid may also be 
formed by the action of nitric acid on sugar 
or starch, to which bodies it approaches, 
nearly, in composition, being formed of 
carbon, oxygen and hydrogen, in certain 
definite proportions, or in other words, of 
carbon and oxygen, along with the elements 
of water. Oxalic acid is generally met with 
in the form of small white crystals. Oxalic 
acid is not now used medicinally ; formerly, 
it was so, in the form of the wood-sorrel, 
which was employed for the purpose of 
making febrifuge acid drinks, whey, &c. ; 
but there are many substitutes, such as 
lemon-juice, better adapted for the purpose, 
and less suspicious. 

What is known in the shops under the 
name of "essential salt of lemons," or salt 
of sorrel, is a compound of oxalic acid with 
potassa, and was formerly obtained from 
the wood-sorrel. 

Oxalic acid derives its chief importance 
here from its frequent effect as a poison, 
either by accident or design. The accidents 
have generally arisen in consequence of ox- 
alic acid having been sold or taken in mis- 
take for Epsom salts, the crystals of the two 
closely resembling one another. The precau- 
tion of tasting a single crystal would be suf- 
ficient to detect the difference. 

The symptoms produced by poisoning from 
oxalic acid vary considerably. When a large 
dose has been swallowed, the chief effect is 
complete prostration of strength, in fact, a 
state of collapse, accompanied with stupor, 
in which the patient dies, often within thirty 
minutes after taking the poison. Severe pain 
at the stomach usually comes on soon after 
the poison has been swallowed; but this, and 
vomiting, which also generally occurs and 
continues with great severity, may be absent. 
The vomited matters are strongly acid, and 



dark in colour. The rapidity with which 
death often ensues after a poisonous dose of 
oxalic acid has been swallowed, renders it 
almost impossible, in many cases, to procure 
medical assistance in time ; it is, therefore, 
highly desirable that the most prompt mea- 
sures should be adopted by those around. 
The principle of treatment is based on the 
fact that the very soluble oxalic acid itself 
forms with lime especially, and with magne- 
sia, insoluble and, therefore, comparatively 
less hurtful compounds. Chalk or whiting 
(the carbonate of lime) mixed up with water, 
is the best possible antidote, and should be 
given freely : if this is not at hand on the emer- 
gency, a portion of old mortar [from the ceil- 
ing] should be taken as a substitute, rubbed 
up with milk and water, and given as quickly 
as possible; or, instead of it, magnesia. If 
none of these remedies can be procured, very 
copious draughts of water should be given 
to promote vomiting, which in any case 
should be excited, if it has not been already 
occasioned by the poison. There was for- 
merly a prejudice against giving water largely 
in oxalic acid poisoning, from the fear that 
it might favour the solution and passage of 
the salt into the blood ; the practice has, 
however, been found advantageous, provided 
free vomiting is encouraged. Of course, 
while these measures are in progress, me- 
dical aid should be sought. Should the pa- 
tient survive the poisoning, symptoms of irri- 
tation of the stomach and alimentary canal 
must be expected, which will require the 
most soothing treatment, chiefly by demul- 
cent medicines and diet, and it may be by 
leeches to the pit of the stomach. 

OX-GALL. — The [inspissated] gall or bile 
of the ox has been much lauded as a remedy 
in habitual constipation. A few years ago 
it was extensively tried, and undoubtedly 
proved, and does prove serviceable in cer- 
tain cases, but, perhaps, having been over- 
praised, it seems to have become again 
almost too much neglected. In some cases 
of constipation in pregnancy, it answers ex- 
tremely well, and is very safe. Its prepara- 
tion for medicinal purposes is simple, all 
that is required being to place a quantity 
of fresh ox-gall in a fiat dish, in a sufficiently 
warm situation — such as an oven — and per- 
mit evaporation to go on, till the gall be- 
comes sufficiently firm to make into pills, of 
which from five to ten grains weight may be 
taken once or twice a-day. Besides acting 
as an aperient, ox-gall has been said to as- 
sist digestion. This may be, either from its 
bitter giving tone to the stomach, or from 
its giving its own chemical aid to the solu- 
tion of certain constituents of the food. 



OXY 



381 



PAI 



OXIDE of BISMUTH.— See Bismuth. 

OXYGEN GAS— Is one of the elementary 
bodies, and df one is more important than 
another, it, perhaps, is entitled to the first 
place. Its name, derived from two Greek 
words, was given in consequence of the er- 
roneous idea that it was the sole cause of 
acid properties in bodies; it has also been 
named "empyreal air," " dephlogisticated 
air," &c. Oxygen gas, in mechanical mix- 
ture with nitrogen, constitutes the atmo- 
sphere which surrounds our globe, (see^.?>,) 
and on its presence, in due proportion, de- 
pends the continuance of animal existence, 
the phenomena of combustion, &c. Whe- 
ther the nitrogen gas with which oxygen is 
mingled in the atmosphere fulfils other ob- 
jects or not, it certainly does the important 
one of diluting it, and of tempering its 
potent agency, which, were it not for this 
dilution, would act with such chemical en- 
ergy as must quickly prove destructive to 
organized life upon our globe, as at present 
constituted. 

Oxygen, in combination, forms what are 
called basic oxides. These are bodies such as 
potassa, soda, oxide of iron, &c, which tend 
to unite with its next class of compounds, 
the acids. Besides these, oxygen forms com- 
pounds which do not exhibit aptness for en- 
tering into combination. 

Further, oxygen, by uniting in different 
proportions with the same body — such as 
nitrogen, may give rise to a variety of very 
different compounds... Oxygen has never 
been separated in a palpable form ; it is 
known by its effects. The important part 
which oxygen plays in the various fulfil- 
ments of animal life and existence has ren- 
dered the foregoing notice necessary. Under 
such articles as Animal Heat, Air, Blood, 
Digestion, Motor Change, Respiration, &c, the 
reader will find those fulfilments and effects 
sufficiently entered into. The employment of 
oxygen in the form of inhalation, as a reme- 
dial agent in various diseases, has often been 
proposed, but never established in practice. 

OXYMEL. — A mixture of honey and vine- 
gar. Simple oxymel is made in the propor- 
tion of five pounds of honey to seven ounces 
of acetic acid, and eight ounces of water. 

Oxymel of squill is made by mixing four 
ounces of squill vinegar with half a pound 
of honey. 

The above are pleasant and useful prepa- 
rations in some forms of catarrh and cough, 
and may either be used alone, or combined 
with other medicines. 

OXY-MURIATIC ACID.— The old name 
for chlorine. 

OYSTERS. — Respecting the wholesome- 



ness of this well-known shell-fish, much dif- 
ference of opinion exists among medical 
men ; nutritious, especially when uncooked, 
they certainly are, but their digestibility 
in all probability depends greatly upon the 
person by whom they are eaten. Some, 
whose stomachs generally require much con- 
sideration, can eat oysters in moderation 
with impunity: Dr. Paris, however, con- 
demns them for invalids. Oysters have, 
though rarely, like other shell-fish, caused 
symptoms of irritant poisoning. 

OZONE — Is a " substance" of penetrating 
odour, which, according to M. Schonbein, 
who has paid much attention to the subject, 
is constantly liberated in greater or less 
quantity in the atmosphere, according to the 
development of electricity. He has ascer- 
tained it to be generally most abundantly 
developed during winter while there is 
snow, or during stormy weather in summer. 
From these circumstances, and from its pro- 
perties in respect to the respiratory func- 
tions, M. Schonbein is disposed to attribute 
to this substance the production of some of 
those epidemic catarrhs — influenza, &c. — 
Avhich so evidently depend on atmospheric 
causes. By others, ozone is considered to be 
oxygen in a peculiar condition. The subject 
is one of much interest. 

PAIN. — The sense of pain, like other sen- 
sations, originates in the nerves, and very 
generally appears to be located in the parts 
where their ultimate branches terminate ; 
the perception of pain, however, by the sen- 
tient being, must depend upon the brain, 
the sense of it being conveyed to that 
organ by the nerves. This we know, cer- 
tainly, to be the case, for if the nervous com- 
munications with the brain are cut off, as by 
injury to the spinal cord, (see Nerves,) or if 
that organ itself is oppressed, as in stupor, 
there is no sensation, and consequently no 
pain. There may be the appearance of sen- 
sation, and of pain being felt, in consequence 
of reflex action, as explained under article 
Nerves, but it is appearance only. If almost 
any portion of the healthy body, is in- 
jured, pain is felt, because the universally 
distributed nerve branches are injured in the 
process, and, as might be expected, the sen- 
sation is referred to the seat of the injury ; 
but pain being felt in a particular part, or 
as if in a particular part, is not necessarily 
indicative of injury at the place where it is 
felt ; it may arise from irritation of the nerve 
cord which supplies the part, at almost any 
part of its course. This is most strikingly 
exemplified in the cases of persons who have 
suffered amputation of a limb, and who often 



P AI 



382 



PAI 



experience the sensation of pain, as if in the 
member they had lost. Similar, in some de- 
gree, to the above, are the sympathetic pains 
observed in some cases of disease ; such, for 
instance, as the pain at the point of the 
shoulder from affection of the liver, the pain 
in the knee which is so general an accompa- 
niment of hip-disease, or the pain in the legs 
which may result from acid in the stomach. 
Pain, therefore, although a most valuable 
guide in the investigation of disease, is by 
no means an unerring one, and must not be 
too implicitly trusted. 

The faculty or power of feeling pain, the 
" sensibility" of the various parts of the 
animal body, when in a healthy condition, 
varies greatly, depending in a great measure 
upon the supply of nerves they receive ; thus, 
such parts as bones, tendons, ligaments, &c. 
are generally but little sensitive ; when, how- 
ever, they become inflamed, they are acutely 
so. Further, it would seem that certain 
affections of the central parts of the nervous 
system greatly increase the sensibility to 
pain, as well as diminish it, more particu- 
larly affection of the spinal cord. Such is 
the case in hydrophobia, lockjaw, &c, in 
which every portion of the surface of the 
body becomes painfully sensitive. 

Lastly, in functional disorder, or irritabi- 
lity of the nervous system, such as occurs 
in hysteria, there is often intense suscepti- 
bility to pain, as well as to other outward 
impressions ; but this evidently depends on 
very different causes, and requires very dif- 
ferent treatment from the cases above men- 
tioned. — See Hysteria. Pain is not at all 
times referred to the terminations of the 
nerve ; in neuralgia either of the head or 
face, or affecting the great nerve of the thigh 
and leg — sciatica — the pain is often com- 
plained of in the site of the main cord of the 
nerve itself. 

Pain varies greatly in kind, as all know ; 
it is dull and aching, sharp and cutting, 
throbbing, tingling, smarting, burning, &c, 
these differences depending in some mea- 
sure upon the part affected. Inflammation 
of the skin is generally accompanied with 
pain of a burning, tingling, or smarting cha- 
racter ; that of a " serous membrane," such 
as lines the chest, causes pain that is sharp 
and cutting, which is the case in pleurisy : 
the pain of toothache is dull, aching, and 
throbbing ; the pain of spasm is sharp, but 
distinguished from that of inflammation by 
not being aggravated by pressure. 

It is probable — and cases of hysteria jus- 
tify the supposition — that some persons are 
much more acutely sensible of pain than 
others ; it is certain that some bear it much 



better, both physically and mentally, than 
others. It is sometimes of importance to 
ascertain this ; it may be done at times, by 
remarking, when it is necessary to apply a 
blister, how far the irratibility, either men- 
tal or physical, is excited by it. 

Pain is not an unmitigated evil ; were it 
not for its warning, we should be liable, un- 
wittingly, to inflict all manner of injuries 
upon our bodies. We see this in cases in 
which the sensibility to pain is impaired or 
destroyed, in consequence of disease of the 
brain, or of paralysis of the nerves of sensa- 
tion. In the former case more especially, as 
has already been alluded to in this work, 
serious results may follow forgetfulness of 
this fact ; the feet, either of an adult or of a 
child, may be parboiled, or a mustard plas- 
ter may be kept on the skin till the most 
severe effects are produced, simply because 
the warning symptom of pain is, for the time 
being, in abeyance. This is no imaginary 
possibility, and it is one the occurrence of 
which should deservedly bring down the 
censure of gross carelessness upon any one 
under whose management it might happen. 

The absence of sensibility to pain, in con- 
nection with cases of apoplectic stupor, &c, 
is what we may expect. It sometimes, how- 
ever, occurs while the mental faculties re- 
main active ; this, when it does happen, is 
generally after some severe accident, such 
as an extensive burn or the like which 
seems to overwhelm the nervous system. In 
such cases the severest operations may be 
undergone without suffering, but the symp- 
tom is one of the most fatal import. 

The presence or absence of pain, or its 
alleviation, is by no means a light considera- 
tion in the treatment of disease ; the mere 
sensation of it exerts a great call upon the 
system, and it is quite possible — indeed the 
author has, he believes, seen it — for a person 
to die from severe pain alone : hence the in- 
estimable value of those modern discoveries, 
the anaesthetic, or pain-relieving powers of 
chloroform and ether, which, by saving a 
patient the exhausting shock of the pain of 
a severe surgical operation, place him in a 
much more favourable condition for recovery 
than he would be without their aid — a con- 
sideration which far outbalances the few and 
far-between fatal accidents which have un- 
deniably followed the use of the above agents. 
It is the fact of the exhausting tendency of 
pain which renders opium so valuable a 
medicine, and one the existence of which 
so abundantly testifies of the beneficence of 
our Creator, who, in conferring upon man 
the liability to suffer from the warning pang 
of pain as a necessary adjunct to his present 



P AI 



883 



PAL 



being, lias also given the means of its alle- 
viation. 

Although, however, it may be advisable in 
most cases to alleviate or annul pain, and 
when it is very severe, imperative to do so, 
it is possible to sacrifice too much to the one 
obj ect. Generally speaking, it is not difficult, 
for a time at least, to overwhelm the sensa- 
tions of pain by powerful doses of anodynes ; 
and although, as far as can be done, con- 
sistent with other means of treatment, suf- 
fering should be relieved, it may not be de- 
sirable totally to annihilate what is, in many 
cases, an index of the progress of a disorder ; 
neither can it be advisable to sacrifice to the 
one object — the alleviation of pain — other 
considerations of more vital and lasting im- 
port. In other words, it would not be right 
to give, for instance, a large dose of opium 
to annul a present pain, with the risk or 
certainty of interfering with some of the se- 
cretions or excretions of the body, such as 
that of the bronchial membrane, the due 
performance of which must be absolutely 
necessary to the ultimate well-being of the 
patient. This point is dwelt upon because 
it is one on which the public require a little 
enlightenment. To unprofessional persons, 
the man who most quickly relieves that 
which every patient thinks the most promi- 
nent symptom of his case — pain — naturally, 
perhaps, appears to be the superior practi- 
tioner to one who does so more slowly ; but 
yet, the latter may be following, by far, the 
safer, and one may add, more conscientious 
practice, and be much more likely to conduct 
his case, in the end, to a successful issue, 
than if he had sunk other considerations 
before the one — the relief of the present 
pain. The relief of pain by anodynes (see 
Anodyne) has been chiefly alluded to in the 
foregoing remarks, these being the remedies 
which were most likely, from their remark- 
able power of subduing pain, to be resorted 
to, to the exclusion of other really more 
important indications and methods of treat- 
ment. There are, however, other means of 
alleviation, which cannot strictly be called 
anodynes, but which may, in many cases, be 
used with much advantage, without being 
open to the objections which hold good against 
opium and the like. Of these, heat, especial- 
ly when combined with moisture, is at once 
the most useful and generally applicable ; 
cold may answer the purpose in some cases, 
but not generally, except in pain affecting 
the head. The position of the body, or of a 
limb, the mechanical support of a painful 
part, either to relieve its natural weight or 
to take pressure off the site of the pain, 
and throw it on some sound texture; the 



abstraction of blood by leeches, or scarifica- 
tions — as shown in the case of the gums, 
which, by relieving the swelling and tension, 
also relieve the pressure upon the extreme 
nerve-branches — and many other remedies 
applicable to the relief of pain, are to be 
kept in mind. Lastly, the kind word and 
the gentle tone are anodynes, which, though 
they may not relieve real pain, will yet, 
either in rich or poor, make it more bear- 
able, and while incapable of harming, give 
the double blessing on them that bestow and 
on them that receive. 

Refer to Nerves — Opium. 

PAINTS and PAINTING.— The inju- 
rious effects exerted upon the health of 
those who occupy newly painted houses or 
rooms is a circumstance too frequently 
overlooked. That living in, and especially 
sleeping in rooms which have been newly 
painted with " oil colours," does occasion 
uneasy feelings, such as headache, &c, most 
can testify; but that the effect produced is 
more than transient uneasiness, is evident 
from the fatal influence the same circum- 
stances exert upon birds, &c. 

Refer to Lead. 

PAINTER'S COLIC — See Colic and 
Lead. 

PAINTER'S PARALYSIS.— See Lead- 
Palsy. 

PALATES.— The palates are divided into 
hard and soft. The former is the rigid roof 
of the mouth, which, commencing behind 
the upper teeth, extends backward, and 
merges into the soft palate, which is a fold 
or curtain of the mucous membrane lining 
the mouth, and from the centre of which 
depends the uvula, a small rounded projec- 
tion which any one may see by examining 
his own throat in a glass. — See Uvula. From 
each side of the uvula proceed two arched 
"pillars" or folds of membrane, an anterior 
and a posterior, between which, on each side, 
is placed the tonsil. — See Tonsil. The soft 
palate, during the act of swallowing, pre- 
vents the regurgitation of food into the nose, 
while, at the same time, the arched pillars 
above described, by closing over the root of 
the tongue, keep the morsel from passing 
back into the mouth. The membrane within 
the mouth, which covers the hard palate, is 
liable to be the seat of small blisters, par- 
ticularly in those who suffer from some forms 
of indigestion ; in such cases, of course, the 
cause, and not the effect, requires treatment. 
— See Indigestion. The hard palate is oc- 
casionally deficient at birth, and to so great 
an extent as to require the introduction of 
a metallic plate to fill up the gap. In such 
cases the fissure often extends through the 



PAL 



884 



PAL 



soft palate, dividing the uvula into two 
parts. These '" congenital " affections are 
usually associated with hare-lip, and, like 
it, require the operative aid of the surgeon 
for their reparation. Fortunately, recent 
improvements in the mode of operating, 
particularly by Professor Fergusson, of 
King's College, have rendered the measures 
resorted to much more generally successful 
than formerly. 

Refer to Nose — Throat — Tonsils — Uvula, §c. 

PALLIATIVES — Are remedial agents 
which aim rather at relieving urgent symp- 
toms than at curing or removing the disease 
which these symptoms indicate. Too often 
it happens that the palliative is all that is 
left for even the highest skill to administer, 
and if that skill cannot hinder the breaking 
of the " golden bowl," or the snapping of 
the ''silver cord" which binds the living 
man to life in this world, it is much to 
be thankful for that there are means and 
remedies which mitigate the pangs of fatal 
disease. There are diseases which baffle 
the most searching investigation, not only 
in the living body but in the dead; and 
there are others which, although recognised, 
are so, only to tell that (in the present state 
of our knowledge) they are beyond the reach 
of human aid to cure. In such, the pallia- 
tive only remains ; and if this be the case 
with educated skill, how often, rather how 
generally, must it be so with the limited 
knowledge of the unprofessional. On this 
account, in a work like the present, ad- 
dressed to the latter, palliative treatment 
occupies a large space amid the remedial 
measures recommended as being " most 
safely usable by those who are put in pos- 
session of the information." 

Refer to Pain. 

PALM-OIL— Yielded by the fruit of a 
species of cocoa-nut, is brought to this 
country as a substance of the consistence of 
butter. It is used as an external applica- 
tion for similar purposes as the olive and 
other oils, but is in no way superior. 

PALPITATION of the HEART— Is un- 
usual action of that organ, of which the 
patient is sensible. It may take the form 
either of a fluttering sensation about the 
region of the heart, perhaps extending into 
the throat, or it may amount to violent 
beating, either regular or irregular. 

The liability of the heart's action to be 
increased by exciting emotions of the mind, 
almost of any kind, whether of fear or of 
joy, renders palpitation a very common 
affection, and when it occurs only under 
occasional circumstances like the above, one 
which cannot be considered otherwise than 



a perfectly natural occurrence. When, 
however, palpitation arises on every trivial 
occasion, either of mental emotion or of 
physical exertion, or without occasion at 
all, as it often does, even during rest in bed, 
then it requires attention, not solely on 
account of the discomfort it gives rise to, but 
because it may lay the foundation of disease 
of the organ which is so constantly subject 
to over-excitement. It has already been 
stated in this work that heart affections 
have been observed to become more common 
after seasons of much public excitement of 
any kind — an effect traceable only to the 
frequent disturbance of the organ by the 
passions or emotions. 

Palpitation of the heart, independent of 
disease, is most liable, indeed is very liable 
to occur in the young of both sexes, and in 
females particularly, soon after the age of 
puberty — in the latter being very generally 
associated with hysterical tendencies ; in 
such cases, it is met with in its most aggra- 
vated forms, and often of such violence as 
to prove truly alarming. In any case the 
tendency to palpitation is more common in 
the nervous temperament, and is increased 
by whatever gives undue predominance to 
that temperament, such as indolence, luxu- 
rious habits, and the indulgence of feelings 
and imagination artificially excited ; and 
having once begun, it is kept up and aggra- 
vated by the continued attention with which 
the mind is apt to dwell upon the ailment. 
The individuals subject to it easily imagine 
themselves the subjects of heart disease, 
watch every motion almost of the heart, 
and thus, under the influence of their own 
imaginary fears, produce the very symptoms 
they dread. This nervous condition (for it 
is generally nothing else) is only to be got 
rid of by those measures which give a more 
vigorous and healthy tone both to mind 
and body. The false excitement of imagina- 
tive literature (if it has been indulged in) 
must be exchanged for a more healthy 
mental aliment, something which calls for 
some healthy mental interest. This must, 
of course, be regulated in some measure by 
the habits and tendencies of the person, but 
where it can be adopted, the pursuit of 
some branch of natural history, botany, 
geology, or any other out-door occupation, 
such as gardening or sketching from nature, 
are the best pursuits ; they occupy the mind, 
and draw it away from its own morbid 
fancies, even in the time of exercise, which 
is rendered doubly invigorating by the men- 
tal excitement which accompanies it. Along 
with these means a system of diet (see Food) 
calculated to give good blood nourishment 



PAL 



385 



PAL 



should be adopted ; heated and ill-ventilated 
rooms, above all things, are to be avoided, 
early hours observed, and if a feather bed has 
been habitually lain upon, a firm hair or wool 
mattrass she aid be substituted. One article 
of diet requires especial mention, as being 
peculiarly injurious in such cases; tea of 
any kind is better avoided, but green tea is 
absolute poison ; coffee is scarcely allow- 
able, and cocoa or milk should invariably be 
substituted for either of the above more sti- 
mulant beverages ; wine or malt liquor may 
be injurious, or the reverse, according to 
the previous habits of the patient and the 
nature of the case ; if depression or debility 
follow tbeir withdrawal, the tendency to 
palpitation is certain to be increased. In 
addition to these measures, regulation of 
the bowels, the use of the shower-bath, or 
better, of the douche down the spine, and 
occasional mustard plasters on the chest 
or between the shoulders, are all useful, 
especially if, as frequently happens in cases 
of aggravated palpitation, any tenderness 
of the spine is found to exist. In cases of 
nervous palpitation, medicine is not much 
called for, unless to remedy other disorders, 
such as indigestion. Some patients derive 
much benefit from a teaspoonful of the 
ammoniated tincture of valerian, taken twice 
or three times a day in water, to which, if 
there is much nervous irritability, ten drops 
of tincture of henbane may be added ; sal- 
volatile in teaspoonful doses is often useful, 
especially if there is much flatulence ; or 
ether, either sulphuric or chloric, may be 
taken in ten or fifteen drop doses, either 
alone or with the above-mentioned remedies. 
The ethers, however, are more generally 
serviceable as remedies during an attack of 
palpitation than when taken regularly. 
When palpitation is habitual and severe, a 
medical man should be consulted, especially 
if the mind is at all uneasy. His examina- 
tion willdetect the real nature of the affec- 
tion, and his advice will be most likely to 
indicate with certainty the remedies which 
will most quickly relieve that which, though 
but a functional disorder, may, if neglected, 
become an organic disease. With respect 
to palpitation dependent on disease of the 
heart, enough has been said in the article 
devoted to the subject of heart disease in 
general. 

PALSY or PARALYSIS— Is loss of sen- 
sation, or of the power of motion, in parts 
naturally possessed of those endowments. 
The affection varies considerably in kind 
and degree. There may be loss of sensa- 
tion merely, either of a part, or the whole 
body, without the power of motion being 
2H 25 



impaired, but this is comparatively rare ; 
generally it is the power of motion which 
is lost or diminished, that of sensation 
being often not affected at all, and when it 
is, only slightly so. Paralysis of motion 
may be confined to a single finger, to part 
of a limb, or to the whole of one. It may 
extend only to the lower extremities, while 
the upper portion of the body is functionally 
unaffected, or one entire side of the body 
may be totally or partially deprived of the 
power of motion. In a few cases it occurs 
that general paralysis of all the muscles of 
voluntary motion has taken place, life being 
carried on for some time by the involuntary 
functions solely. — See Nerves. 

Palsy or paralysis of one side of the body, 
what medical men call "hemiplegia," is 
much more common than the other forms of 
the disease, and may occur at any age, even 
from infancy upward, but is most general 
after middle life, and more frequent in males 
than females ; it takes place under very 
opposite and varied conditions of the sys- 
tem. When a person has suffered from an 
apoplectic attack, the result of effusion of 
blood into the substance of the brain, from 
the giving way of a vessel, if recovery takes 
place, it is very generally trammelled with 
paralysis. — See Apoplexy. 

The rupture of a vessel in the brain is 
one common originating cause of paralysis. 
It is one, however, which may occur without 
there being any decided apoplectic symp- 
toms at all ; there may be slight effusion of 
blood in the head, but not more than causes 
at the moment transient faintness and con- 
fusion. It may be (if the attack occurs 
during sleep) not even that, but either with 
or without it, paralysis is found to have oc- 
curred, either total or partial, and remain- 
ing partial, or gradually increasing for some 
time after its first appearance. Another 
form of paralysis is that arising from a more 
decided state of general debility, in which 
the brain partakes, and in which the struc- 
ture itself gives way. It is often the disease 
of over-worked literary men, or men of 
business, and is apt to end quickly, in a 
softened state of the brain, with mental 
imbecility, and perhaps general paralysis. 
Palsy may, of course, arise from other 
causes which act upon and injure the struc- 
ture of the brain, such as tumours, violence 
to the head, &c, but the above are the most 
common, and are sufficient to notice here. 

Whatever the cause, it is always found 
that when the brain proper is the seat of 
the disorder, the paralysis of the body takes 
place on the side opposite to that portion or 

hemisphere" of the brain which is affected. 



PAL 



386 



PAL 



The symptoms which precede an attack 
of paralysis are so very similar to those 
which have been described as being the 
forerunners of apoplexy, that it is needless 
again to go over them. The most frequent, 
however, is the complaint of numbness and 
prickling sensation throughout a whole limb, 
or affecting only a portion of it, such as a 
single finger. Such symptoms in old per- 
sons, or in the predisposed, should never be 
neglected. 

When a person has suffered from a 
" stroke of palsy," or a " paralytic seizure," 
by which is generally understood the para- 
lysis of motion on one side the body, the 
loss of power may be complete, the arm 
and leg lie perfectly inert as far as the will 
is concerned, and the face is generally more 
or less affected in a severe case, the side on 
which the paralysis exists having a rather 
relaxed appearance, while the features are 
drawn toward the other, in consequence 
of the muscles of the sound side still con- 
tinuing active, and being unresisted by 
those on the paralyzed side. This is much 
more visible under any of the mental emo- 
tions which usually affect the features, such 
as laughing, the muscles on the sound side 
only acting, while the paralyzed side of 
the face remains perfectly unmoved. Under 
this condition of circumstances, the speech 
is affected, articulation is thick in conse- 
quence of one side of the tongue being 
also paralyzed, so that when this organ is 
protruded it is drawn to one side : swallow- 
ing is at the same time in some degree im- 
perfectly performed. 

These are the symptoms of a severe attack 
of paralysis, but they are often developed 
in much less intensity ; the leg alone may 
be affected, or the leg and arm, leaving the 
face and head intact, and the mind per- 
fectly clear. In a great number of cases 
the paralytic symptoms, after reaching a 
certain point, go no further, remain station- 
ary for some time, and then begin to amend ; 
the arm and leg recover power, the features 
regain their wonted expression, and the 
speech is well articulated. This amend- 
ment may go on to complete recovery ; but, 
generally, it stops short of this, and the 
person, though comparatively well, is not 
fully restored ; the leg is not lifted as for- 
merly in walking, but drags a little ; the 
hand and arm do not regain their former 
skill and accuracy in executing accustomed 
acts, such as writing, even though the face, 
if it has been "drawn," is perfectly re- 
stored. In this state of partial recovery 
numbers continue for years capable not 
only of enjoying life, but of executing 



many or most of its duties. It is a state, 
undoubtedly, which requires care in diet, 
and in exertion, whether physical or mental, 
and which involves many restrictions and 
self-denials, but none perhaps to which a 
well-regulated mind will not cheerfully sub- 
mit. Indeed, it does happen that individuals 
who, previous to an attack of paralysis, 
have been dyspeptics, or invalids under a 
lax system of living, finding, after its occur- 
rence, the vital necessity of greater careful- 
ness, absolutely enjoy better general health 
than previously. 

When a portion of the body, such as the 
arm, remains permanently paralyzed, it 
usually, after a time, wastes in muscular 
bulk, partly owing to the want of exercise 
which necessarily occurs, but partly also to 
the diminished power of the blood circulat- 
ing through it, which certainly takes place. 
The difference in the power of the pulse in 
a sound and in a paralytic arm is very per- 
ceptible, and experiment has demonstrated 
that in the latter the animal temperature is 
habitually lower. In connection with these 
conditions of paralyzed limbs, it should be 
borne in mind that they have less power of 
resisting differences in heat or cold ; a varia- 
tion in temperature which would not affect 
a sound limb being apt to injure a para- 
lytic one ; water which would not be too 
hot for the former, producing a scald in the 
latter. In addition to the local effects of 
paralysis, there are general ones which often 
accompany the condition: these are usually 
connected with the excretions ; the bowels 
particularly are apt to be very costive, and 
to require much care. 

The mind may not be much affected at 
first, not perhaps for years, but the temper 
is apt to become irritable, a point which 
ought to be remembered with indulgence 
by others. As age, however, advances, in 
most cases, the memory fails, and the mind, 
even the most powerful, becomes gradually 
weakened. It is enough to recall to the re- 
collection the touching accounts of the last 
days of some of our great men, such as 
Walter Scott, who have suffered from para- 
lysis, to illustrate this fact. 

Such are the best-marked symptoms 
which accompany and follow that very 
common disease, a "paralytic stroke," the 
disease of the mental labourer. Many of the 
warning symptoms of paralysis have been 
detailed under the head of apoplexy, and 
the precautionary measures pointed out ; in 
the same article too the means recommended 
to be adopted in the different forms of apo- 
plexy, either threatened or actual, will ap- 
ply to the severer cases of paralysis. When 



PAL 



387 



PAL 



a person becomes affected with paralysis 
without apoplexy being developed, when 
debility, faintness, and loss of power are 
the most prominent symptoms, it is not 
often that very active treatment is required : 
the cause of the disease is probably beyond 
the reach of art to remove, and the object 
must be to place the system in a state which 
will in no way favour a return or increase of 
the attack, but which will give every chance 
of recovery by the natural powers of the 
system. If the attack of paralysis has oc- 
curred in a person of very full habit, the 
chances are that apoplexy has accompanied 
it, and if so, depleting measures will pro- 
bably be requisite : these, of course, should 
be, if possible, under medical direction ; 
but if this is unattainable at the time, they 
may be carried out as recommended, and 
under the precautions enjoined in the case 
of apoplexy. 

When the attack of paralysis is accom- 
panied with faintness and only partial loss 
of consciousness, in the absence of medical 
assistance, a teaspoonful of sal-volatile in 
a little water will be as suitable a remedy 
as any other, and may be repeated once or 
twice in the course of the first hour or two. 
If the depression continues, the individual 
should be placed in bed with head and 
shoulders tolerably well elevated, and kept 
perfectly quiet ; if the bowels are confined, 
a gentle aperient of castor-oil, or of rhu- 
barb and magnesia, should be given, and 
light nourishment, tea, gruel, and the like. 
The warmth of the feet, and particularly of 
the affected side, must be strictly attended 
to. If, either at the time of the seizure, or 
afterward, there is much pain in the head, 
flushing of the face, and appearance of ful- 
ness, leeches, from six to eighteen, may be 
applied, or half-a-pint of blood taken from 
the back of the neck by cupping ; but in 
these cases much caution is always re- 
quired in the abstraction of blood. In such 
a case as the last more active purging will 
be admissible. Mustard plasters to the 
calves of the legs may in some cases be ad- 
vantageous. The great essential, however, 
is the most perfect quietude ; with this, 
time will be the best restorative, the diet 
being kept light and free from stimulants, 
and the bowels attended to. If the urine 
become scanty in quantity, cream of tartar 
drink (imperial) will be of service, or five 
grains of carbonate of potassa, with five 
grains of nitrate of potassa, may be given 
twice a day in a wineglassful of water. 
Moderate friction with the hand to the 
affected side is not only soothing and com- 
fortable in most cases, but probably expe- 



dites the returning strength. Exertion of 
any kind must be very slowly and gradually 
resumed ; but all this will be regulated by 
a medical attendant, under whose care the 
case must be placed. In some cases of 
severe paralysis the natural functions are 
performed involuntarily, and much trouble 
is required to preserve cleanliness. 

The case in which the lower limbs are 
paralyzed, the upper portions of the body 
being unaffected, is named "paraplegia." 
It may be owing to disease in the brain, 
but is more generally caused by disease or 
injury to the spinal marrow. — See Nerves. 
It is generally a very hopeless disease. 
When the result of injury, the symptoms 
are of course developed at once, and, in- 

I deed, are so in some cases of disease ; but 
generally they come on gradually, with 
weakness of the lower limbs or starting in 
them, very often with a sensation as if in- 
sects were crawling over the skin. Such 
cases always imperatively call for proper 
medical assistance ; in them unprofessional 
persons can do but little beyond attend to 
comfort in position, to cleanliness, which 
is apt to be much interfered with, and to 
the prevention of bed-sores, &c, which are 
are very apt to form. — See Bed. 

Cases of local palsy are not uncommon ; 
of these, the disease, amaurosis, already 
treated of, which is a palsy of the nerve of 
sight, is an example. One hand is not un- 
commonly affected with paralysis in the 
course of a single night ; the affection is 
generally attributed to pressure having been 
in some way exerted upon the nerves during 
the time of sleep ; a blister on the forearm 
will very often remove the symptom at once ; 
it is better, however, to apply to a medical 
man for advice, for the attack may depend 
on other causes. Paralysis of one side of 
the face, depending upon injury to the nerves, 
and sometimes resulting from exposure to 
cold, when it occurs, is apt to excite more 
than needful alarm. When the result of cold, 
one or two doses of calomel and colocynth, 
or calomel and compound rhubarb pill, a 
blister and a grain of quinine three times a 
day, are the best remedies. 

In the Journal of Psychological Medicine, a 
case of paralysis of the tongue, the result of 
a violent fit of passion, is recorded. The 
power of articulation was lost for some days, 
but returned under the use of electricity. 
Workmen in lead, and, according to some, 
those who are exposed to the influence of 
mercurial or arsenical vapours, are apt to 
suffer from paralysis of the hand, "dropt 

| hand," as it is called. 

J Lead palsy usually occurs in those who 



PAN 



388 



PAS 



have "been long exposed to the influence of 
the poison, and the majority of those at- 
tacked have suffered from lead colic. The 
attack is preceded by lassitude and feeling 
of numbness, and by stiffness of the parts 
about to be affected, the loss of power gra- 
dually coming on. In a few cases, loss of 
sensation is also observed. Lead palsy is 
not confined to the hand and arm, but affects 
other portions of the body, although the 
former is its most frequent site. The most 
dangerous form of this disease affects the 
muscles of respiration which move the ribs, 
and proves quickly fatal. No treatment 
likely to be effectual could be undertaken by 
unprofessional persons, and the disease is not 
one likely to occur apart from medical aid. It 
is well here to reiterate the caution to those 
who are employed amid lead or its prepa- 
rations, that they should observe the utmost 
cleanliness, especially at meals, for there is 
good reason to believe that the poison often 
finds its way into the system from careless- 
ness on this point. — See Colic, Lead, §c. 

Shaking palsy, in one form, is generally 
the result of old age ; in another it is more 
traceable to direct disease of the brain, and 
is very apt to occur in those who have drunk 
freely. It comes on very insidiously, and 
even under the best care is a very hopeless 
affection as regards cure. This is a different 
affection from the "mercurial tremour," with 
which those who work in that metal, such as 
gilders, are liable to be attacked. 

Kefer to Apoplexy — Nerves, fyc. 

PANACEA. — A remedy capable of curing 
all diseases — it is, perhaps, needless to add, 
an imaginary one — a " myth." 

PANADA. — A food for children and inva- 
lids, best made by boiling for a length of 
time in water, or milk and water, thin slices 
of bread previously well dried in the oven. 
— Refer to Children. 

PANCAKES.— The well-known article of 
food ; they are unsuitable for invalids. 

PANCREAS.— The pancreas (fig. civ. 1) 
Tig. civ. 




is a narrow gland from six to seven inches in 
length, which is situated behind the lower 
portion of the stomach, (fig. civ. 2.) It is 
sometimes compared in shape to a dog's 
tongue. It secretes a fluid somewhat re- 
sembling the saliva, which is poured into the 
duodenum (fig. civ. 3) through a "duct," 
which enters the bowel by the same opening 
as that which conveys the bile, the two fluids 
mingling with the digested food pulp, or the 
chyme, at the same time, and neutralizing 
its acid properties. 

Refer to Alimentary Canal — Digestion. 

PAPILLA — Is a small eminence upon the 
surface of an organized body. The minute 
points visible upon the tongue are called 
the papillse. 

PAPIN'S DIGESTER.— See Digester. 

PARALYSIS.— See Palsy. 

PARAPLEGIA.— Palsy of the lower por- 
tions of the body. — See Palsy. 

PAREGORIC, or Paregoric Elixir. — An 
anodyne. English paregoric is also called 
" camphorated tincture of opium," or com- 
pound tincture of camphor ; of this, half an 
ounce contains one grain of opium. Scotch 
paregoric, also called " ammoniated tinc- 
ture of opium," is four times the above 
strength, containing four grains of opium in 
every half-ounce. These preparations should 
be purchased ready made. 

Refer to Opium. 

PARENT. — See Hereditary — Marriage 
— Idiocy, &c. 

PARIETAL BONE.— See Skull. 

PAROTID GLAND— Is one of the glands 
which secrete the saliva. It is situated a 
little below and in front of the ear, and fills 
up the space beneath the "angle" of the 
lower jaAV. Its "duct," which conveys the 
saliva into the mouth, opens between the 
gum and the cheek opposite the second dou- 
ble tooth. It is this gland which is swollen, 
inflamed, and painful, in the "mumps." 

PAROXYSM. — A periodical accession or 
aggravation of certain symptoms of a disease; 
an attack of toothache may be called a pa- 
roxysm ; there are paroxysms of ague, of 
mania, &c. 

PARSNIPS — Contain a considerable pro- 
portion of saccharine matter, and are nutri- 
tious, but often disagree with weak stomachs. 
They are considered diuretic. 

PARTURITION.— See Child-bed. 

PASSION.— It is sufiicient here to allude 
to the serious effects which may follow the 
indulgence of violent passion. Those who 
give way to it are often themselves sensible, 
either during the paroxysm or at its close, 
of unusual sensations about the region of 
the heart. There can be no question that 



PAS 



389 



PEA 



this important organ is much influenced by 
these violent mental emotions, one of which 
may lay the foundation of that disease which 
another may ripen into sudden death. And 
what a death ! 

PASTRY.— See Confectionary. 

PATELLA. — The knee-cap, or knee-pan, 
is the small, somewhat oval, or heart-shaped 
bone, which is contained within the tendon 
of the " extensor" muscles of the lower ex- 
tremity, serving at once to protect the im- 
portant joint which it covers, and to give 
proper direction to the muscular power on 
the forepart of the limb. The knee-cap is 
very liable to be fractured, or rather torn 
across, in falls where the individual, in the 
endeavour to save himself, violently exerts 
the muscles of the limb ; a painful shock, as 
from a blow, is felt, and the power of extend- 
ing or advancing the limb is instantly lost. 
"When examined, the deficiency occasioned by 
the absence of the upper half of the knee- 
cap is at once apparent, this being drawn 
more or less up the forepart of the thigh by 
the action of the muscles. When the knee- 
cap is broken, as it sometimes is by direct 
violence, the displacement is not so great, 
but the accident is generally more serious, 
owing to the violence injuring the knee-joint 
generally. The treatment of transverse frac- 
ture of the knee-cap might, with care, be 
managed by an Unprofessional person in the 
absence of a medical man. The principal 
object in the treatment of this accident is, 
to remedy the displacement or drawing up- 
ward of the upper fragment of the bone, 
which takes place in consequence of the 
muscles of the thigh, with which it is con- 
nected, being set free from the counteracting 
power of their attachment to the upj)er part 
of the bone of the leg, their common tendon, 
in which the knee-cap is imbedded, being 
torn through, as well as the bone. 

It must be evident to any one, that by 

placing the limb as represented, (fig cv.,) by 

which the aforesaid muscles are rendered 

lax, not only will their tendency to draw 

Fig. cv. 




up the upper fragment be obviated, but 
the position will permit of the bone being 
again brought down to its proper place. 
Accordingly, the first part of the treatment 
2 h2 



of this accident is to place the entire lower 
limb, as represented, on an inclined plane 
made of any convenient material, and cush- 
ioned of course ; this being done, and the 
displaced fragment drawn as nearly as pos- 
sible into its natural position, and in contact 
with the lower fragment which does not un- 
dergo displacement, some additional means 
must be employed to keep the parts steady. 
For this purpose, many different kinds of ap- 
paratus have been used ; probably the most 
easily managed will be the simple one re- 
presented in the cut. This is formed by 
laying a strip of stout bandage, longitudi- 
nally, on each side of the injured bone, (cv. 
1;) these strips are then secured by a few 
turns of two circular bandages, (2, 2,) 
passed, one round the lower part of the 
thigh, the other round the upper part of the 
leg close above and below the fractured 
bone : the ends of the longitudinal bandages 
(1) being then tied, the apparatus is com- 
plete. It will be advisable to add to the in- 
clined plane some additional protection, as 
represented by the dotted line, (3,) to obviate 
the chance of the limb slipping off the ap- 
paratus. It has been observed that those 
who have suffered fracture of one knee-cap 
are more liable than others to suffer from a 
similar accident on the other leg. This is, 
probably, accounted for by the fact, that in 
a large proportion of cases, the two frag- 
ments ^of the "patella" which has been 
fractured are not perfectly closely united, 
and that the person is, therefore, more liable 
to suffer a fall similar to that which pro- 
duced the first accident. Some individuals, 
moreover, are more liable to suffer from 
rupture of the tendons generally than others. 
The knee-cap sometimes suffers displace- 
ment. — See Knee. [After such an accident, 
the patient should wear a laced knee-band- 
age for several weeks.] 

PATENT MEDICINE.— See Quackery. 

PATHOLOGY.— The science of the nature 
of disease. 

PEA. — The common garden pea, in its 
fresh or green state, and when eaten young, 
is wholesome and digestible ; but when it has 
advanced toward ripening, the outer skin 
becomes very tough and indigestible, and 
passes through the bowels unacted upon 
by the" digestive organs — in this condition 
it is very liable to lodge in the folds, or 
" sacculi," of the colon, or large bowel. If 
old peas are eaten regularly, and the bowels 
are at all torpid, a large accumulation of 
these pea-skins may take place, and at 
length give rise to troublesome irritation 
and diarrhoea. A dose of compound colo- 
cynth pill, or of castor-oil, is the best 



PEA 



390 



PEL 



remedy. — See Diarrhoea. Peas in their 
young state contain a considerable amount 
of saccharine matter, but, when ripe and 
Ay, they, like others of the leguminous or 
pulse tribes, contain much vegetable caseine 
— analogous to the curd of milk ; indeed, so 
largely is this the case, that the Chinese 
make from peas a kind of cheese, which 
can scarcely be distinguished from that 
made from milk curd. Dried peas can, 
of course, only be used as human food with 
advantage when reduced to softness, or 
when ground into flour ; when thus ren- 
dered digestible, they contain more real 
nutriment, that is plastic matter, adapted to 
building up the animal frame, than even wheat 
or oats. — Refer to Diarrhoea — Grains, Sfc. 
^ PEACH— The well-known fruit, is, when 
ripe, sufficiently digestible if eaten in mode- 
ration. The peach tribe derive their chief 
interest, in a medical point of view, from 
the hydrocyanic, or prussic acid, which is 
obtained from various parts of the plants by 
distillation. Peach-kernels yield it largely, 
also the blossoms and the young leaves ; 
preparations from these, therefore, must be 
employed with great caution. An infusion 
of the dried leaves of the peach has been 
used in cases of worms. 

PEARS — Are apt to disagree with many 
persons. 

PEARL-BARLEY.— See Barley. 

PEDICULL— See Acari, 

PELVIS — Literally, means a bas*n, the 
term having been given to this particular 
region of the body from its fancied re- 
semblance to that utensil. The pelvis (fig. 
cvi.) is the irregular structure of bone 
which supports the spine, at 1, and which 



Fig. ctL 




rests upon the thigh bones, the round 
"heads" of which are fitted into the cups, 
or cavities, 2, 2. — See Hip. The pelvis is 
composed essentially of three different bone 



masses ; two of these, the "ossa innominata" 
(3, 3,) form, together, the sides and fore- 
part of the pelvic cavity, being united in 
front, (4.) The back part of the pelvis is 
formed by the " os sacrum" (5,) a trian- 
gular bone, which fits like the wedge or 
key-stone of an arch between the two side 
bones of the structure. On the top of this 
bone, which appears, and may be regarded 
to be a number of vertebrse, or spine bones, 
cemented together, the spine is placed ; its 
central canal or cavity, which encloses the 
spinal marrow, being continued down the 
centre of the sacrum — in which the holes 
(7, 7) give passage to small nerves. The 
side bones, (6, 8,) although in the adult 
they are united into one piece, are not so 
in early life, but are in three divisions : for 
the sake of convenience in describing, &c., 
anatomists retain these distinctions even in 
the adult bone. A little consideration will 
show any one how much strength is im- 
parted to the important bony construction 
above described, which is, moreover so 
placed or balanced, with respect to other 
portions of the body, as to throw the weight 
on those portions of itself best calculated 
to sustain it, and the whole upon the thigh 
bones in the most advantageous manner 
possible. Further, the whole structure of 
the pelvis is made as light as can be com- 
patible with strength. The sacrum bone 
(5) is the lightest bone of the body for its 
size ; and, in the arrangements of these 
pelvic bones generally, wherever ligament 
can be substituted for bone, we find it is so ; 
thus, for instance, the two holes (9, 9) in- 
stead of being filled up with bone, have mere- 
ly a thin, light ligament stretched across. 

There is considerable difference in shape 
between the male and female pelvis ; the 
latter being more broad, ample, and ex- 
panded than the former, in every way — a 
matter of necessity in child-bearing par- 
ticularly, so as to afford sufficient room 
for the passage of the infant, the head of 
which is, for the most part, adapted to pass 
through the pelvic cavity by a series of 
turns. The near adaptation, in most cases, 
of the infant head to the passage through 
the almost unyielding pelvic bones, must 
obviously make it a matter of the highest 
importance, that in the female these bones 
should attain their full expansion and de- 
velopment; this they do in the majority of 
instances, but in some cases, particularly in 
consequence of disease, the room afforded 
in the pelvis becomes seriously diminished, 
so as to make ordinary child-birth impos- 
sible. In such instances, the life of the in- 
fant is almost certain to be sacrificed, and 



PEN 



391 



PER 



that of the mother to be put in great ha- 
zard ; in either case, a contingency which 
none should incur knowingly. If, therefore, 
either in consequence of disease in early 
life, such as rickets, or of natural deform- 
ity, or accident, there is reason to suspect 
deformity of the bones of the pelvis, the 
female who is the subject of it should not 
enter into the bonds of marriage, without 
its first being ascertained that child-bearing 
is possible without danger to life, and this 
can.be ascertained by medical examination. 
If, after marriage, causes previously undis- 
covered, or which have come into action 
afterward, should render ordinary child- 
birth hazardous from contraction of the 
pelvis, there yet remains the possibility of 
a living child being preserved by the induc- 
tion of premature labour ; it is, however, a 
question, how far it may be right to enter 
into marriage under such a proviso. The 
cavity of the pelvis is inferior to, but con- 
tinuous with that of the abdomen ; the 
contents, or "viscera," of the two being 
continuous. — See Abdomen. Fracture of the 
bones of the pelvis occasionally occurs in 
consequence of accident. It is always a 
serious mishap, from the circumstance that 
the violence which is capable of fracturing 
these strong bones must, in all probability, 
injure some of the important parts — the 
bladder especially — which they naturally 
surround and guard. The accident is not 
likely to be detected by an unprofessional 
person: if suspected, ^soothing measures to 
the painful parts, hot fomentations, poul- 
tices, and leeches would be advisable ; the 
body being placed in the most easy position, 
and, perhaps, a bandage a foot broad sewed 
round the hips — surgical assistance being 
procured without delay. 

Refer to Abdomen — Bladder — Hip — Spine, 
$c. 

PENNY-ROYAL— Is one of the mint tribe, 
found in wet places in England, and in Eu- 
rope generally, [as well as in the United 
States :] it was formerly much more esteem- 
ed than it is now. It possesses the same 
properties as the mints generally. It is said 
to have the power of driving away fleas. 

PEPPER. — Four species of the peppers 
are used by man — two dietetically and partly 
medicinally, the black and long peppers ; 
two strictly medicinally, the cubeb pepper, 
and the matico. — See Cubebs — Matico. Long 
pepper occurs in the form of cylinders, from 
an inch to an inch and a half in length, these 
being made up of numerous little pepper- 
corns, or berries, compacted together ; it is 
often used as a substitute for the next spe- 
cies, the black pepper, both being brought 



from the East Indies and from the neigh- 
bouring islands. 

Black pepper is the fruit of a trailing 
plant, the berries being produced on spikes 
or stalks to which they closely adhere. 
When half ripe they are red, and in this 
state are gathered ; in drying they become 
black and shrivelled, assuming the form of 
the common black pepper corns. When 
allowed to ripen, they are divested of their 
husks, and then form white pepper, which 
is milder than the black. The aromatic, 
stimulant, and carminative properties of 
pepper are too well known to require de- 
scription : they may often be conveniently 
taken advantage of when stimulants are 
required ; ten to twenty grains of ground 
black pepper may be given at once, if given 
in milk. Black pepper has been used as a 
remedy in ague, and might be tried in the 
absence of other more certain medicines. 
A confection of black pepper is used as a 
remedy in piles. Peppers, even when whole, 
are liable to adulteration ; still more when 
ground. In the investigations of the Lancet 
Sanitary Commission, it is stated, "Some 
years since it was not uncommon to meet 
with artificial pepper-corns." " This spu- 
rious pepper was made of oil-cake, common 
clay, and a portion of Cayenne pepper, 
formed into a mass, and granulated by being 
first pressed through a sieve, and then rolled 
in a cask." Of course the adulterations of 
ground pepper are more easily effected. In 
the report of the above investigations, an 
extract from Mitchell's "Treatise on the 
Falsification of Food," states, "In the state 
of powder, pepper is nearly always adulter- 
ated, substances being sold for the express 
purpose. It is often mixed with the pow- 
dered husks of mustard, which are openly 
sold for this purpose, as is also the sweep- 
ings of the pepper warehouses, under the 
name of ' P. D.,' or pepper dust." In addi- 
tion to the above, linseed-meal, wheat-flour, 
pea-flour, and sago-meal, are also used to 
adulterate ground pepper, and were detected 
in various samples by the Lancet commis- 
sioner. Jamaica pepper, or Allspice, is an 
agreeable aromatic, applicable to the same 
purposes as aromatics generally. The pow- 
der may be given in doses of from ten to 
thirty grains. 

Refer to Capsicum. 

PEPPERMINTS.— See Mints. 

PERCUSSION— In medicine is the pro- 
cess of eliciting sounds from any portion of 
the body by striking upon it, or some inter- 
posed medium, by means of the fingers, or 
by an instrument adapted for the purpose. 
The object of eliciting those sounds, and 



PER 



PER 



the mode in which, to the educated ear, 
they give information of the condition of 
the parts beneath, has been sufficiently ex- 
plained in the article Lung. 

PERFORATION.— The term in medicine 
is chiefly used to express the formation of 
an aperture in some portion of the coats 
of the alimentary canal, which allows the 
escape of a portion of the contents of the 
stomach or bowels into the cavity or sac of 
the "peritoneum," thereby causing ago- 
nizing pain, severe inflammation, and in 
almost every instance death. As the escape 
of a small portion of the contents of the in- 
testines is sufficient to occasion these severe 
symptoms and fatal consequences, a very 
small opening may be the occasion of death. 
The most common sites of the perforation 
are the stomach, or the small boWel near its 
junction with the large — in the latter case 
usually occurring in the progress of fever, 
and being occasioned by ulceration. The 
occurrence of perforation in the stomach is 
often for some time preceded by dyspeptic 
symptoms, pain, especially after food, and 
perhaps vomiting. Females, especially those 
of a weak, lymphatic, or scrofulous consti- 
tution, are more liable to it than males ; 
but it may happen in all constitutions, and 
without previous symptoms. When perfora- 
tion occurs, and the contents of some part of 
the intestines escape, there is sudden, intense, 
agonizing, burning pain, perhaps vomiting, 
and there is extreme depression or collapse 
of the system generally. In such a case, 
the hope of saving life is very faint, even 
under the most skilful treatment, and of 
course a medical man should at once be 
procured. All that unprofessional persons 
can do is to mitigate the intense agony, 
which opium alone can relieve. Full doses 
of whichever of its preparations are most 
easily procurable may be given, and re- 
peated at short intervals until some relief 
is obtained. Heat to the bowels may afford 
some comfort. If there is much vomiting, 
the opium will, as in all similar cases, pro- 
bably be best retained if given solid, in the 
form of pills — of one grain each. in such a 
case — opiate clysters, containing each thirty 
to forty drops of laudanum may be service- 
able. When there is great depression, if 
the person survives some time, stimulants, 
wine or brandy, are given. 

Refer to Inflammation. 

PERICARDIUM.— The bag in which the 
heart is enclosed. — See Heart, Carditis, $c. 

PERICRANIUM.— The membrane which 
invests and adheres to the bones of the 
skull ; in other bones the corresponding 
membrane is named the periosteum. 



PERINEUM.— The space at the fork of 
the lower limbs between the fundament and 
the generative organs. 

At this spot the operation of cutting for 
the stone, in males, is usually performed. 
Falls, with the legs astride any body suffi- 
ciently narrow to allow it to bruise the peri- 
neum, are apt to be followed by serious 
consequences, bloody urine or complete 
stoppage. For the same reason, the prac- 
tice of "hoisting," carrying an individual 
astride upon a piece of wood, either in the 
way of practical joke or punishment, is 
seriously to be condemned. 

PERIODICITY.— The recurrence at regu- 
lar intervals of marked phenomena in the 
progress of vegetable or of animal life, is 
at once one of the most interesting, one of 
the most certain, but at the same time — as 
to cause — one of the most obscure facts in 
the range of scientific inquiry. Among 
plants a daily periodicity is so well marked, 
both as regards their opening and their 
closing, that it is familiar to all: even the 
children know when the daisies and the 
clover " go to sleep ;" and the famous Lin- 
nasus constructed, or rather arranged, what 
he called the floral clock, from the times of 
the opening and shutting of certain plants. 
It is sufficient to allude to the different but 
regular times of leafing and flowering of 
tree and plant, to the certain returns of 
"seed-time and harvest," to confirm that 
what holds good in the revolution of the 
twenty-four hours does so throughout the 
year. In the animal kingdom periodicity 
is equally well marked : each kind carries 
its young a certain time ; with slight varia- 
tion, the changes from the cradle to the 
grave in man, progress in well-marked 
periodical order. What is observed in 
health is seen also in disease. The regular 
return of the paroxysm in the quotidian, 
the tertian, and the quartan ague ; the re- 
gularity with which the eruptions of scarlet 
fever, small-pox, or measles, appear and 
decline, all tell of the same thing ; the 
nightly hectic of the consumptive patient 
does so also. These are well-marked in- 
stances, so much so, that they cannot fail 
to attract attention ; but there are, doubt- 
less, numberless others in the progress of 
disease, equally interesting and important, 
but unobserved. The causes of periodical 
changes are generally very obscure ; some, 
unquestionably, such as the lunar influences 
upon the tides, the effect of prolonged heat 
and light, as from the sun, in stimulating 
vegetation, we can readily distinguish and 
appreciate, but the majority are beyond 
our ken. Some may be connected with the 



PEE 



393 



PER 



hidden springs of life, others are more than 
probably linked with the barometric and 
electric changes which are continually 
going on in the diurnal revolution of the 
twenty-four hours. The following table, 
drawn up some years since by Dr. Laycock, 
of York, in some degree indicates the nature 
and connection of periodical changes : — 

Table of the Meteoric and Physiological Events 
occurring at the Barometric hours, during a 
solar day of twenty-four hours. 
4 to 5 o'clock a.m. 

Barometer at its minimum height. 

Minimum of electric tension, nearly. 

Intermediate minimum variation east of 
magnetic needle. 

Minimum of temperature. 

Hour at which several flowers bloom. 

Certain moths escape from the chrysalis. 

Minimum consumption of oxygen. 

Onset of cholera, epidemic diarrhoea, Egyp- 
tian ophthalmia, and quotidian ague. 

Period of increased excitement in the 
insane commences. 

Hours of alleviation of symptoms and of 
sleep in hectic and infantile fever. 
4 to 5 o'clock p.m. 

Barometer at its minimum height. 

Minimum of electric tension. 

Minimum variation east of magnetic needle. 

Certain moths escape from the chrysalis. 

Termination of a paroxysm of quotidian 
ague. 

Onset of a quartan agtfe. 

Exacerbation of fevers ; accession of hectic 
fever. 

Period of increased excitement in the in- 
sane begins. 

8 to 10 o'clock A.M. 

Barometer at its maximum height. 

Maximum of electric tension. 

Maximum variation east of magnetic needle. 

Maximum excitability of the circulation. 

Maximum of muscular power. 

Period of increased excitement in the in- 
sane, ends. 

8 to 10 o'clock p.m. 

Barometer at its maximum height. 

Maximum of electric tension. 

Maximum variation east of magnetic needle. 

Meteoric lightning and thunder storms 
appear. 

Certain insects escape from the chrysalis. 

Consumption of oxygen at its minimum. 

Minimum of muscular power. 

Minimum excitability of the circulation. 

Hour of natural sleep. 

Period of increased excitement in the in- 
sane ends. 

Paroxysm of a quartan ends, 



In connection with the above, Dr. Lay- 
cock remarks, "What effect have barometric 
variations on animal life, and especially on 
the phenomena of epidemics?" Huxham 
specially refers to the phenomena of inter- 
mittent fevers as being probably influenced 
by barometric variations through the vary- 
ing pressure of the atmosphere on the veins. 
More recently, Sir D. Barry took up both 
the pathological and phj-siological views of 
Huxham, and in the same spirit observes — ■ 
"1st. It being now evident that the blood 
in the veins is placed under the influence of 
atmospheric pressure, it would be curious 
to trace the connection which appears to 
exist between diseases generally, intermit- 
tent fever for example, and the daily atmo- 
spheric variations. The reader will see at 
once that facts countenance these specula- 
tions. 2d. Has the electricity of the air 
or the magnetism of the earth any influence 
on vital phenomena ? If any, we may infer 
d, priori that the results would be seen in 
the nervous system. Now, according to the 
table, the period of increased excitement in 
the insane commences when the electric 
tension of the air and the variation east of 
the magnetic needle are at a minimum, and 
vice versa. The unpleasant influence of 
thunder-storms is well known to persons of 
nervous temperament, and to those predis- 
posed to disease of the nervous system ; and 
as these occur most usually in the evening, 
we should look for nervous attacks at that 
time. 

The whole subject of periodical changes 
has hitherto been too little attended to, 
when its importance and the magnitude of 
the scale on which these changes take place 
are considered. Under the article Influenza 
it was stated that, during the occurrence 
of that epidemic, remarkable barometric 
changes were observed. 

PERIOSTEUM. —The membrane which 
closely adheres to, and invests the bones, 
except at their articular or joint-forming 
surfaces. — See Bone — Node, §c. 

PERISTALTIC— The contractile, worm- 
like movements of the intestines. 

PERITONEUM.— The peritoneum is the 
" serous" membrane which lines the abdo- 
men, covering both its walls and its contents 
— the viscera. The peritoneum is, in its in- 
terior, what is called a "shut sac." It con- 
tains simply the serous fluid which it se- 
cretes, and which facilitates the movements 
of its interior surfaces, and, consequently, 
the various movements of the bowels, &c. 
upon each other. The parts which the pe- 
ritoneum covers, all lie exterior to its cavity, 
the outer sides of the "sac" being folded 



PER 



394 



PHO 



over them. In dropsy of the belly, the 
water is effused into the cavity of the "sac." 
Wounds which Open the peritoneal covering 
of the bowels are always extremely dan- 
gerous, from the liability of this membrane 
to become violently affected with spreading 
inflammation. 

PERITONITIS — Peritoneal Inflamma- 
tion. — Also arises from other causes, such 
•*s prolonged parturition and the like. — See 
Inflammation. 

PERSONS FOUND DEAD.— See Death. 

PERSPIRATION.— See Skin. 

PERUVIAN BARK.— See Bark. 

PESSARY. — An instrument used to sup- 
port the womb, when displaced. — See Womb. 

PESTILENCE.— See Epidemic. 

PETECHIA — Are spots which appear 
upon the skin in certain forms of fever. 
They often resemble and are mistaken for 
flea-bites. Petechise frequently assume 
different colours and forms, differences 
which have lately been assumed as one of 
the distinctive marks between the typhus 
and typhoid forms of fever. 

PETROLEUM — Literally "rock-oil," a 
liquid bituminous substance which flows 
from the clefts of the rocks in some coun- 
tries. Like other oils, however, its origin 
is in the first instance vegetable. In Trini- 
dad it occurs in beds or lakes. Petroleum 
has been recommended as an external ap- 
plication in rheumatism, and in skin diseases. 
It is not much used at present. 

PHAGEDENIC— A term applied to a 
form of ulcer, which, from its rapid exten- 
sion, gives the idea of the tissues being 
eaten away. 

PHARMACOPEIA— Is a book or system 
which includes the medicinal agents, their 
preparations and mode of preparation, au- 
thorized by the principal, legally constituted 
medical authorities of the kingdom: also 
the measures and weights which are to be 
employed in dispensing the medicines. In 
the United Kingdom there are the three 
pharmacopoeias, (of England, Scotland, and 
Ireland,) which, although they agree in 
general arrangements, and in the general 
recognition of medicines and their prepara- 
tions, yet differ in so many important par- 
ticulars, as to cause not only confusion in 
many instances, but even danger. Thus, 
for example, under the head of Paregoric, 
it was pointed out that the preparation 
which goes by that name in Scotland con- 
tains four times as much opium as the pare- 
goric of England, a difference quite suffi- 
cient to give rise to poisoning. Medical 
men and druggists must, it is true, or ought, 
to be alive to all such differences; but 



others are not, and even in the compound- 
ing of prescriptions accidents are possible, 
through inadvertence. An individual who 
has received a prescription from a practi- 
tioner in any one of the three kingdoms, 
ought, if sending it to be made up in another, 
to mention the fact. It is the safest plan. 
New pharmacopoeias are issued by the vari- 
ous colleges at intervals of years, with such 
alterations and amendments as the progress 
of medical and pharmaceutical science 
render necessary. A new London Pharma- 
copoeia was issued in 1851. The medicines 
alluded to in this work are generally in ac- 
cordance with it. [The Pharmacopoeia of the 
United States is revised every ten years, 
and is that by which all preparations are 
made. As it differs in some points from 
those of Great Britain, the reader should 
always ask the apothecary in relation to 
the difference in the strength of an article, 
before giving it as directed in the English 
works, lest he do harm.] 

Refer to Medicines — Measures — Weights. 

PHARMACY. — The art of preparing 
medicines. [This art is now the business 
of a special set of intelligent men in the 
United States, who are designated as phar- 
maceutists or apothecaries. By the apothe- 
caries' code of ethics they are not permitted 
to prescribe medicines.] 

PHARYNX.— See Throat. 

PHLEBOTOMY.— The cutting or opening 
of a vein for the purposes of blood-letting. 
— See Blood-letting. 

PHLEBITIS.— Inflammation of the veins. 
— See Vein. 

PHLEGM.— Mucus.— See Mucus. 

PHLEGMASIA DOLENS.— See Swelled 
Leg. 

PHLEGMON. —The term is generally 
used in connection with inflammation, as in 
erysipelas, which affects the cellular tissue 
beneath the skin. 

PHOSPHATES. — Compounds of phos- 
phoric acid. — See Phosphorus — Soda, Phos- 
phate of, fyc. 

PHOSPHORUS— Classed among the ele- 
mentary bodies of matter, is interesting in 
this work, less for its medicinal properties 
or preparations than for the share it takes 
in the composition of animal bodies and for 
its extensive economic uses. 

After its discovery in 1669, phosphorus 
was prepared from urine ; it is now chiefly 
procured from bones, and is made in large 
quantities for the manufacture of the vari- 
ous kinds of lucifer and other "instantane- 
ous lights," of which it forms the essential. 

When pure, phosphorus at an ordinary 
temperature looks and cuts like darkish 



PHO 



395 



PHO 



coloured wax; it is very inflammable, and 
when cut or handled should be kept under 
water. It is usually sold in moulded sticks : 
its luminous properties in the dark are sub- 
jects of popular information. 

Phosphorus in the form of its salts, that 
is, phosphates of lime, magnesia, potassa, 
&c, exists in the soil, whence it is, in this 
compound state, absorbed by vegetables, 
and by them handed over to the animal 
creation ; in the seeds of the grains, espe- 
cially, phosphorus exists in comparatively 
large proportions. 

In the animal body, phosphorus is an 
essential constituent of the albuminous 
(see Albumen) and fibrinous compounds: it 
enters into the composition of the substance 
of the brain and nerves in considerable pro- 
portion, and largely into that of the bones, 
to which the phosphatic earthy salts give 
much of their solid firmness. As phos- 
phorus is contained in the various tissues 
of the body, it of course exists in the blood, 
and in milk, which is suited to be the sole 
nutrient of the living animal ; it also exists 
in the excretions, as stated above, in the 
urine, and also in the discharges from the 
bowels. 

Various preparations of phosphorus have 
of late been brought forward as medicinal 
agents, but do not require notice here. For 
Phosphate of Soda — See Soda. 

The large use made of phosphorus in match 
manufactories invests it with great interest, 
and the peculi ar manner in which, under care- 
less management, it has been found to affect 
the health of a few of the work-people, de- 
mands attention from its hygienic import- 
ance. Some persons who have been em- 
ployed for a length of time in a lucifer- 
match factory, become affected with disease 
of the lower jaw; portions of the jaw-bone 
become " necrosed," or die, cause abscesses 
in their vicinity, and are either cast off by 
the natural processes, or require to be re- 
moved by the surgeon. In some cases, 
nearly the entire jaw has thus been lost. 
Probably, constitutional predisposition has 
something to do with the liability to this 
phosphorus disease, but, at the same time, 
there is no question that, in other manufac- 
tures, free ventilation of the places in which 
the processes are going on, and strict atten- 
tion to cleanliness on the part of the work- 
people, must prove great preventives. It is 
said that saucers filled with turpentine, dis- 
tributed about the workrooms, by absorbing 
the phosphoric vapours, are a safeguard. 
There is, however, a prospect that by the 
use of phosphorus in its peculiar "amor- 
phous" condition, for the manufacture of 



lucifers, not only may the evils attending 
the manufacture be prevented, but also the 
accidents which have occurred from children 
sucking the common lucifers, and thereby 
being poisoned. The following account of 
the amorphous phosphorus, is at once very 
interesting, and well illustrates one of the 
most curious points in chemistry — the exist- 
ence of the same body in most opposite con- 
ditions and possessing most opposite quali- 
ties. The extract is taken from a paper 
read by Dr. George Wilson before the Royal 
Scottish Society of Arts, in April, 1852. 

"The simplest lucifer match consists of 
a splinter of wood dipped into melted phos- 
phorus, and then covered with gum or glue. 
More frequently, phosphorus is associated 
with chlorate or nitrate of potassa, and with 
sulphur or sulphuret of antimony. The em- 
ployment of such materials necessarily 
renders the manufacture a very hazardous 
one, from the risk of fire ; and in certain 
of the continental states, the preparation of 
lucifer matches has been absolutely pro- 
hibited. Another and quite unexpected 
hazard was soon found to attend their ma- 
nufacture. The work-people were attacked 
by a very painful, and often fatal disease 
of the jawbones, which became carious, oc- 
casioning in many cases death, in several 
the loss of the upper and under jaw, or. 
other severe mutilation and disfigurement, 
and always much suffering. The German 
surgeons, who have paid great attention to 
this distressing disease, refer it to the ab- 
sorption of the vapour of phosphorus, given 
off chiefly during the drying of the matches, 
but likewise at other stages of the manu- 
facture. Phosphorus, also, is well known 
to act as a poison when swallowed in the 
solid form ; and as it occurs in this condition 
in lucifer matches, fatal accidents have 
more than once occurred from children 
sucking them. The red or amorphous phos- 
phorus is much less combustible than ordi- 
nary phosphorus, and not at all poisonous. 
To prepare the new substance, ordinary 
phosphorus is melted in a peculiarly con- 
structed retort, and kept for some hours at 
a temperature of about 500° F. A very 
singular change is the result of this heating, 
during which the phosphorus combines with 
caloric, and renders it latent, but does not 
otherwise undergo any chemical altera- 
tion. The original phosphorus was a pale 
yellow, or white transparent body, so com- 
bustible that it must be kept under cold 
water, and when brought into the air grows 
luminous even at the freezing point, and 
enters into a full blaze at a temperature of 
about 150° F. By the prolonged heating 



PHR 



396 



PHY 



it becomes a soft opaque mass, which is 
easily pulverized, and then forms an uncrys- 
talline powder of a scarlet, crimson, purple- 
brown, or brown-black colour, so incombus- 
tible that it may be exposed in summer in 
the open air, and handled with impunity ; 
nor does it grow luminous till it is about to 
enter into full combustion at the tempera- 
ture of 482° F. It is further so harmless to 
living creatures, that more than a hundred 
grains have been given to dogs without 
doing them any injury. Although, in its 
free state, it is sparingly combustible, yet, 
when it is mixed with the ordinary ingre- 
dients of lucifer matches, such as sulphur, 
or sulphuret of antimony and chlorate of 
potassa, it kindles readily. In proof of 
this, matches made with amorphous phos- 
phorus were shown to ignite as easily as 
those made with ordinary phosphorus. And 
it was stated, that they would soon be 
manufactured on the large scale, and sold, 
it was believed, as cheaply as the common 
matches." 

The following are stated as some of the 
advantages connected with the use of the 
new form of phosphorus, that — 1. " It in- 
volved much less risk of destruction of life 
and property by fire ; 2. It was more suit- 
able for matches intended for warm cli- 
mates ; 3. It was not poisonous in the solid 
form, so that matches made with it would 
be comparatively harmless if sucked or 
chewed ; 4. It gave off no vapour at ordi- 
nary temperature, so that it could not oc- 
casion disease in the match-makers." 

One more word about phosphorus. It is 
constantly being abstracted from the soil 
by vegetables, especially by those, such as 
the grains, used by man and animals. If 
this constant withdrawal of its phosphates 
from the soil is not compensated for, it be- 
comes incapable of developing its vegetable 
produce in plenty and perfection ; hence, 
cultivators resort to bone-dust, and other 
expensive means of making up to the earth 
in one way what they draw from it another. 
Urine contains phosphorus abundantly, but 
every method is resorted to to conduct" the 
vast stream of phosphates, which issue from 
every large city, or from many a farm-yard, 
by the most expeditious road, into that sea, 
which is at the same time bearing vessels 
freighted with foreign manures ! 

PHRENITIS.— inflammation of the brain. 
— See Brain. 

PHTHISIS PULMONALIS — Pulmonary 
Consumption. — See Consumption. 

PHYSIC. — See Physician. Among the 
lower orders in some places, the term physic 
is applied solely to purgative medicines. 



PHYSICIAN, « M. D." or " Doctor os 
Medicine."— These titles are rightfully as- 
sumed [in England] by those, only, who 
have undergone, successfully, the examina- 
tion instituted by colleges or universities 
legally chartered to grant such titles or de- 
grees. The conventional meaning of the 
term physician, is, one who treats internal 
diseases of the body alone, in contradistinc- 
tion to surgeon, one whose province is the 
treatment of external disorders and the 
performance of operations, and to accou- 
cheur, one who devotes himself solely to the 
diseases of women, and particularly to the 
management of child-birth. To these may 
be added what was formerly the apothecary, 
and is now the "general practitioner." 
These divisions into physician, surgeon, ac- 
coucheur, and apothecary, arose [in England] 
at a time when the science and practice of 
the healing art was very different from what 
it is at present. The physician was the 
only educated man, as Chaucer says — 

" In all this world ne was ther non him like 
To speke of phisike and of surgerie." 

He probably practised the higher depart- 
ments of surgery, as well as medicine strictly 
so called. The ordinary surgeon added to 
his emoluments by the trade of the barber, 
and the apothecary was the mere vendor 
of drugs. The separate department of the 
accoucheur is comparatively of recent date. 
Time and the tendencies and requirements 
of the age have abundantly changed these 
old distinctions, chiefly with respect to the 
position and standing of the general prac- 
titioner. The physician and surgeon have 
been advancing in scientific requirements, 
but the general practitioner has approached 
them so closely, that all seem likely before 
long to merge in one profession in name, as 
they now, in great measure, do in practice. 
The surgeon cannot be a good surgeon, in 
the proper sense of the word, (not meant to 
designate a mere operator,) unless he is also 
a good physician ; and the physician, if he 
does not handle the knife, must be a good 
anatomist to practise his profession properly. 
In large towns, and in certain districts, the 
distinction into pure physician and into pure 
surgeon is maintained, and, as at present, 
with advantage, at least when age, expe- 
rience, or peculiar talent have fortified the 
titles ; but the great mass of medical men 
must be " general practitioners," highly 
educated, and fitted for every duty of the 
healing art. With such a class the kingdom 
is rapidly filling, and many of its members, 
whatever their title, stand, and will stand, 
among the foremost in their profession, and 
must be the " consulting men" of future 



PHY 



397 



PIC 



years, when time and experience, combined 
with talent and industry, have given them a 
claim to the honour. The high education 
of all medical men is now levelling every 
distinction. As long as the education of 
the physician was so infinitely superior to 
that of the medical profession at large, the 
prestige which attached to the title was its 
just due. It still is its just due as the 
tribute to the mark of high attainment, but 
it is not just when paid to the exclusion of 
the profession generally, the members of 
which, as a body, whatever their title, must 
now, or at least in a few years, be all as 
nearly on a level as the difference between 
man and man permits. Nay, more, the me- 
dical profession, as the education of its mem- 
bers is now conducted, must become the 
most highly intellectual body of men in the 
kingdom. The studies of a medical man must 
embrace the widest possible range, from the 
simplest truths of mathematics and of natu- 
ral philosophy, to the latest developments of 
practical psychology, and within this range 
their knowledge is real, true knowledge, the 
knowledge of the manifestations of God in 
his works ; and their deductions from that 
knowledge must be the alleviation of the 
physical, and many of the mental evils of 
fallen man, and higher still, their preven- 
tion ; for it must ever be to the honour of the 
medical men of the present age, that though 
their bread may be said to be got through the 
misfortune of their fellow-men, they have been 
ever the foremost to point out how these mis- 
fortunes are to be avoided — they have been the 
first rousers, and the chief leaders of the sani- 
tary movement everywhere. In large cities, 
and in the metropolis especially, there al- 
ways will be, probably in an increasing de- 
gree, (and it is expedient there should,) a 
division of labour among medical men. One 
will take the skin, another the eye, another 
the chest, and so on, as his particular de- 
partment, and -will attain such acquirements 
in connection with his own department, as 
will give him an extra claim to confidence 
when that is concerned, especially in obscure 
or difficult cases ; but this cannot be with 
the kingdom at large, and in the provinces, 
the great mass of. disease must continue to 
be the care of the general practitioners, 
whose experienced leading members must, 
under the present system of education, be- 
come what the physician has been. 

The above remarks may appear to some 
irrelevant to the present work, but the pub- 
lic generally require some enlightenment as 
to the present constitution of the profession, 
and on the bearing of its different members 
21 



to one another. [In the United States this di- 
vision of labour among practitioners does not 
exist, though some devote themselves more to 
the practice of one branch than another. 
When the family physician desires assistance, 
he will know where to seek it ; and it is better, 
therefore, for each person to have his regular 
medical attendant, than to seek for himself 
one who is especially celebrated in one class 
of complaints. Above all things let him 
avoid every practitioner whose reputation is 
the result of newspaper puffing, as well as 
the officious advice or opinion occasionally 
offered by such vendors of drugs as disgrace 
the title of "apothecary." To treat diseases 
or injuries should be the sole business of the 
physician, except when located in small 
communities.] 

Refer to Practitioner, General — Surgeon. 

PHYSIOGNOMY.— See CouxMenaxce. 

PHYSIOLOGY.— The science of the func- 
tions of living bodies, generally and spe- 
cially. 

PICKLES. — Vegetable substances pre- 
served in vinegar. Even when well pre- 
pared they are not very digestible, but the 
generality of those purchased are deleterious 
on another account — the more or less amount 
of copper which they contain ; this poison- 
ous addition being made to impart the fresh 
green colour so generally desired by the 
purchasers and consumers of these articles. 
The recent investigations of the Lancet Sani- 
tary Commission on this subject disclosed 
the fact that all the pickles examined con- 
tained more or less copper; in some it ex- 
isted in poisonous quantity. The slightest 
impregnation with this poison cannot be too 
strongly condemned, but it is probably used, 
at times, in ignorance, for even some cookery 
books openly advise its employment to 
"green" pickles. Fortunately, the detec- 
tion of this adulteration, even in a small pro- 
portion, is easy. If a perfectly clear and 
bright piece of iron (wire will do) be im- 
mersed for a few hours in the vinegar of the 
pickle, if copper is present the metal will 
be deposited in a perceptible, though thin 
crust upon the iron. "Another very sim- 
ple and efficient method of detecting the 
presence of copper in pickles, is the follow- 
ing : — Put three or four drops of the sus- 
pected vinegar on the blade of a knife ; 
add one drop of sulphuric acid, and heat 
the under surface of the knife over the 
flame of a candle. The vinegar in evapo- 
rating will deposit the copper upon the 
iron, if any be present." In the investiga- 
tions of the Lancet, it was ascertained 
"that the pickles which contain the largest 



PIL 



398 



PIL 



quantity of copper are those which consist 
entirely of green vegetables, as girkins and 
beans." 

Sulphuric acid, which is detected in 
pickles, comes more under the head of vine- 
gar adulterations. — See Vinegar 

PILES, or Hemorrhoids — Are tumours 
which form at the verge of the anus or fun- 
dament, and may be situated either within 
or without the bowel ; they are either what 
are called "blind," or they are bleeding 
piles. Piles are often constituted by an 
enlargement or "varicose" condition of the 
veins situated about this part, this enlarge- 
ment being caused by whatever tends to 
obstruct the return of the blood through 
the veins of the abdomen generally ; thus, 
affections of the liver, constipation, with 
overloaded bowels, pregnancy, &c., are all 
frequent causes of this form of piles, in 
which the swellings are generally, smooth, 
and of the colour of the surrounding skin. 
Generally, the tumours vary in size accord- 
ing to the operation of the acting obstruc- 
tion ; if they have occurred in consequence 
of pregnancy, they diminish or disappear 
after child-birth ; if loaded bowels have 
been the cause,, a dose of suitable aperient 
medicine relieves the effect. Sometimes 
the enlarged veins become filled with a 
fibrinous deposit from the blood, and then 
the tumours are permanent. Another form 
of pile is more of the character of a morbid 
growth: in it the tumours are more generally 
internal, and are red, florid, and uneven on 
the surface, and often very painful. From 
the causes of piles already stated, it may be 
imagined that the sedentary, those who are 
most liable to suffer from constipation and 
liver disorder, are also most likely to be the 
subjects of piles ; the same may be expected 
to be the case with women who have borne 
large families. If the causes which first 
produced the disease do not continue in 
active operation, or are guarded against, 
the hemorrhoidal tumours may continue 
long quiescent, and give little trouble ; but 
if from any cause, whether neglect of the 
bowels, cold, the abuse of purgative medi- 
cine, &c, they become inflamed, much suf- 
fering is induced ; the state is then called 
a "fit of the piles," which lays the indivi- 
dual up from active exertion. In other 
cases, instead of inflammation, bleeding may 
occur, and every time the bowels are re- 
lieved a considerable amount of blood may 
be lost by stool. 

The preventive treatment of piles is of 
the first importance, and the causes of the 
disease pointed out, will at once suggest 
the remedies, which are, chiefly, a sufficient 



amount of exercise and proper regulation 
of the bowels, with avoidance of food of too 
heating and stimulating a nature. If the 
liver is apt to get too loaded it must be 
regulated; (see Biliary Disorders;) but in 
doing this and also in regulating the bowels, 
it is of some importance what aperient 
medicines are employed. Aloes, from their 
power of acting upon the rectum or lower 
bowel, are often said, when taken too con- 
stantly, to produce piles, but their effects 
in this way have perhaps been somewhat 
overrated. Certainly, if taken habitually 
in quantity to irritate, they will both cause 
piles and aggravate them when existing ; 
but, on the other hand, the effect of aloes 
in thoroughly unloading the lower bowels, 
and in stimulating the liver, renders the 
medicine a very efficient remover of the 
causes of piles. The moderate use of aloes, 
therefore, when an aperient is often required, 
need not be entirely eschewed by those who 
suffer from piles, unless they find by expe- 
rience that the affection is aggravated by 
the use of the drug. The other aperients 
most useful in piles are, when active effect 
is required, castor-oil or senna infusion ; 
when a milder action is required, rhubarb 
and magnesia, the electuary of senna, or the 
saline medicines, such as Epsom salts in 
small doses, largely diluted, will be found 
useful. Sulphur combined either with an 
equal part of cream of tartar, or of calcined 
magnesia, forms one of the best of the mild 
aperients in piles ; of either mixture a tea- 
spoonful may be taken for a dose, the first 
in treacle, the second in milk. It must be 
remembered that, except for unavoidable 
purposes, purging is to be avoided in those 
subject to piles, and that mild easy action 
of the bowels is to be encouraged ; above 
all, such a state of bowels as permits the 
feecal mass to become so hard as that it irri- 
tates or scratches the piles in passing, must 
be avoided. This is apt to occur if the 
bowels have been constipated for a day or 
two, in which £ase it is advisable to use a 
small clyster of warm water, [or thick flax- 
seed tea,] so as to soften the contents of the 
bowel previous to evacuation. Indeed, in 
those subject to piles, clysters — if care be 
taken not to irritate with the pipe of the instru- 
ment — form a most valuable adjunct to other 
means of prevention or of treatment. — See 
Clyster. 

When, from any cause, inflammation, or a 
" fit of the piles," is induced, the first essen- 
tial is rest in the horizontal posture, so as 
to give every facility for the return of the 
blood from the affected parts ; the diet 
should be reduced, made as cooling as pos- 



PIL 



399 



PIL 



sible, and the bowels kept lax by some of 
the means pointed out above. If the in- 
flammation is severe, four or five leeches 
may be required ; if not, warm fomentations 
and steaming will often give relief; at other 
times the cooling lead lotion, or an ointment 
made with half a drachm of goulard ex- 
tract, rubbed up in an ounce of lard, will 
be most serviceable. When piles show a 
tendency to bleed, and indeed in any case 
when they are decidedly developed, a medi- 
cal man should be consulted ; not solely on 
account of the pain and inconvenience re- 
sulting from the presence of the tumours 
themselves, but because of the constitutional 
tendencies they exhibit. The treatment of 
bleeding piles is often a delicate matter. If 
the loss is so great as to be manifestly weak- 
ening the patient, there can be but little doubt 
that it must be stopped, and may be with 
safety ; but at other times it is a safety-valve 
which cannot be closed without hazard, as 
long as the cause which first opened it con- 
tinues. That is to say, instead of stopping 
the loss of blood from the piles by direct ap- 
plications, it must be done by constitutional 
remedies, adapted to diminish the plethora, 
either local or general, which originated the 
disorder ; in this case, the preventive treat- 
ment of piles generally, as already stated, 
must be resorted to. Apoplexy and other 
diseases have followed upon the unwary 
closure of bleeding piles. After constitu- 
tional treatment, however, piles may con- 
tinue to bleed merely from local causes ; in 
this case the drain is injurious, and must 
be stopped. Many remedies for the stop- 
page of bleeding piles are used. Common 
pitch, rolled into three-grain pills, and two 
of these taken twice a-day, is sometimes 
very efficient. Cream of tartar alone, in 
teaspoonful doses, taken stirred in water, 
answers well in some cases. Mr. Vincent 
recommends, especially when protrusion of 
the bowel also takes place, that after each 
evacuation, a small injection, composed of 
one grain of sulphate of iron or green vi- 
triol, should be thrown into the bowel, and 
retained. When inward piles are protruded 
at the evacuation of the bowels, it is very 
important that they should be returned to 
their proper site as soon as possible ; other- 
wise they are very liable to inflammation 
and strangulation. A piece of linen, well 
oiled, is the best medium for exerting the 
pressure requisite for this operation. When 
piles reach a certain point they may require 
a surgical operation for their removal. 
[This operation should not be too long de- 
layed, as the constitution is sometimes very 
much shattered by permitting the disease, 



and especially the open form of it, (bleeding 
piles,) to remain too long unchecked,] 

liefer to Rectum — Leeks — Veins, &c. 

PILL. — This well-known and convenient 
form for the administration of medicine is a 
mass of medicinal substance, of such con- 
sistence as to permit of its retaining the 
globular form into which it is made. Pills 
may be made simply of the active ingre- 
dients they contain, with the addition of a 
little syrup, gum mucilage, or treacle, to give 
coherence ; but when the active ingredients, 
as, for instance, calomel, are not sufficient, 
either as regards bulk or consistence, to 
form a pill in this way, then some additional 
substances must be used ; the most common 
are bread crumb, hard or Castile soap, soft 
extract of liquorice, or conserve of roses. 
Of the above, the pills made with conserve 
of roses or with treacle retain their soft- 
ness for the greatest length of time ; pills 
made with bread crumb especially, soon 
become very hard ; it is, however, very con- 
venient for the extempore preparation of 
some pills, such as those of calomel and 
quinine. When used, the bread, which must 
be stale, is crumbed in the mortar with the 
fingers ; it is then rubbed well up with the 
active ingredient ; and, lastly, formed into 
an adherent mass by the addition of a few 
drops of gum mucilage, or of syrup. When 
hard soap is used to form pills, it must first 
be scraped into thin shavings before it is 
mingled with the other substances. The 
soap may be in sufficient quantity to form a 
mass without other addition, or a little mu- 
cilage, or syrup, or glycerine may be re- 
quired. Soft extract of liquorice or con- 
serve of roses generally requires to be sim- 
ply rubbed up with active ingredients. 
Glycerine has recently been used as an 
addition, in small quantities, to pill masses, 
for the purpose of keeping them moist, and 
answers very well for the purpose. A little 
fixed oil of any kind will also preserve soft- 
ness. — See Glycerine. 

After the composition of the pill, its size 
and consistence are important considera- 
tions. Pills are frequently made too large, 
that -is to say, five grains in weight. Not 
only is a pill of this dimension uncomfort- 
able to swallow, but there is some chance 
that the whole does not become dissolved in 
the stomach. A pill of three grains in 
weight will generally be found the most 
convenient and effective size. A pill must 
neither be too soft nor too hard, but in the 
matter of consistence something must de- 
pend upon the length of time it is to be 
kept ; pills that will be used in the course 
of a few days or a week, may be made with 



PIL 



400 



PIL 



less attention to this object than those which 
are to be kept an indefinite period. When 
the latter is the case, conserve of red roses 
may be employed, or spirit of wine added 
to pills, such as the compound colocynth, 
which contains resinous matters, or as stated 
above, a few drops of glycerine may be 
added to the pill mass before rolling. It is 
not likely that for domestic purposes a "pill 
machine" would be procured; the best me- 
thod, therefore, of dividing a mass into 
separate pills will be to weigh out twenty- 
four grains of the pill mass at once, and to 
divide this as nearly as possible into eight 
equal parts, or pills, rolling each between 
the finger and thumb, and when they are 
put together, adding a little flour, magnesia, 
or liquorice powder, to prevent their ad- 
herence. Pills which are likely to be kept 
for some time before use, should be pre- 
served in a well-stopped or corked bottle, 
but never in a box ; in the latter they often 
get so hard as to be completely useless, and 
are apt to pass through the bowels perfectly 
unchanged, in the aged especially. For 
domestic use, either in this country or in 
emigrant life, it is the most desirable plan 
to purchase compound pills, either in the 
mass or ready rolled ; as, however, it may 
prove useful, the composition of some of the 
most generally serviceable pills will be here 
given. 

The most useful purgative pills for do- 
mestio store are — 

The Compound Rhubarb Pill. — Mild ape- 
rient. 

The Compound Colocynth Pill. — Active ape- 
rient. 

The Compound Gamboge Pill. — Very active 
aperient. 

Blue Pill. — Best procured and kept in 
mass. 

Plummers' Pill. — Alterative and diapho- 
retic — procured either in mass or rolled. 

Compound Galbanum Pill. — Stimulant and 
carminative — procured either in mass or 
rolled. 

Expectorant or Cough Pill. — See Influenza. 

Many other forms of pill are ordered, and 
used, but it would serve no good purpose to 
burden either the memory or the medicine- 
chest with them, especially as their compo- 
sition is given when they are recommended 
in this work. Those above enumerated will 
be ample store — others may be made up as 
required. 

The Compound Rhubarb Pill, one of the 
best, mildest, and safest aperients, is thus 
made : — Take of 

Rhubarb, in powder 4 drachms. 

Aloes, in powder 3 " 



E:}* 



each 1 
drachm. 



Myrrh, in powder 2 drachms. 

Hard Soap, scraped J " 

Treacle sufficient to form a pill mass. 

(Oil of caraway is often mixed with this 
pill, but it renders it more disagreeable to 
most persons.) 

The dose of the compound rhubarb pill is 
from three to twelve grains. It may be 
kept either in powder, to be made up with 
treacle (or syrup or gum mucilage) when 
required, or it may be kept in a soft mass, 
wrapped in oiled silk, or ready rolled. Per- 
sons going to warm climates would find the 
form of powder the best in which to keep 
this pill, preserving in a well-stopped bottle. 

The compound rhubarb pill may be taken 
alone, or, in some cases, combined with one- 
third either of blue pill or calomel, espe- 
cially in cases of biliary disorder. 

The Compound Colocynth Pill is, perhaps, 
more extensively used in this country than 
any other purgative of the kind. It is con- 
siderably more active than the compound 
rhubarb. The compound colocynth pill is 
thus best made : — Take of 

Aloes, in powder, (see Aloes,) \ of each 8 

Scammony, in powder /drachms. 

Colocynth, in powder , 

Sulphate of Potash, in powde 

Ginger, in powder... 

Rectified spirit sufficient to make into a 
pill mass. 

As the remarks, both as to combination, 
keeping, &c. which have been made on the 
compound rhubarb pill, apply exactly to the 
compound colocynth, it is unnecessary to 
repeat them again. A very good addition 
to the compound colocynth pill is that of a 
drachm of ipecacuanha powder to the quan- 
tities given above ; in other cases, when it is 
desirable to soothe, and to prevent griping, 
one-third of extract of henbane, as ordered 
in the Edinburgh Pharmacopoeia, is a most 
valuable addition. 

The Compound Gamboge Pill is of less mo- 
ment, as a store pill, than the above, but it 
is valuable for very strong individuals, who 
require powerful medicine, and where eco- 
nomy is an object. It is thus made: — 
Take of 

Aloes, in powder \ of each 

Gamboge, ditto J 3 drachms. 

Ginger 1 " 

Soap 4 " 

and beat into a mass to form pills. The 
dose is from three to twelve grains. 

Blue Pill and Plummers' Pill, as stated 
above, should be procured ready made, and 
kept in mass, in well-closed pots ; the latter 
pill, however, will keep well ready rolled. 

Compound Galbanum Pill.— 'See Galbanum. 



PIM 



401 



PL A 



Expectorant, or Cough Pill, as given under 
article Influenza, is thus made : — Take of 

Opium, in powder 25 grains. 

Squill, ditto 80 " 

Ipecacuanha, ditto 60 " 

Camphor, ditto (see Camphor 

Powder) 90 " 

Gum Ammoniac, ditto 120 " 

Ehubarb, ditto 60 " 

The above pill will keep well, either in 
powder or rolled, and will be found the 
most useful and convenient form of cough or 
expectorant medicine, either in emigrant life 
or elsewhere, particularly in chronic cough. 

Many other combinations of pill might be 
enumerated, but the above, along with the 
information scattered throughout the pre- 
sent work, ought to be guide sufficient to 
any one of moderate intelligence. Pills 
may be made, either in a mortar, or, if the 
substance used is in small quantity, on a 
slab or Dutch tile, by means of a spatula. 

[Pills under the above names are directed 
by the United States Pharmacopoeia, though 
the proportions vary a little, but any good 
apothecary will be able to explain the dif- 
ference, which does not materially affect 
the dose. Many of the "Indian" and other 
quack pills are made from these directions, 
but as the vendors are unprincipled, and sub- 
stitute common drugs for those usually di- 
rected, they should always be avoided. It 
is a good rule to distrust any medicine of 
which the composition is kept secret.] 

Refer to Medicines, §c. 

PIMENTO— Allspice.— See Pepper. 

PIMPLES.— See Skis. 

PINE-APPLE— The well-known fruit, is 
rather hazardous for those of weak digestive 
powers. 

PINS and NEEDLES— Occasionally get 
fixed in the throat, from the careless and 
reprehensible practice of holding them in 
the mouth. — See Gullet. When swallowed, 
they generally work their way to, and show 
themselves at, some distant part of the body. 
Very recently, the author extracted a good- 
sized sewing-needle from the thigh of a child 
about two years old. The needle could only 
have entered the body by being swallowed, 
and, indeed, its course into the thigh could 
in some measure be traced by symptoms 
which had been exhibited some time before 
its appearance at the surface. 

PITCH.— See Tar. 

PLACENTA.— The after-birth.— See Af- 
ter-birth. 

PLAGUE. — This disease, so well known 
to all by name, and, happily, by name only 
in this country, belongs to the class of ma- 
lignant fevers. Its contagiousness has been 
2i2 



disputed, but is testified by the best autho- 
rities who have had practical acquaintance 
with the subject. The last time the plague 
visited this country was in 1665, the period 
of the Great Plague of London ; since then, 
however, it has appeared in, and ravaged 
various parts of Europe — as in Marseilles 
in 1720, Moscow in 1771, and Malta so late 
as 1816. Egypt, Asia Minor, and Turkey 
are, at present, the countries principally 
liable to the visitations of this fearful 
scourge ; and, whatever other influences 
may be at work to foster its germs, and to 
perpetuate its presence in these lands, there 
cannot be the smallest doubt that the total 
neglect and ignorance of the simplest laws 
of health materially add to the evil. 

The symptoms of plague are thus de- 
scribed by Dr. Gregory: — "A feeling of 
great languor and lassitude ushers in the 
attack of plague, which, for the most part, 
happens toward evening. There is always 
a cold stage, though it is seldom of long 
duration. Heat of skin, headache, and gid- 
diness succeed. The pain of the head is 
referred to the temples and eyebrows ; the 
eye appears heavy, dull, and muddy. The 
expression of countenance changes in a re- 
mai'kable manner. Sometimes there is a 
wild and furious look ; sometimes a look 
claiming commiseration, with a sunk eye 
and contracted feature. The most striking 
of all the early symptoms of plague is the 
staggering, and the sudden extreme prostra- 
tion of strength. A strong tendency to void 
the urine is generally noticed. The stomach 
is very irritable, and rejects almost every 
thing presented to it. The tongue is white 
and moist. The bowels are sometimes tor- 
pid, and at other times loose, the evacua- 
tions being always highly offensive. The 
speech falters. The pulse is at first small, 
hard, and quick ; but after the appearance 
of buboes it often becomes fuller and softer. 
It is sometimes intermittent ; in point of 
frequency its average may be stated at 100. 
The heat of the skin is seldom very intense. 
The head is occasionally perfectly clear and 
collected ; at other times stupor occurs im- 
mediately after the formation of the hot fit. 
Some cases of the disease are ushered in 
by a violent fit of mania ; the greatest in- 
difference with regard to recovery prevails, 
and is always reckoned a most unfavourable 
symptom. 

"After one, two, or, at furthest, three 
days, pains in the groin and arm-pits an- 
nounce the formation of buboes. Those pains 
are often highly acute, and, unless speedily 
followed by the swelling of the gland, the 
patient dies delirious. In women, the arm • 



PL A 



402 



PL A 



pit, in men the groins, are chiefly affected. 
Carbuncles appear at the same time, but 
indifferently on all parts of the body. Pe- 
techise and vibices are much more frequent 
than carbuncles, which, it appears, do not 
occur above once in twenty cases. The 
fatal termination is sometimes preceded by 
violent hemorrhages from the mouth, nose, 
or intestines. 

" The duration of the disease is very 
various. A few cases are on record where 
the patient died within a few hours from 
the invasion. To many it proves fatal dur- 
ing the first paroxysm or period, which in- 
cludes the time from the evening "of the 
attack to the close of the following night. 
The third and fifth days are, however, upon 
the whole, those of the greatest danger. 
The former is the usual period of the ap- 
pearance of bubo ; the latter of the abate- 
ment of the febrile symptoms. If the 
patient survives the fifth day, and the bubo 
is fully formed, he may be considered as 
nearly out of danger. The convalescence, 
indeed, is always very tedious, from the ex- 
treme debility which the disease leaves, 
and the patient's life is not unfrequently 
again put into imminent hazard from the 
occurrence of gangrene in the extremities. 

" In the malignant form of plague every 
variety of treatment has been tried, but 
with so little effect that it may be con- 
sidered as a disease nearly beyond the 
reach of medicine. The violent headache 
which occurs during the first twenty-four 
hours seems to point out the propriety of 
blood-letting, and it is recommended by the 
general custom of Turkish practitioners ; 
but in the hands of English surgeons it 
proved of no avail. In the cases in which 
it was tried it did not appear, however, to 
make matters worse. Where mercury can 
be brought to affect the mouth it appears 
to be of some service, but it is seldom that 
sufficient time is afforded for this specific 
effect of the remedy. Ether and laudanum 
are valuable medicines in allaying the irri- 
tability of the stomach. Wine and opium 
are of no use during the violence of the 
disease, and bark can seldom be retained. 
This is much to be regretted ; for wherever 
it can be made to stay on the stomach, even 
in those severe cases where carbuncles and 
vibices appear, its good effects are conspi- 
cuous. Camphor, bark, and wine are given 
with much advantage during the period of 
convalescence. Emetics, purgatives, and 
the cold affusion have been tried, but it 
does not appear that they are of any ser- 
vice. Diaphoresis can seldom be produced, 
owing to the disposition to vomit; but 



wherever it can be produced, the symptoms 
seem to be unmitigated by it. 

" The latest period of the contagion of 
plague, or that between communication witl. 
an affected individual and the appearance, 
is extremely short, and liable to very little 
variation. It is scarcely ever less than 
three days, and it seldom exceeds six. In- 
stances, indeed, are recorded of the disease 
not appearing until the tenth day, but these 
cases are rare. 

" The contagion spreads to a very small 
distance only from the body of the patient. 
The consequence of which is that the dis- 
ease is seldom if ever communicated ex- 
cept by actual contact. 

" The dead body does not communicate 
the disease so readily as the living. This 
appears to be well understood in Turkey ; 
but that the contagion is sometimes received 
from the dead body cannot be doubted. 

" The contagion of plague is readily im- 
parted to fomites, in which it may lurk for 
a very long time, more particularly if ex- 
cluded from the air." 

Refer to Fomites. 

PLASTERS — Are compounds of adhesive 
tenacious substances. Many are, princi- 
pally, compounds of an oxide of lead and 
oil, others of wax and resin. " Plasters 
should not adhere to the hand when cold ; 
they should be easily spread when heated ; 
and should remain tenacious and pliant 
after they are spread ; but should not be so 
soft as to run when heated by the skin. 
All plasters become too consistent and brit- 
tle when long kept ; but in this case, those 
which are unctuous may be remelted by a 
gentle heat, and some oil added to them." 
Plasters are not so commonly used as mere 
external applications as they were at one 
time, but amid the poorer classes they are 
still very favourite and much trusted reme- 
dies, and in some cases are unquestionably 
serviceable. 

Plasters may either be simply adhesive, 
such as the common diachylon or the isin- 
glass plaster ; they may be protective, such 
as the lead ; warm, like the cumin, &c. 

The most useful platers are- 
Adhesive or Diachylon Plaster. 

Belladonna Anodyne. 

Cantharides Blistering. 

Cumin Warm & stimulant. 

Galbanum Warm & stimulant. 

Isinglass Adhesive. 

Lead.. Protective. 

Mercurial Discutient. 

Opium. Anodyne. 

Roborans or Iron.. Supporting. 
Soap ..Adhesive. 



o • r3 
U s3 

P3 



PL A 



403 



PLE 



The above plasters may be employed for 
the purposes indicated, and should always, 
if possible, be procured ready spread. As 
a general "strengthening" plaster, the 
roborans, or iron plaster, is perhaps the 
best, and undoubtedly gives much comfort 
and support in many cases, especially those 
in which there is much weakness of the 
back. In such cases it cannot be used in 
better form than that spread on dimity, 
which is now sold as prepared by ma- 
chinery. It may, however, be spread on 
leather. Either the cumin or galbanum 
plasters may be used for the same purposes 
and be prepared in the same way, but they 
are more stimulant, and sometimes produce 
uncomfortable or unbearable irritation on 
delicate skins ; indeed, any plaster will 
cause this with some people. Lead is least 
liable to do so. 

Lead plaster, spread on soft leather or 
dimity, is one of the best protectives in the 
tendency to or formation of bed-sores. If 
kept long after it is spread, however, it be- 
comes brittle, cracks off, and is useless ; it 
is therefore better kept in roll, and spread 
when wanted. With exception of the ad- 
hesive plasters, however, required in the 
treatment of the wounds, &c, all the others 
are but occasionally required, and may for 
the most part be dispensed with. The most 
useful adhesive plasters are the common 
diachylon and the soap plaster. These may 
be bought beautifully spread by machinery, 
and in this country this -will always be the 
most advantageous mode of procuring them ; 
but persons, such as emigrants, proceeding 
to warmer climates, should never get them 
thus prepared — otherwise, when they come 
to unfold their plaster for use, they will find 
it one adherent mass, and perfectly useless; 
they should take the plaster with them in 
roll as it is sold — it can then, when required, 
be spread on any material, such as calico, 
or even paper, by means of a heated knife, 
or flat piece of iron, if no better material is 
at hand. The common plaster spatula is 
neither expensive nor cumbersome, and 
might very well be added to an emigrant's 
outfit. When used it should be heated suffi- 
ciently to melt the plaster when the flat 
surface is applied to the end of the roll, the 
melted plaster being allowed to drop on the 
material on which it is to be spread. When 
sufficient has been melted, it is then to be 
spread evenly and thinly by means of the 
edge of the instrument. When spread 
plasters are warmed for application, the 
unspread side should always be held to the 
heat. When plasters are to be removed 



from the skin, they should always be well 
warmed through by warm water. 

It is a common popular error to suppose 
that the plasters used in the treatment of 
wounds exert some healing influence ; 
whereas they are only used to keep the 
severed parts in as close apposition as pos- 
sible, in order that the natural healing power 
may be exerted. It is requisite to notice 
the error, for it might in some cases inter- 
fere with the use of substances, such as 
gums, &c, as plasters, which might be ad- 
vantageously used as such. 

Refer to Blister — Dressing — Wounds, $c. 

PLASTER ov PARIS— Sulphate of Lime 
— Gypsum — Has been noticed in various 
parts of this work as an occasional adulte- 
ration in confectionary, &c. It is some- 
times used in the treatment of fractures. 

PLETHORA— Fulness— Is the term ap- 
plied to that condition of system in which 
the blood is superabundant, both in quan- 
tity and quality, over what the requirements 
of the body call for. It is a condition not 
uncommon among the well-fed and indolent, 
in whom the digestive organs continue in 
full vigour. Individuals of the sanguine 
temperament, while leading a life of mental 
activity and anxiety, have greater powers 
of activity than most others, but they, in 
many instances, border upon plethora, and 
if they become so placed that their former ac- 
tivity is either uncalled for or interfered with, 
provided there is not much mental anxiety, 
they quickty become plethoric ; the vessels 
are overloaded with rich blood, and instead 
of the former power of exertion, oppressive 
languor and inactivity succeed ; in fact, the 
whole of the functions, and the brain and 
nervous system especially, are weighed 
clown and clogged ; there is mental slug- 
gishness, heavy sleep, and inaptitude for 
exertion. This last symptom is too often 
mistaken for weakness ; the person labour- 
ing under the mistake resorts to additional 
food and stimulants — it need scarcely be 
added, only to increase the evil. An indi- 
vidual in this condition, it may be said, is 
ripe for inflammation ; if cold be taken, it is 
very likely to light up inflammatory action 
somewhere, and once lighted up, the action 
is very liable to be of the severest kind. 

Should febrile disease of any kind, as for 
instance small-pox, or erysipelas, or rheu- 
matic fever, be excited in the constitution, 
the symptoms run high, and the case is very 
likely to become one of danger. For similar 
reasons, accidents are not well borne — at 
least their after-effects are often such as to 
put life in danger. 



PLE 



404 



PLU 



Persons who are in a plethoric condition, 
not unfrequently get relieved by some na- 
tural effort : piles show themselves and 
bleed, or the nose bleeds, or spontaneous 
diarrhoea comes on ; and instead of the indi- 
vidual being weakened, he feels stronger 
and lighter than before — a true indication 
of the real state of matters. The evil re- 
sults of mistaking a state of oppression 
from plethora, of false debility (see Debility) 
for one of weakness, must be evident to all. 
Even the pulse is liable to deceive, and in 
these states of oppression to seem low and 
weak, but it is essentially different from 
the pulse of debility. The latter, if the 
finger is pressed even slightly upon it, is 
extinguished at once ; but the pulse of op- 
pression seems rather to resist the pressure, 
to become stronger, and to beat up against 
the finger, rather than to give way. As 
might be expected, plethoric individuals are 
often the subjects of apoplexy. A state of 
plethora must always be one, if not of 
danger, at least of hazard, and ought to be 
guarded against ; its well-known causes na- 
turally direct the attention to the best modes 
of prevention. 

If a person suffering from plethora is 
threatened with an immediate attack, such 
as apoplexy, the condition cannot be too 
soon or too actively removed. Bleeding, in 
some way, free purging, and low diet are 
the immediate remedies ; but, in the absence 
of any threatened attack, it is not advisable 
to invoke the aid of these powerful agents; 
the condition should be reduced gradually 
and steadily by the formation of, and per- 
severance in, modes of living suited to 
counteract the tendency. When a man suf- 
fering from the effect of plethora gets rid 
of his unpleasant symptoms by a "coup," 
such as the loss of a basinful of blood, by 
a few calomel pills and black draughts, he 
is probably highly pleased to be so easily 
rid of his enemy, and by means which in- 
volve no self-restraint or giving up of in- 
dulgences ; so, trusting to the repetition of 
the same remedial measures, he puts no 
check upon himself, and when the plethora 
again reaches a certain height, he again 
bleeds and purges, and this goes on till he 
is overtaken some day with an apoplectic 
attack, or till he becomes the subject of or- 
ganic disease. It is a false and most pre- 
carious security. - 

Persons who have a tendency to plethora 
must have exercise, they must use up their 
blood and muscle in active motion ; but in 
doing this, especially at first, they must be- 
ware of over-doing it. It will not do for a 
plethoric man to commence a new system 



of living for health, with violent exertion — 
otherwise he may precipitate the very evil 
he dreads ; some overloaded vessel may 
yield under the increased tension caused 
by the muscular exertion and excited cir- 
culation. Plethora, to be reduced, must be 
so steadily, but gradually ; active exercise, 
increased as the ability to take it increases, 
must be balanced with aliment proportioned 
to the amount taken, stimulants being rarely 
if ever permissible, or required, and animal 
food in very moderate proportion. Early 
hours, and curtailment of the time devoted 
to sleep, is desirable. In most cases, tepid 
bathing is preferable to either hot or cold, 
and, either by it or by sponging, the skin 
must be kept active. The bowels require 
especial attention, and are better rather 
lax than otherwise ; any slight tendency 
to plethoric oppression being counteracted 
by acting upon them by the compound colo- 
cynth, or compound colocynth and blue pill, 
or by small, largely diluted doses of Epsom 
salts, or by Seidlitz powders. If the kid- 
neys are inactive, the infusion of broom, or 
of dandelion, carbonate of potash, or the 
nitrate of potash — saltpetre — may be taken, 
or the super-tartrate of potash — cream of 
tartar — used in the form of imperial, as a 
common drink. 

Refer to Apoplexy — Debility — Fat, §c. 

PLEASURE.— The cheerful excitement 
of the mind, by what is called pleasure, is 
rather a preservative of health than a re- 
medy in real sickness, when the less stimu- 
lant but cheering tonic of hope is the better 
adapted mental remedy. Pleasurable re- 
laxation there must be, both for mind and 
body, and especially for the young; and 
they act unwisely, who, instead of direct- 
ing the mind to sources of, and leading it 
to find its happiness in innocent, cheerful, 
well-directed relaxation and pleasure, would 
make this world one never-closing work- 
shop, or have it a perpetual valley of tears. 

Refer to Dancing. 

PLEURA. — The " serous" membrane 
which lines the chest and covers the lungs. 
— See Lungs. 

PLEURISY. — Inflammation of the pleura. 
— See Lungs. 

PLICA, or Plica Polonica. — A peculiar 
disease of the hair which occurs in Poland 
and the adjacent countries. — See Hair. 

PLUMMERS' PILL— Also called com- 
pound calomel pill, is one of the most use- 
ful alterative and gently diaphoretic pills 
or remedies in general use ; it rarely acts 
on the bowels, and may be taken for a con- 
siderable time without affecting the system. 
Plummer's pill also contains a preparation 



PNE 



405 



01 



of antimony. The dose is from three to ten 
grains. 

Refer to Mercury — Pill, §c. 

PNEUMONIA.— Inflammation of the sub- 
stance of the lungs. — See Lungs. 

POISON. — Considerable difficulty has 
been experienced in giving such a definition 
of the word poison as shall, while suffi- 
ciently inclusive, be sufficiently precise. 
Some substances, such as strychnine, cor- 
rosive sublimate, &c. &c, can never be con- 
sidered otherwise than as poisons, in every 
sense of the word, but when cayenne or 
common pepper, cream of tartar, even com- 
mon salt, and other substances not unu- 
sually used in food, have been found in large 
doses to act as poisons, it becomes very 
difficult to frame a correct definition of 
the term. Mr. Taylor, in his Manual of 
Jurisprudence, says — "Perhaps the most 
comprehensive definition which can be sug- 
gested is this : — A poison is a substance 
which, when taken internally, is capable of 
destroying life without acting mechanically 
on the system." Some substances, how- 
ever, act as poisons through the skin, such 
as those of infectious diseases ; others, pro- 
bably, through the lungs. Poisons are 
usually classed under the three heads of 
irritant, narcotic, and narcotic-acrid poi- 
sons. Of the first, arsenic and the mineral 
acids are examples ; of the second, opium 
and henbane ; of the third, alcohol and 
strychnine. As the treatment to be im- 
mediately adopted in cases of poisoning 
by various substances, is given sufficiently 
when these substances are treated of, it is 
unnecessary to repeat it here. 

It may be received and acted on as a general 
rule, in cases of poisoning, that the sooner 
the ejection of the poisonous agent from the 
stomach can be procured the better. In the 
majority of instances, perhaps, nature effects 
this in a more or less perfect manner before 
any remedy can be employed ; indeed the 
occurrence of vomiting is often the first 
symptom of the action of the poison. 

These natural efforts, however, must not 
be alone trusted to, even if they take place, 
and, in almost every case, the best thing that 
can be done is to excite full, free vomiting. 
This may be brought about by any of the 
emetic substances so often mentioned, but 
sulphate of zinc, or white vitriol, when it 
can be procured, is the agent generally pre- 
ferred for the purpose. In its absence, salt 
or mustard [or alum] maybe used, and are 
almost always procurable ; indeed any other 
emetic at hand should be resorted to — an in- 
fusion of the root of the sweet violet, in the 
absence of others, or chamomile tea, or warm 



water in abundance ; the action of vomiting 
being also excited by irritating the throat 
with the finger, or with a feather. 

Next to the evacuation of the poisonous 
substance, its neutralization is important ; 
indeed, in the case of such poisons as the 
mineral acids, it is to be the first object. 
It is unnecessary to repeat here the proper 
remedies which more especially neutralize 
the effects of different poisons, as they are 
given in their proper places ; but, as a gene- 
ral rule, milk, oleaginous substances, and 
demulcent fluids, such as linseed-tea, or 
barley-water, or hasty pudding, will be use- 
ful, if given freely, in protecting the coats of 
the stomach from the contact of the poison, 
and by interfering with the absorption of 
the latter into the system. 

Lastly, it must be an object to counteract 
the effects of the poison upon the system at 
large ; as in the case of opium, the narcotic 
influence is combated with forced exertion, 
coffee, &c, or, in poisoning by prussic acid, 
by stimulants and cold affusion. 

When poisoning is known or suspected 
to have occurred, the first thing is to procure 
proper medical assistance as quickly as pos- 
sible ; nothing must stand in the way of that. 
The next is, to ascertain the nature of the 
poison, if possible, and the amount taken — 
the remedial measures which may be known, 
either by reference to such works as the 
present, or from other sources of informa- 
tion, being adopted as quickly as may be. 
All vomited, and other matters — such as 
evacuations from the bowels — which may 
contain trace of, or afford clue to the poison, 
must be reserved for the inspection of the 
medical man. Sometimes, individuals, from 
throwing away, in the excitement of the 
moment, the poisoned food, or whatever it 
may be, have found themselves unpleasantly 
situated, and objects of suspicion. If there 
is any idea that there has been criminal 
proceeding connected with the poisoning, 
some responsible person should secure what- 
ever may guide in the investigation of the 
truth, and place all under lock and key, and 
seal, till the arrival of the authorities : food 
and vomited matters should be sealed in 
suitable vessels. 

The symptoms which would give rise to 
the suspicion of poisoning having taken 
place, are those of sudden illness shortly 
after taking food or medicine, the individual 
having previously been in good health, or, 
at least free from the peculiar, and generally 
violent, symptoms developed, particulai^ly 
those indicative of irritation of the stomach 
and bowels, or of narcotic or irritant influ- 
ence upon the nervous system. When poi- 



P k 406 

sons are either given or taken for criminal 
purposes, the symptoms usually show them- 
selves quickly and severely, on account of 
the dose of the deleterious substance being 
generally large. At the same time it is to 
be remarked, that the presence of much 
food on the stomach, sleep, and intoxica- 
tion have all been known to retard the de- 
velopment of symptoms from even large 
doses of poison. If a number of persons 
who have partaken of the same dish are 
seized shortly after with symptoms of ill- 
ness, the suspicion of poison is, of course, 
greatly strengthened. 

It is perhaps necessary, however, to cau- 
tion all against a too hasty assumption of 
the fact of poisoning, at least as far as the 
criminal implication of others is concerned. 
If there is suspicion, it will in any case be 
better to take such measures as may be 
thought requisite, as quietly as possible, 
until the bearings of the case have been 
examined by competent persons. 

This caution is necessary, for there are 
diseases, such as British cholera, [cholera- 
morbus,] which not unfrequently first break 
out shortly after a meal, and spasms of the 
stomach are not uncommon with some after 
food ; perhaps the disease which has most 
frequently given rise to suspicion of poison- 
ing — doubtless on account of its all but uni- 
versal fatality — is "perforation," alluded to 
a few pages back. 

In connection with the above remarks, 
the following, from Taylor's Medical Juris- 
prudence, is important: — "It seems highly 
probable, that the mere fact of a person 
eating a full meal after long fasting, will give 
rise to symptoms resembling those of irri- 
tant poisoning." "Mr. Holland, of Man- 
chester, has communicated two cases of this 
description. In one the symptoms were very 
violent and the patient nearly died, in fact 
was laid out for dead : the other patient 
suffered from severe gastralgia — nervous 
pain in the stomach — for several weeks. 
Poisoning was at first strongly 'suspected, 
but the suspicion was removed by the fact 
that others in health had partaken of the 
same food, principally potatoes mixed with 
gravy, without any injury, and there was 
no reason to suppose that any irritant poi- 
son could have been mixed with the food. 
The two who suffered were extremely weak 
and exhausted from long fasting, and were 
observed to eat their food, which was quite 
wholesome, voraciously." Further, it must 
be remembered that, although symptoms of 
poisoning may be distinctly traceable to the 
effects of a meal recently eaten, it by no 
means follows that the poisoning has been 



POI 

the consequence of something added, either 
intentionally or accidentally, to the food ; it 
may be the consequence of changes which 
have taken place in the food itself: many 
casualities from this cause are recorded. In 
Germany, numerous deaths have occurred 
in consequence of sausages prepared in that 
part of Europe undergoing a peculiar kind 
of putrefactive fermentation, which renders 
them highly deleterious. In this country, 
the flesh of animals which have died from 
disease has not unfrequently been known to 
give rise to symptoms of poisoning. Fat or 
oily food, when in a state of decay, seems 
peculiarly injurious — salmon, bacon, &c. 
having in this state been found poisonous. 
At a festival held in the canton of Zurich 
some years ago, at which about 600 persons 
were present, nearly two-thirds of the num- 
ber were affected with symptoms of poison- 
ing, in consequence of partaking of meat 
which had become slightly tainted, and of 
hams — probably the injurious article — which 
had been badly cured : some of the number 
affected died. Shell-fish, it is well known, 
will, in some persons, produce symptoms 
of poisoning at any time, and in certain 
states are probably deleterious for all. — See 
3Iussel — Oyster — Copper, §c. A recently 
noticed source of poisoning requires men- 
tion. It is that which might ensue from the 
flesh of game birds — partridges especially — 
which have been destroyed by feeding on 
grain steeped in arsenic and scattered about 
for the purpose of destroying other birds. 
It is said that partridges thus destroyed are 
not found lying on their sides like dead birds 
generally, but are found sitting as if in life. 
It is to be feared that birds found thus, 
fresh, and in good condition, might, by un- 
scrupulous or ignorant persons, be sold as 
other game. 

It has been mentioned, that the common 
garden rhubarb contains oxalic acid — not 
in sufficient quantity to injure in the mode- 
rate use ; but when used largely, especially 
in some constitutions, it may give rise to 
unpleasant symptoms connected with the 
kidneys. 

Liebig records a singular mode of fatal 
poisoning, which occurs in Germany "from 
the drinking of what is called the feather- 
white wine." This poisonous wine is wine 
still in a state of fermentation, which is 
increased by the heat of the stomach. The 
carbonic acid gas which is disengaged pe- 
netrates through the coats of the stomach, 
through the diaphragm, and through all the 
intervening membranes, into the air-cells of 
the lungs, out of which it displaces the at- 
mospheric air. The patient dies with all 



POL 



407 



POO 



the symptoms of suffocation caused by an 
irrespirable gas. The best antidote in this 
form of poisoning is the inhalation of am- 
monia. The development or formation of 
poison within the body itself is a subject 
which has been but little investigated. The 
characteristic ingredient of the urine, urea, 
if retained in the circulation, acts as a 
narcotic poison. Oxalic acid is certainly 
formed within the body ; perhaps prussic 
acid. When the faecal contents of the ali- 
mentary canal, especially of the large bowel, 
are long retained and reabsorbed into the 
circulation, as they undoubtedly are, they 
exert effects somewhat akin to poisoning, 
and the author believes he has traced ex- 
treme temporary depression of the system 
to this cause alone. 

In connection with poisons, the fact — 
more than once alluded to in this work — 
must not be lost sight of, that it is possible 
for the long-continued daily reception of 
even minute doses of certain poisonous sub- j 
stances, at last, by " accumulation," to exert 
pernicious effects upon the system. — See 
Mercury — Lead, §c. This must not be con- , 
founded with the criminal, secret, slow poi- j 
soning so often recorded as the practice in 
ages gone by, a crime which it is more than 
doubtful could be practised in the present 
day without certain detection. 

Before leaving the subject of poisoning, it | 
is requisite to advert to the influence which 
habit exerts over the ^effects exercised by 
poisons on the human subject. All know 
how largely the habitual consumers of opium 
can increase their doses, and that the same 
is observed with respect to other drugs, 
chiefly of the narcotics ; but the most re- 
markable instance of this power of habit is 
in the case of the " arsenic eaters" of Sty- 
ria and adjacent provinces, of whom it is an 
ascertained fact that they habitually con- 
sume large and poisonous doses of solid ! 
arsenic, not only without injury, but with, it 
is alleged, apparent benefit to health. — See 
Wounds, Poisoned, and the various articles 
on poisonous agents. 

POLYPUS— Is a tumour, the result of the 
morbidly excessive growth of the mucous 
membrane lining a cavity. It is most fre- 
quently met with in the nose and in the 
womb, but also occurs in the ear, &c. Polypi 
vary much in texture, in some cases being 
easily torn, and bleeding after the least 
injury, at others being firm and almost car- 
tilaginous; their colour is usually gray or 
yellowish, and they possess but little sensi- 
bility ; they are generally attached to the 
surface whence they spring by a narrow 
neck. The chief inconvenience which results 



from polypus in the nose is the interruption 
to breathing through the nostril, at night 
especially ; the affected person can only lie 
with the mouth open, which therefore be- 
comes most uncomfortably parched. When 
polypus, however, in this situation, increases 
to a large size, it necessarily displaces the 
adjacent parts, such as the soft palate, or 
distends the nostrils. In any case, polypus 
is so uncomfortable a companion, that its 
removal is generally sought. This must, in 
all cases, be effected by the surgeon, by 
means of ligatures, scissors, or forceps, and, 
therefore, proper surgical advice should be 
resorted to. Occasionally, polypus in the 
nose will yield to the persevering use of 
astringent powders, such as that of burnt 
alum, or it may be regularly touched twice 
a day with tincture of steel by means of a 
camel-hair brush. Polypus of the womb 
cannot possibly fall under the cognizance of 
unprofessional persons. 

POMEGRANATE.— This anciently known 
tree, a native of Asia and Africa, [and 
growing in the Southern portions of the 
United States.] is cultivated in warm coun- 
tries generally. The flowers, the rind of 
the fruit, and the bark of the root have 
been used in medicine as astringents, but 
the most general remedial use in modern 
medicine has been that of the root bark as 
a remedy in tapeworm ; for this purpose it 
is extensively used in India. Dr. Christian 
says, "it seems scarcely ever to fail if pro- 
perly used." "The original mode of ad- 
ministering it is to steep two ounces of the 
fresh bark in two pints of water for twelve 
hours, then to boil the whole down to one 
pint, and to give a wineglassful of the 
strained decoction every two hours till the 
whole is taken." " Sometimes joints of the 
worm begin to come away in less than an 
hour after the last dose ; but often the doses 
must be repeated several successive morn- 
ings before they take effect ; and it is right 
to repeat them occasionally for four or five 
days after joints have ceased to come away. 
Laxatives should be administered from time 
to time. The remedy sometimes causes 
nausea and vomiting. The fresh root is 
most efficacious. It is probable that the 
recent introduction of the kousso, and the 
greater attention directed to the employ- 
ment of the root of the male fern, as reme- 
dies in tapeworm, may supersede the use of 
the pomegranate root in this country, but 
in many situations the latter drug might be 
procured where neither of the former could 
When given in powder the dose of pome- 
granate root is twenty grains. 

POOR. — While poverty is so great a& 



POO 



408 



POO 



aggravation of the evils of sickness, it is 
unfortunately too often one of its most 
general causes. It is a perfectly well ascer- 
tained fact that physical deprivation and 
physical disease are to one another as cause 
and effect; and, however sad the reflection, 
that the insufficiently fed and clothed, and 
hard-worked labourer, has much less chance 
of prolonged health and life than those more 
fortunately placed. The following extracts 
from Dr. Combe's "Physiology of Diges- 
tion," put this in a strong light : — "If over- 
feeding be the prevailing error among the 
middle and higher classes of the commu- 
nity, the opposite condition is as unques- 
tionably that of a large proportion of the 
labouring poor. Pressed upon all sides by 
the powerful competition both of constantly 
improving machinery and of a superabun- 
dant population, the manual labourer is 
impelled to undergo an amount of ever- 
recurring bodily exertion which far exceeds 
the natural powers of his constitution, even 
when supported by the fullest supply of 
nourishment ; and when, as often happens, 
along with this excess of labour, his food, 
from inadequate wages, the size of his fa- 
mily, or his own injudicious management, is 
defective in quantity or in quality, the con- 
sequences to his health and happiness are 
disastrous in the highest degree. 

" To those who have never reflected on the 
subject, it may seem like exaggeration to 
say that, as a general fact, at least nine- 
tenths of the lower orders suffer physically, 
morally, and intellectually, from being over- 
worked and under-fed ; and yet I am con- 
vinced that the more the subject shall be 
investigated, the more deeply shall we be- 
come impressed with the truth and import- 
ance of the statement. It is true that very 
few persons die from actual want of food ; 
but it is not less certain that thousands 
upon thousands are annually cut off, whose 
lives have been greatly shortened by excess 
of labour and deficiency of nourishment. 
It is a rare thing for a hard-working artisan 
to arrive at a good old age. They almost 
all become prematurely old, and die off long 
before the natural term of life. It is in this 
way that, as remarked by Dr. Southwood 
Smith, the mortality of a country may be 
considered as an accurate indication of the 
misery of its inhabitants. According to 
Villerme, the rate, of mortality among the 
poor is sometimes double that among the 
rich. Thus it is found, he says, that in a 
poor district in France one hundred die, 
while in a rich department only fifty are 
carried off; and that, on taking into ac- 
count the whole population of France, a 



child born to persons in easy circumstances 
has the chance of living forty-two and a 
half years, while one born of poor parents 
can look for no more than thirty. 

" These are striking facts, and their truth 
is confirmed by every day's experience in 
Britain as well as in France. Many causes 
concur to produce this melancholy result, 
but among the principal is, unquestionably, 
the disproportion so generally existing be- 
tween toil and nutrition. In the army the 
operation of the same principle has long 
been recognised in the inferior strength 
and health of the privates compared with 
the officers. The officers being better fed, 
better clothed, and better lodged than 
the common soldiers, bear up successfully 
against fatigue and temporary privations, 
by which the latter are overwhelmed. Dur- 
ing epidemics, too, the poor, from their im- 
paired stamina, almost invariably become 
victims in a proportion far exceeding that 
of the more wealthy classes. This is, no 
doubt, partly owing to their greater intem- 
perance and want of cleanliness ; but even 
these vices often derive their origin from 
the same root — the want of adequate repose 
and comfortable sustenance. 

" The bad consequences of defective nou- 
rishment are not confined in their operation 
to the bodily constitution of the labouring 
poor. Their minds also are deteriorated. The 
pressure of poverty is unfavourable to the 
growth of refinement and morality, and 
crime and turbulence are never so much to 
be dreaded as during times of scarcity and 
manufacturing or agricultural distress. 

"Among the poorer classes, the children 
as well the parents suffer both physically 
and morally from insufficient food. Their 
diet being chiefly of a vegetable nature, 
and consisting of porridge, potatoes, and 
soups, with very little butcher meat, proves 
far from adequate to carry on vigorous 
growth in the one, or repair waste in the 
other ; hence arise in the young an imper- 
fect development of the bodily organization, 
a corresponding deficiency of mental power, 
and a diminished capability of resisting the 
causes of, disease. In workhouses and other 
charitable institutions, ample evidence of 
these deficiencies obtrudes itself upon our 
notice in the weak and stunted forms and 
very moderate capacities of the children." 
[Though true in Europe, there are few, if 
any poor in the United States that do not 
obtain a sufficiency of meat ; and the chil- 
dren of the most miserable are often ex- 
tremely well developed.] 

Happily the recent changes with respect 
to the importation of food have modified in 



POP 



409 



POR 



some degree the force of the above observa- 
tions, but they still hold good in too many- 
instances. The fact of the connection be- 
tween deficient nourishment, clothing, &c. 
and the production of disease, ought ever 
to be kept in mind by those who have the 
management of their inferiors in intellect 
or in worldly means. 

Many of the evils attendant on poverty 
are, unquestionably, out of the power of the 
poor themselves to rectify, but many others 
connected with the subjects of ventilation, 
cleanliness, &c, &c, which do so much to 
ward off the incursions of disease, are in 
most instances in their own hands. 

Those who are taken, either by the calls 
of duty, or by the dictates of benevolence, 
to visit the poor in sickness, have many 
prejudices, theoretical and practical, to en- 
counter. It is marvellous the dread of fresh 
air or of "cold water," the faith in quack 
nostrums and old women's receipts, the 
constant anxiety that food should be taken 
and stimulants administered, and the per- 
verse disobedience of the directions of a 
medical attendant. All these, and many 
others which are met with, ought to be 
special objects for good advice, for kind and 
rational explanation. The more leisurely 
visits of a clergyman, or of others who visit 
the poor, may well be in part devoted to 
instruction on these points, if the power 
of imparting the information is possessed, 
as it ought to be, by every educated person. 

Refer to Bed-room— Drainage — Houses — 
Water, $c. 

POPLITEAL SPACE.— The hollow of the 
ham behind the knee. 

POPPY — Papaver somniferum, or opium 
poppy, is the common cultivated poppy of 
the gardens, of various hues, varying from 
red or purple to white. Its principal pro- 
duce, opium, has already been treated of. 
The capsules or seed-vessels of the poppy, 
when dried, are used for their narcotic pro- 
perties, owing to the opium which they 
contain. In order to have the dried capsule 
in the most efficient state, that is, contain- 
ing the largest amount of opium ; it should 
be cut green before it is fully ripe. When 
the seeds have been matured the seed-vessel 
is much exhausted. Poppy capsules are 
principally used in the form of decoction 
for purposes of fomentation. To make the 
decoction, rather more than an ounce of 
the capsules, well broken up, is to be added 
to each pint of water, and the whole boiled 
for a quarter of an hour. This preparation 
often proves soothing and relieves pain. 

Syrup of poppy is made from the poppy 
capsule, but is a preparation which should 
2K 



be absolutely abandoned as dangerous. 
There is always considerable variation in 
the amount of opium contained in the cap- 
sules, and this variation is necessarily en- 
tailed upon the syrup prepared from them, 
a most dangerous contingency in a prepara- 
tion of opium — for such it is — the use of 
which is in a great measure confined to 
children ; half a teaspoonful has proved 
fatal to a child six months old, and yet 
larger doses are often given. The calcula- 
tion of the proper strength of syrup of pop- 
pies is about one grain of opium to the 
ounce. If an opiate syrup is to be employed, 
it ought to be made with as definite propor- 
tions as any other preparation of the drug. 

Although the poppy seed-vessel possesses 
such powerful narcotic properties, it is re- 
markable that the seeds are entirely free 
from them, and are mild and pleasant in 
flavour. They contain a fixed oil, and in 
some parts of Asia are converted into bread 
or cakes. 

Refer to Opium. 

PORRIGO.— A disease of the scalp.— See 
Skin. 

PORK.— The flesh of the hog is generally 
and justly considered the most indigestible 
animal food in common use. In Dr. Beau- 
mont's table, showing the average time re- 
quired for the digestion of different articles 
of food, pork (fat and lean together) is shown 
to require above five hours for digestion. 
There is no doubt that much of the indi- 
gestibility of pork is due, not only to the 
fat, ostensibly existing as such, but to the 
large amount of fatty matter mixed with 
the muscular fibres : at the same time, 
pork, more than other meat, seems to exert 
marked injurious effects. In some few 
cases, even symptoms of poisoning have fol- 
lowed the use of pork as food ; but in these 
there probably must have existed some 
peculiar " idiosyncrasy," or the meat must 
have been diseased. It is by no means un- 
frequent, however, for severe diarrhoea to 
be the result of a pork diet continued for 
two or three days in succession. This often 
occurs in the families of the poor after the 
pig has been killed. [In the United States, 
especially in the winter, or during "killing 
time," pork is the principal article of diet, 
and seldom disagrees with those who then 
partake of it.] 

Refer to Bacon. 

PORTER —The well-known beverage, is 
brewed from malt very highly dried. Dr. 
Paris says, " Much has been said upon the 
fraudulent adulteration of this article, but 
we are inclined to believe these statements 
have been exaggerated." Mr. Donovan, 



POR 



410 



POR 



however, affirms that, until the interference 
of the legislature, porter was liable to every 
species of adulteration. In the Medical 
Circular, for June 30th, 1852, the following 
observations occur in connection with this 
subject : — " If we are to believe the asser- 
tions of previous writers, supported by the 
evidence adduced in connection with numer- 
ous excise prosecutions during the last few 
years, the adulteration of malt liquors has 
been practised to a very considerable extent, 
both by the brewers and the publicans. 
The following is a summary, exhibiting a 
list of the substances said to have been 
thus employed, together with the effects 
they are intended to produce : — 

Quassia, gentian, wormwood, broom-tops, 
nux vomica, and strychnine, to impart bitter- 
ness, in lieu of hops ; capsicums and grains 
of paradise, (in concentrated tinctures,) 
ginger, corianders, orange-peel, and cara- 
way seeds, to give pungency and flavour; 
opium, cocculus Indicus, nux vomica, to- 
bacco, extract of poppies, and the tincture 
and juice of henbane, to communicate in- 
toxicating properties, or "strength;" molasses, 
colouring, sugar, burnt sugar, and corian- 
ders, as substitutes for malt ; sulphuric acid, 
(oil of vitriol,) alum, green vitriol, and com- 
mon salt, to impart an appearance of age; 
and "foots," pearlash, Scotch soda, and 
some of the articles before named, as "head- 
ing" or to give the beer the property of 
bearing its "head" or "froth." 

The following list of articles, said to 
have been seized at different breweries and 
brewers' druggists' laboratories, is copied 
from the "Votes and Proceedings of the 
House of Commons," published some years 
since. In many cases heavy penalties were 
inflicted on the offending parties: — "Coccu- 
lus Indicus, multum, (an extract of coccu- 
lus,) colouring, honey, hartshorn shavings, 
Spanish juice, orange powder, ginger, grains 
of paradise, quassia, liquorice, (root,) cara- 
way seeds, copperas, capsicums, and mixed 
drugs,, (various.)" 

Some of the articles in the above lists are 
virulent poisons. Such are opium, nux 
vomica, henbane, tobacco, cocculus Indicus, 
and extract of poppies. We have reasons 
for stating that the three latter are those 
only which we may suspect meeting with in 
beer at the present day. The use of coc- 
culus Indicus has been recommended by 
several writers on brewing. One of these 
conscientious gentlemen (?) states that "it 
is impossible with pure malt and hops alone 
to produce a strong-bodied porter," and then 
directs the employment of "cocculus Indi- 
cus, grains of paradise, and nux vomica, for 



that purpose." Another author, equally base 
and ignorant, orders "3 lbs. of cocculus to 
be used for every ten quarters of malt;" 
and adds, "it gives an inebriating quality 
which passes for strength of liquor; it pre- 
vents second fermentation, and, consequent- 
ly, the bursting of the bottles in warm 
climates." The latter assertions are utterly 
unfounded, and are mere excuses for adulte- 
ration. Another author informs his readers, 
that " 6 lbs. of roast sugar and 1 lb. of cori- 
anders are equal in strength and intoxicating 
qualities to a bushel of malt." In a work 
published about six years since, it is stated 
that "cocculus Indicus is commonly smug- 
gled out of the hands of the druggist into 
those of the brewer, in common soda bar- 
rels, with three or four inches of Scotch 
soda at the top and bottom of each ;" and 
also, that "it forms the principal ingredient 
in B. E., or black extract, which is osten- 
sibly prepared for tanners, but its real des- 
tination is the beer-cask." 

Mr. Taylor, in his Manual of Jurisprudence, 
says, < ' According to Dr. Ure, the best London 
porter always contains opium ;" but adds, 
" in repeating Dr. Ure's experiments, I have 
not obtained any results indicative of the 
presence of opium in this liquid." 

Of course, the fact that fraud and adul- 
teration may render such an article of human 
consumption as porter most deleterious, 
does not in any way afford an argument 
against its use when properly and truly 
manufactured, and there are few medical 
men who will not testify to the highly be- 
neficial effects which follow the use of good 
porter in many cases. It is, in fact, a most 
admirable tonic, superior to any other form 
of malt liquor, and especially so because 
it is less likely to disagree and to become 
acid on the stomach than the other varieties 
of malt beverage ; neither is it so likely to 
give rise to gravelly deposites in the urine in 
the predisposed. Dr. Prout recommends the 
use of porter in diabetes, not only for its 
tonic properties, but as less likely to prove 
injurious in many cases of that disease than 
any other drink. 

In convalescence from acute disease, por- 
ter is a strengthening medium most grate- 
ful to the patient. In order to prove of 
service, porter must not be flat ; it is, 
therefore, better for invalids, at least, to 
drink it bottled. 

PORT WINE— Belongs to the class of 
" dry and strong" wines, being put down in 
Brande's tables, as containing an average 
of 22-96 per cent, of alcohol. The colour 
of port is due to the colouring matter of the 
grape husk, which is pressed out in the pre- 



POS 



411 



POS 



paration, along with a considerable amount 
of astringency and extractive matter, from 
which the white wines are free. The large 
percentage of spirit contained in port wine 
is, of course, not all the result of the natu- 
ral fermentation, but is added on account 
of the depraved taste which has rendered 
it necessary for foreigners to add spirit to 
the genuine wine to render it marketable 
in Britain ; spirit, too, which for the most 
part must remain in the wine in an uncom- 
bined condition. Probably, no wine im- 
ported into this country, or, in many cases, 
professed to be imported, is liable to the 
same extent of adulteration as port wine, an 
immense amount of deleterious stuff being 
sold under the name, especially when re- 
tailed in small quantities, or direct from the 
wood. In such cases the poor often suffer ; 
probably, after illness, they may be able, 
or enabled to purchase, it may be one, or 
perhaps a couple of bottles of port; the 
liquid being frequently drawn from the 
cask and put into their own bottles, it need 
scarcely be added, that it is often worse 
than nothing. There are few medical men 
at least, who will decry the virtues of port 
wine as a remedy, either in some stages of 
acute illness or in most convalescences ; but 
if it is to be of any service it must be ge- 
nuine ; those, therefore, who charitably 
interest themselves in the wants of their 
poorer brethren, should keep this in mind, 
and, if inclined to aid^with the often most 
welcome gift of a little wine, send it from 
their own cellar, instead of giving money 
for its purchase. Good port wine is often 
one of the most valuable remedial agents 
in the hand of the physician : in the low 
stages of low fever, in diseases of debility 
generally, and in convalescence from most 
of the exhausting diseases. Gargling with 
port wine in relaxed sore-throat is a good, 
but, perhaps, somewhat unnecessarily .ex- 
pensive remedy. 

POSITION.— The position, either of the 
whole body or of the affected part, in those 
suffering under illness, or from the effects 
of accident, is one of the most important 
considerations connected with treatment; 
it is, moreover, one frequently overlooked, 
particularly by unprofessional persons. Al- 
though the structural arrangements and 
vital activities of the living body counter- 
balance the influence of gravity under or- 
dinary circumstances, the latter force is 
apt, more or less, to exert its power, when 
weakness and long constraint in one pos- 
ture diminish the powers of its counter- 
agents. It is undoubted that the muscular 
movements, which are continually going on 



with most persons in health, tend greatly 
to assist in regulating and equalizing the 
distribution of the blood and other fluids ; 
even in the healthy, the temporary want of 
this assisting power is shown in the liability 
of the feet or legs to become slightly swollen, 
in consequence of long sitting or standing 
in one posture. 

In regulating position, it has for the most 
part to be done, either with reference to the 
relaxation of the muscles, to facilitate the 
flow of the blood or other fluids within the 
body, or to obviate pressure on any portion 
of the body. 

The regulation of position, with reference 
to the relaxation of certain muscles, or sets 
of muscles, is most generally required after 
fractures ; and the principles on which this 
relaxation is to be adopted have been suffi- 
ciently alluded to under the article Frac- 
tures itself. This muscular relaxation may 
also be an object in the treatment of wounds 
which run transverse to the fibres of the 
muscle directly underneath, such as trans- 
verse wounds of the thigh. — See Wounds. 

The regulation of position with reference 
to the flow of the blood or other fluids is 
often of immense importance, and too often 
neglected. The blood may have a tendency 
to gravitate toward the most dependent parts 
of the body, either from general or from 
local causes. 

In some diseases accompanied with great 
exhaustion, and, indeed, in many aged peo- 
ple, independent of disease, it would appear 
as if the forces which circulate the blood 
lost the power of counteracting the force of 
gravity, even in the horizontal posture ; con- 
sequently the blood is apt to accumulate in 
the most dependent parts. In the lungs 
especially this is the case, and there is 
every reason to believe that congestion or 
accumulation of blood in these organs in 
the first place, giving rise to a kind of in- 
flammation in the second, may be the conse- 
quence of long continuance in one position, 
as on the back. In such cases care ought 
to be taken, when practicable, to change 
the position. Stagnation or congestion of 
blood occurs, in the majority of instances, 
from some obstruction to the circulation, 
either at its centre — the heart — or in conse- 
quence of mechanical impediment acting 
upon the veins of the part or parts involved, 
such as happens from the pressure of tu- 
mours, or of the pregnant womb upon the 
large veins of the abdomen, &c. 

Again, at all times, in the healthy body, 
when in the erect posture, there is the force 
of gravity to be overcome in the return of 
the blood from the parts lower than the 



POS 



412 



POT 



heart to the heart, and for this special 
provision is made, most remarkably, in the 
numerous valves "with which the veins of 
the lower extremities are provided ; any 
deficiency in these valves (see Veins) favours 
the gravitation of blood. In all the above- 
named instances, position is of the very 
highest importance, not only as regards the 
comfort of the patient and the treatment 
of the disease, but sometimes as a matter 
of safety. — See Veins. 

While position is to be considered and 
taken advantage of, as a means of facili- 
tating the flow of blood through the veins, 
it is also a useful auxiliary in regulating its 
passage through the arteries, for it makes 
a very considerable difference, whether the 
propulsion of the blood by the heart and 
arteries is exerted against the force of 
gravity, or not. This is well shown, when 
there exists from any cause a tendency to 
fainting. This condition, as pointed out in 
the article on the subject, depends upon 
diminished circulation of blood through the 
brain ; it must, therefore, be evident to all, 
that in the erect posture, when the blood 
has to be driven upward to the head, against 
the force of gravity, a much greater exertion 
of power is required than if it had merely 
to be sent in an horizontal direction, as it is 
when an individual is lying down, and, 
consequently, that in fainting, in which the 
action of the heart is much enfeebled, the 
usual treatment of laying a person almost 
flat is the most rational plan which can be 
adopted ; it, moreover, illustrates well the 
influence of position. In a tendency to 
apoplexy, or to overfulness about the head, 
on the other hand, it is a matter of safety 
that all positions, such as stooping when 
awake, or sleeping with the head low, which 
favour the arterial flow to, or impede the 
venous flow from the head, are to be avoided. 
On precisely similar grounds as the above, 
position is highly important in wounds in- 
volving severance of vessels. It must be 
evident to all, that in the case of an artery 
being wounded, the most rational mode of 
preventing — which it will do entirely some- 
times — or at least of impeding the effusion 
of blood, must be to place the wounded part 
in such a position that the force of gravity 
must act as strongly as possible against the 
force of the circulation; in other words, 
that if an artery of the hand is wounded, 
less blood will be lost by holding the hand 
and arm straight upward, than in any other 
position, (see Artery ;) and further, that the 
very same principles in reverse must,, apply 
in the case of the veins. It might also seem 
as if common sense alone would be suffi- 



cient to teach persons generally such simple 
facts, but it is not so. It is not very long 
since a woman nearly lost her life in Lon- 
don, in consequence of the giving way of 
one of the veins of the leg, from ulceration 
— she almost bled to death because not one 
of those around had knowledge sufficient to 
lay her flat down, and to elevate the bleed- 
ing leg above the level of the rest of the 
body. Her life was saved in consequence 
of the fortunate arrival of Mr. Wakley, to 
an inquest, who, of course, at once obviated 
what might have been a fatal contingency, 
the result of ignorance. The regulation 
of position, with reference to the escape of 
fluids, such as matter from any part of the 
body, requires attention : surgeons generally 
take care that it is properly seen to, but it 
might escape the notice of uprofessional 
persons. As a general rule, parts should 
always be placed so that any discharge from 
them may have as free escape as possible. 
It is this fact, in cases of abscess, which 
often makes the artificial opening of the 
surgeon preferable to the natural one of the 
disease. He chooses the point for his inci- 
sion where the matter can have the readiest 
escape ; that is, the lowest portion of the 
abscess, in the natural and unconstrained 
position of the portion of the body in which 
it is situated. 

Position, with reference to pressure upon 
different parts of the body, particularly in 
persons long confined to bed, requires much 
attention ; it has been already alluded to 
under articles Bed, Bed Sores, &c. 

There are many other points connected 
with the important subject of position, but 
the foregoing remarks — directed rather to 
principles than to details — will probably 
serve to attract a little more attention than 
is often given to considerations so closely 
linked, not only with comfort, but with the 
safety and well-being of the sick and in- 
firm. 

POSSET.— An old form of domestic pre- 
paration for the sick, made with milk curdled 
by means of treacle, beer, &c. 

POTASH, or Potassa, or Potashes, or 
Vegetable Alkali — One of the fixed alka- 
lies and a compound of the metal potassium 
with oxygen, is very widely distributed 
throughout nature ; in the soil, in vegetable 
and animal bodies, it is an almost constant 
ingredient. 

Many preparations of potash are used in 
medicine ; the most generally used are — 

Potash, in its pure form of caustic potash, 
especially in its solution, the liquor potassae ; 

Bicarbonate, or supercarbonate of potash ; 

Acetate of potash ; 



POT 



413 



POT 



Bitartrate, or supertartrate of potash, or 
cream of tartar ; 

Chlorate of potash; 

Nitrate of potash ; 

Hydriodate or iodide of potash ; 

Tartrate of potash with soda, or Rochelle 
salt- 
Potash derives its name from its source 
and mode of manufacture. It is procured by 
"lixiviating," that is, mixing and steeping 
vegetable ashes in water, and evaporating 
the solution or "lye" which results. From 
this solution, potash, in the form of a car- 
bonate, is obtained, but the process being 
very roughly carried out, yields, of course, 
a very impure material, the "pot-ashes" of 
commerce, -which are brought chiefly from 
Russia and North America. The rough 
potash is purified in various ways, either in 
the country of its manufacture or after im- 
portation. When imported in a purified 
state it is sold as " pearl-ash," and after pu- 
rification in this country, as purified pearl- 
ash, or carbonate of potash. This must not 
be confounded with bicarbonate or super- 
carbonate of potash, which is the more ge- 
nerally used medicinal preparation. There 
is great variation in the amount of car- 
bonate of potash obtained from various ve- 
getables, but weeds yield it most abundantly 
after burning. For example, while oak- 
wood yields but 1-53, and beech-wood 1-45, 
in every thousand parts, the fern yields 
6-26, thistles 35-7, wormwood 73-0, and the 
common fumitory 79-0, in every thousand. 
Pure cai'bonate of potash is sold in the form 
of a white, granular salt, which is very de- 
liquescent ; that is, becomes moist or partly 
dissolved, in consequence of attracting mois- 
ture from the atmosphere. 

Bicarbonate of potash occurs in crystals, 
but is more generally sold in the form of a 
white powder. It is, while applicable to 
the same purposes, a much milder prepara- 
tion than the carbonate. 

The solution of pure potash, or "liquor 
potass^," is very similar in its medicinal 
action to the above preparations ; in its un- 
diluted condition it is caustic, and acts as 
an irritant poison. 

All the above preparations of potash are 
antacid, diuretic, and cooling ; the simple 
carbonate, however, is but little used as a 
medicinal agent. The bicarbonate, in doses 
of from ten to twenty grains, dissolved in 
a couple of ounces of water, may be given 
when its antacid action is required ; for 
diuretic pm^poses the doses must be at least 
double the above. The dose of the " liquor 
potasses," or potassa solution, is from ten to 
twenty drops, diluted in the same way. The 
2k2 



bicarbonate of potash is often used along 
with an acid in forming effervescing draughts 
in febrile diseases ; for the amount of acid 
requisite, see article Effervescing. In some 
disorders of the liver, and where there is a 
tendency to the formation of red gravel in 
the urine, potash, especially the liquor po- 
tassee, is one of our most useful remedies. 
A very good combination is fifteen drops 
of the solution in a teaspoonful of dan- 
delion tea : this may be taken at least 
twice a-day. A very good preparation of 
potash, "Brandreth's solution," is used by 
some in preference to the common potash 
solution. It is requisite that those who 
regularly, or for any length of time, take 
these preparations of potash on account of 
red gravel or other diseases, should' be on 
their guard, lest too continued a use of 
the remedy may induce other disorders as 
bad, or probably worse than the existing one. 
The author could, in one case, trace a sud- 
den breaking up of the nervous system with 
alkaline and phosphatic urine, to no other 
cause than the long and incautious use of 
potash to obviate a tendency to red gravel. 
As mentioned under article Fat, the use of 
potash solution tends to diminish that con- 
stituent of the body. Potash is preferable 
to soda as an antacid in gout, from its form- 
ing a more soluble compound with the pecu- 
liar acid of that disease. — See Gout. 

Poisoning by potash solution has some- 
times occurred ; in this case, diluted acids, 
milk, demulcent drinks, or oil will be the 
best remedies. The acetate of potash, a 
compound of acetic acid and potash, is 
chiefly used as a diuretic, and as a remedy 
in skin diseases — the dose from thirty grains 
to sixty, well diluted in water : it may act 
upon the bowels. 

Chlorate of potash is generally sold in 
the form of flat, white crystals ; it is cooling, 
and a good saline remedy in inflammatory 
fever ; it is most valuable, however, as a 
remedy in thrush or "aphtha," (see Aph- 
tha,) and in cases of sore mouth generally 
— the dose five to fifteen grains, dissolved in 
water, for an adult. 

Bitartrate of potash, or cream of tartar, 
is a compound of potash with tartaric acid. 
In its impure state, in which it forms a gray 
or brown concretion, it is known by the 
name of argol or winestone, and is formed 
inside the casks in which new wine is kept. 
The coloured, impure, crude tartar is puri- 
fied, dissolved, and the solution gradually 
evaporated. In this process crusts form on 
the surface of the solution, which are suc- 
cessively skimmed off, whence the name 
"cream of tartar" is given to the purified 



POT 



414 



POT 



preparation ; this is generally sold in the 
form of white powder, which feels gritty in 
the mouth, and gives a pleasant acid taste. 
Cream of tartar is used to form the cooling 
pleasant drink "imperial," which by most 
persons may be taken freely. In doses of 
from sixty to one hundred grains, cream of 
tartar given, stirred into half a tumblerful 
of water — it will not dissolve — is one of 
the best diuretics we have ; in doses of two 
or three drachms it acts as a mild laxative. 
— See Jalap. Some persons cannot take 
cream of tartar in any form without suffer- 
ing from irritation of the kidneys. An 
overdose might produce inflammation of the 
stomach. 

Nitrate of potash, or saltpetre, a compound 
of potash and nitric acid, is now brought 
chiefly from India, where it is obtained by 
"lixiviation," or by dissolving the nitrates 
of lime, soda, and potash, out of the soil in 
which they exist in large quantity ; the lixi- 
viation being conducted over wood ashes. In 
this way the other nitrates are decomposed 
by the potash of the ashes, and nitrate of 
potash or saltpetre formed. Nitrate of 
potash may be also formed artificially, as it 
was in France during the war, when the 
British cruisers interrupted the foreign sup 
plies to that country, at a time when the 
salt was so largely required in the formation 
of gunpowder. It is made by throwing up 
large compost heaps containing lime in some 
form or other, either mingled with decaying 
animal matter, or watered regularly with 
urine. These heaps are allowed to remain 
two or three years unmoved, during which 
time, by slow decomposition, nitric acid is 
formed in combination with the lime, and 
the nitrate of lime being then dissolved out 
by water, is easily converted into nitrate of 
potash by decomposition. At present, how- 
ever, " a great part of the nitre (nitrates of 
potash) used for the manufacture of powder, 
in France, is obtained in Paris, from the 
lower stones of the houses, which are con- 
stantly in contact with the liquids of the 
streets and drains. The lime of the walls 
is gradually dissolved by the nitric acid 
formed ; the walls lose their coherence and 
firmness — hence the name of wall corrosion, 
given to this injurious formation of nitre. 
The potash of the nitre is generally derived 
from bricks, and even the mortar contains 
some potash, which gradually decomposes 
the nitrate of lime, aided by the superior 
crystallizing power of nitre, so that the 
latter salt is formed. But, generally, in 
order to obtain all the nitric acid as nitrates, 
potash must be added to the liquid obtained 



from the scrapings of the walls by lixivia- 
tion with water. 

Saltpetre is usually sold in crystals of 
various sizes, or in the form of crystalline 
powder ; its taste is peculiarly cooling. In 
doses of twenty grains, dissolved in two or 
three ounces of water, it increases the flow 
of urine, and is most frequently given for 
this purpose. In large doses, such as half 
an ounce or more, it occasions pain at the 
stomach, and vomiting, with extreme de- 
pression of the system, and may thus prove 
fatal. Free dilution with some demulcent, 
such as thin gruel or barley-water, induce- 
ment of vomiting, and counteraction of the 
depression by stimulants, would be the most 
appropriate treatment. 

Hydriodate of potash, or iodide of potash, 
is a compound of iodine, or rather of iodic 
acid with potash ; it occurs in the form of 
white, and, when well formed, cubical crys- 
tals. It is a preparation now much used by 
medical men, but is not a remedy calcu- 
lated for domestic administration. It may, 
however, be used in the form of its oint- 
ment in bronchocele, or " full- throat." — 
See Bronchocele. It is very liable to adulte- 
ration. 

Tartrate of potash and soda, or Kochelle 
salt, chiefly requires notice from its being 
the active ingredient of the well-known 
" seidlitz powders," which consist of the 
common soda and tartaric acid, (effervescing 
powder,) with the addition of a drachm of 
the tartrate of potash and soda to the alka- 
line powder. — See Seidlitz. Rochelle salt 
may, however, be used alone as an aperient, 
well dissolved in water, in doses of from 
one to six or eight drachms ; its action is 
rather milder than, but resembles that of 
Epsom salts ; the taste, however, is much 
more agreeable. Rochelle salt also is sold, 
generally in crystals, but may be bought in 
powder. 

POTATO. — This well-known tuber, in- 
troduced into Ireland in the sixteenth cen- 
tury, from America, by Sir Walter Raleigh, 
not only forms a daily article of food 
throughout a large proportion of the civil- 
ized world, but, unfortunately, owing to the 
ease with which it is cultivated, has become 
the staple article of nutriment to millions. 
As an addition to other and more nutritive 
food, the potato is most invaluable ; as the 
sole article of diet, although capable of sup- 
porting life, it is a wretched material, and 
any combination of circumstances which 
induces or compels a population to depend 
upon it in too great a degree, must be re- 
garded as most unfortunate. 



POT 



415 



POU 



The potato, undoubtedly, contains the 
elements of nutrition, that is, starchy and 
gummy matters, (see Food,) capable of 
sustaining the respiratory processes, and 
also "plastic material," adapted to build 
up the muscular and other constituents of 
living animal bodies. But those plastic ma- 
terials are so deficient in quantity, and their 
amount is so small compared "with that of the 
other constituents of the tuber, which, more- 
over, contains a very large amount of water, 
that a man living solely upon potatoes must 
consume a very large quantity to keep him- 
self in health and strength, even if he can 
do the latter when undergoing any thing 
like exertion. From seven to ten pounds of 
potatoes per day is by no means an unusual 
amount for a labouring Irishman to con- 
sume ; but the ten pounds of the root con- 
tain no more real nutriment than one pound 
and a half of good wheaten bread, although 
they afford abundant respiratory or carbon 
material. In consequence of the less 
amount of muscular, "plastic" nutriment 
contained in his food, the Irish labourer is 
less adapted for continued exertion than the 
Englishman on his wheat and meat, or the 
Scotchman on his oatmeal. — See Oats. 
Moreover, it has been remarked, that the 
constitution of the Irish labourer is apt to 
give way earlier in life than that of the men 
of the sister kingdoms, and he is certainly 
more liable to be the ^victim of epidemic 
disease. 

A remark of Liebig's well illustrates the 
value of the potato as an article of nutri- 
ment. He says, "A horse fed on potatoes 
and compelled to work, loses weight ; when 
he does no work, his weight remains un- 
changed." Thus evidently showing that 
the root is unable to supply the loss by 
"motor change," when active muscular ex- 
ertion is undergone. 

As an addition simply to other varied and 
more nutritious aliment, the potato must be 
esteemed most valuable ; it supplies the na- 
tural desire for vegetable food, and affords 
it of a kind well adapted to promote the 
health of the system in one of its most di- 
gestible forms. The appearance of true sea 
scurvy in so many parts of the kingdom, 
during the period when, in consequence of 
the potato blight, the population generally 
were compelled to use drier and more animal- 
ized food in unusual proportion, sufficiently 
indicates how much we owe, in the matter 
of health, to the regular intermixture of the 
potato with our ordinary diet ; and it is a 
questionable system of dietetics which, ex- 
cept from some very cogent reason, ex- 
cludes the weW-cooked potato from the din- 



ner-table of the invalid : the well-cooked 
potato, for nothing can be more indigestible 
than a badly-cooked one. It is, perhaps, 
superfluous to point out that a well-boiled 
potato should break down in a mealy form to 
its very centre ; by well boiled is not meant 
excessively boiled, for when this is done 
much of the nutriment of the root is lost. 
In Dr. Beaumont's tables, roasted and baked 
potatoes are said to take but two and a half 
hours for digestion, while boiled potatoes 
take an hour longer. 

Potatoes which boil " waxy" are peculiarly 
unwholesome, and often pass through the 
bowels unchanged ; the same may be said 
of early potatoes, not the early kinds when 
matured or ripe, but as they are generally 
used in an immature condition. Mashed 
potatoes do not generally get sufficiently 
mingled with the saliva to secure the full 
digestion of their starchy constituents. — See 
Digestion. Potatoes soaked with gravy and 
dripping from roasted meat, though suitable 
for persons of strong digestion, are very 
liable to disagree with dyspeptics. 

Potato starch, in the form of "British 
tapioca," is a very wholesome preparation. 

Potato spirit or brandy has been found 
more than usually deleterious. 

Refer to Food — Fecula. 

POTENTILLA TORMENTILLA. — See 

TOKMEXTILLA. 

POULTICE.— A poultice is generally un- 
derstood to be an application adapted to 
afford moisture and generally warmth, 
through the medium of some soft substance; 
or rather it ought to afford these essentials, 
for, too often, cold dampness, or hardness 
and irritation, are the only effects derived 
from the ill-made and badly applied poul- 
tices with which nurses are apt to indulge 
their charges. 

As above stated, any soft substance which 
will retain heat and moisture maj r be used 
to form a poultice ; but some materials are 
better adapted than others for the purpose. 
The substances most generally used for 
poultices are bread, linseed-meal, oatmeal, 
arrow-root, carrots, turnips, &c.; with these 
are often intermingled lard, milk, honey, 
treacle, yeast, &c. ; bran, so often recom- 
mended in this work as a medium for ap- 
plying heat and moisture, can scarcely be 
considered as a poultice properly so called. 
The mustard cataplasm is also, sometimes, 
called a poultice, but improperly. The name 
cold poultice is also used. 

The essentials of a good poultice are that 
it shall be perfectly smooth and free from 
lumps or hardness, that it shall be as soft 
and moist as possible without being sloppy, 



POU 



416 



POU 



and that it shall have sufficient bulk to 
retain both its warmth and moisture with- 
out being too heavy. No material, perhaps, 
offers more facility for making a good poul- 
tice than bread, and accordingly we find 
that the 

Bread poultice is, perhaps, more commonly 
used than any other. It is made either with 
water or milk, but the latter is a very doubt- 
ful addition, and the same may be said of 
the grease or lard often added to this form 
of poultice. The milk is apt to turn sour, 
and can answer no better purpose than the 
water ; and when a greasy poultice is used, 
the bread is not requisite. The best mode 
of making a bread poultice is to break the 
crumb of bread into a hot basin, pour boil- 
ing water over it sufficient to soak it tho- 
roughly, and allow it to stand covered over 
for a few minutes by the side of the fire ; 
any superfluous moisture being drained off, 
the pulp should be thickly spread upon a 
piece of cloth of the requisite size. In some 
cases it is advisable to interpose a piece of 
thin muslin between the poultice and the 
surface on which it is placed. The tem- 
perature at which a poultice is to be applied 
must vary according to circumstances, but, 
generally, the best is that which is most 
agreeable to the patient ; occasionally it is 
useful to- have it as high as it can be borne. 
After a poultice is applied to the body, it is 
a good plan to cover the' part, either with a 
fold of flannel or with oiled silk, to assist 
in retaining the warmth and moisture ; the 
latter, moreover, prevents the moisture 
which necessarily exhales from the applica- 
tion damping the clothes, &c, often a very 
great inconvenience in badly applied poul- 
tices. Indeed, the bad management of poul- 
tices generally amid the poorer classes, con- 
stitutes a serious objection to their use; 
they are often either made so sloppy as to 
wet every thing around, and to put the pa- 
tient in great risk from cold, or they are 
made so small and stiff as very quickly to 
become caked and hard upon the surface, 
particularly if not sufficiently often re- 
newed. Even in the most favourable cir- 
cumstances a poultice requires renewal at 
least three times in the twenty-four hours. 

The cold bread poultice is often conve- 
nient, and must be made simply with cold 
instead of hot water. 

The bread poultice may be made the 
medium for various medicated applications ; 
thus hot decoction of poppy " heads," &c. 
may be used instead of hot water, or goulard 
may be added to the cold poultice with ad- 
vantage. It is a necessary caution, that 
the material used for these medicated 



poultices should not, after use, be thrown 
where it can be picked up by poultry. 
After the bread poultice, probably the 

Linseed-meal Poultice is more generally 
used than any other. For this purpose, 
ground linseed, free from grit, should be 
procured. To make the poultice, a suffi- 
cient amount of boiling water is to be 
poured into a hot basin, and the meal stir- 
red in till the whole is of the proper con- 
sistence ; the mass being beaten smooth 
before use, is then to be spread evenly upon 
the cloth. This forms a very smooth poul- 
tice when well made, and the oil which the 
linseed naturally contains tends to keep it 
soft. It is rather more stimulating than 
the bread poultice : occasionally it is made, 
by mistake, of the whole seed instead of the 
meal. 

The Oat-meal Poultice may be made in a 
similar way to the linseed ; but, although 
oats contain a considerable amount of fatty 
matter, it is not sufficient alone to make an 
oily poultice, like the linseed; it is therefore 
very common to add a little lard ; this, how- 
ever, must not be done when the oatmeal 
poultice is, as very generally made, the 
medium for the 

Fermenting or Yeast Poultice, which is best 
made by adding yeast, in the proportion of 
two tablespoonsful to the quarter pound of 
meal, [cornmeal answers well,] to a ready- 
made oatmeal poultice, mixing thoroughly, 
and, if requisite, heating to a proper tem- 
perature. If oatmeal is not at hand, flour 
may be used. This poultice is a very com- 
mon application in cases of mortification or 
of fetid sores. 

Arrow-root, made as for the table, was 
recommended by the late Dr. A. T. Thomson, 
as a soothing poultice in irritable sores and 
the like. 

Other substances, such as carrots, turnips, 
&c, are often recommended and used as 
poultices, but they possess no advantage 
over those already named, and are objection- 
able from their smell ; they may, however, 
be used, and - indeed any soft substance, 
consistent with cleanliness, which will re- 
tain warmth and moisture, when bread and 
meal are not procurable, or when their use 
in this way is an object. When medicated 
poultices are required, as mentioned above, 
it is better to make the bread poultice with 
the infusion or decoction of the medicinal 
agent. In this way the 

Hemlock Poultice may be made, or it may 
be formed as ordered in the Dublin Pharma- 
copoeia, thus: — Take of dried hemlock leaves 
an ounce, water a pound and a half by 
measure, boil down to a pound, and add of 



POU 



417 



POW 



the powder of hemlock leaves sufficient to 
make a poultice. This poultice is often 
effectual in subduing the pain of cancerous 
and painful sores. 

Honey, treacle, &c. are not desirable ad- 
ditions to a poultice. 

Bran Poultice. — See Bran. 

Few applications are more generally used, 
either in regular or domestic surgery, than 
poultices, and, in their proper place, few 
are more useful. It is worthy of remark, 
that the most ancient poultice on record is 
that of figs, applied to King Hezekiah, by 
the direction of the prophet Isaiah. 

In painful swellings, attended with inflam- 
mation, such as boils in inflamed wounds 
and the like, or for promoting the discharge 
of matter, no application is more suitable 
than the poultice. For the uses of the 
large hot bran poultice in internal affec- 
tions, see Bran — Heat. To the use of poul- 
tices, however, there is a limit, not always 
well observed, particularly in the case of 
wounds and ulcers. Up to a certain point 
they are most valuable — beyond it they do 
harm ; instead of soothing and encouraging 
sufficient discharge, they attract the blood 
too strongly to the part, increase beyond 
measure the discharge, and encourage the 
formation of "proud flesh." It is only 
practical experience which can teach the 
appearances indicative of the precise time 
when a poultice should be left off, but it 
may be guessed at when*healing processes, 
which have been going on favorably, seem 
to come to a stand-still or retrograde ; when 
the discharge rather increases than dimi- 
nishes, and the surface and edges of the 
sore seem to become full, and at the same 
time pale and flabby. 

After poulticing has been carried suffi- 
ciently far, the simple water dressing (see 
Dressing) is in most cases most suitable — it 
is cooler, pleasanter, and not so like a hot- 
bed as the common poultice. Some sur- 
geons, and among them the celebrated Mr. 
Liston, substituted the water dressing in 
all cases for the poultice. Indeed, the above 
gentleman used to say, the nurses of his 
hospital wards had forgotten how to make 
"a poultice," of which he says, in his 
Operative Surgery, " the very name is asso- 
ciated with putrefaction and nastiness." 
That Mr. Liston carried his prejudice 
against the poultice too far, may be sus- 
pected from the fact, that many of the first 
surgeons of the day continue to take ad- 
vantage of it ; but that the water dressing 
may be substituted in many cases is unques- 
tionable ; and it is certainly a much more 
elegant and agreeable application in every 



way. It does not, however, in all cases 
answer the purpose of the poultice ; indeed, 
that it does not act in the same way is evi- 
dent from the fact that when a sore has 
been stimulated, as above described, by 
over poulticing, the substitution of the 
water dressing quickly gives it a more 
healthy character, thereby proving its less 
excitant character. 

Somewhat similar, in principle at least, 
to the lint and oiled silk application is the 
Spongio Piline, introduced a few years ago 
as a substitute for the poultice. This, the 
invention of Mr. Marckwick, consists of 
sponge cut up into fragments, and felted 
into a mass with cotton wool, a layer of this 
mingled material being backed with a 
waterproof varnish. The mingled sponge 
and cotton will of course absorb moisture 
freely and retain it, and therefore in some 
measure act as a poultice. The author, 
however, cannot from his own experience 
speak favourably of its effects ; in moderate 
sized pieces it certainly does not answer 
well, but where large sheets of the material 
— as for a whole limb — are required and 
used, it may probably be very useful. 

Refer to Dressing — Heat, $c. 

POULTRY — As food must be considered 
under the divisions of the oily and non-oily. 
The flesh of the first class, including ducks, 
geese, &c, is certainly difficult of digestion, 
and perfectly inadmissible, even when 
plainly cooked, for invalids. The flesh of 
the non-oily kind, such as common fowls, 
turkeys, &c, is more soluble in the stomach, 
but it is far from being as easily digested 
as generally imagined ; certainly it is not 
equally digestible with tender mutton. The 
flesh of this description of poultry, as of 
chicken, for example, is more likely to agree 
if boiled rather than roasted. The flesh of 
poultry, when digested, does not, probably, 
prove so stimulant to the system as that of 
the larger animals ; it is therefore more 
useful in many cases of convalescence, when 
animal food is first permitted. 

" In the boiling and roasting of poultry, 
the flesh of which is white, and contains 
little blood, the temperature of the inner 
parts, when the flesh has been well-cooked, 
seldom exceeds 130° or 140°. The flesh of 
poultry or game is therefore sooner dressed 
than flesh which contains much blood, such 
as beef or mutton."* The broth made 
from chicken or fowl offers one of the best 
forms for giving animal nourishment in 
early convalescence. 

POWDER.— The form of powder is a very 



T> 



Liebig's Chemistry of Food. 



POW 



418 



PRE 



common one for the administration of medi- 
cines, as in this way the peculiar actions 
of the drug are more readily and certainly 
developed. Powders, generally, are pre- 
pared on the large scale by " drug grind- 
ers," but as in the process the drug is very 
liable to extensive adulteration, some per- 
sons prefer preparing their own powders, 
although it is a very troublesome process. 
As drugs are more liable to spoil in the 
form of powder, emigrants and others may, 
in some instances, find it an advantage to 
powder their own. An iron mortar is gene- 
rally used for powdering crude drugs ; and 
if these are at all acrid, or indeed in any 
case, it is an advantage to have it fitted 
either with a. wooden cover, or with a lea- 
ther fastened round both mortar and pestle. 
A fine sieve is required to separate the finer 
portions of the powder from the coarser. 
Dr. Christison remarks in his Dispensatory ; 
— "The most prompt and effectual mode of 
obtaining fine powder is to use the mortar 
And sieve alternately — that is, to sift away 
the finer particles as soon as partial pul- 
verization is accomplished, to pound or 
triturate again what remains on the sieve, 
to sift this as soon as a little more fine 
powder is formed, and to repeat the alter- 
nate trituration and sifting frequently, till 
the whole substance has passed through the 
sieve. In this way much time is saved, and 
much less of the finest powder is lost by 
being driven off in triturating or pounding 
the coarser residue." As simple powders 
of the majority of the drugs used in medi- 
cine are prepared, it would take up un- 
necessary space to enumerate them here. 
The most useful compound powders admis- 
sible for domestic use are the 

Aromatic powder. 

Compound chalk powder, with opium. 

Compound ipecacuanha, or Dover's pow- 
der. — See Dover's Potoder. 

Compound jalap powder. — See Jalap. 

These are better purchased, particularly 
the compound chalk with opium, but may 
be made. 

The compound aromatic powder is made 
by reducing to fine powder equal parts of 
cinnamon, cardamom seeds, and ginger. 

Powders ought always to be kept in well- 
closed bottles, otherwise they lose their 
medicinal properties ; some, such as squill 
or aloes, become damp and caked into a 
mass. 

Powders are generally administered in 
some thick vehicle, such as preserve, thick 
gruel, or the like ; if given in thin fluids, 
such as tea, &c, they are apt to sink to the 
bottom, and are partly lost. 



PRACTICE.— The old saying that "prac- 
tice makes perfect," is applicable to the 
practice of medicine, but it is with soms 
reservation; a reservation which is not al- 
ways taken into account by the public, nor 
admitted by a certain class — the "practical 
men" — in the profession. Without prac- 
tical experience it is certain no man can be 
either physician or surgeon, however great 
his theoretical knowledge ; but it is equally 
certain, if practical experience alone be 
trusted to, it will do but little to bring its 
possessor up to his proper position as re- 
gards medical science, and must often leave 
him at fault, when he ought not to be so, 
particularly in cases which differ from the 
ordinary routine. Neither years nor extent 
of practice can make the man a good prac- 
titioner, or, at least, as good a practitioner 
as he ought to be, if he neglects those aids 
and appliances in the investigation and 
treatment of disease, which the industry 
of his numerous brethren are daily bring- 
ing forward. The public may draw their 
own inferences. 

PRECORDIAL REGION.— The forepart 
of the chest over the heart. 

PRECIPITATE. — Something thrown 
down ; in chemical language, the term is 
applied to a substance which is separated in 
a fluid, by decomposition, and which falls to 
the bottom. 

PRECOCITY— Untimely maturity— is oc- 
casionally seen in the development of the 
body, and can only be regarded as a form of 
disease. Precocity of mind is by no means 
uncommon in children, and in too many 
instances is equally significant with undue 
physical > development, and much to be 
dreaded. The morbid excitability of brain 
is but the result of disease, and gives no 
promise of supereminence in after-life. As 
a general rule, a precocious, or "strikingly 
clever" child, cannot be too much kept back 
from mental exertion ; every effort should 
be made to divert the tendency to cerebral 
excitement, and by encouraging physical 
exertion,to divert the nervous power to the 
body at large : too often the reverse system 
is practised. 

PREDISPOSITION.— See Disease, He- 
reditary — Marriage, &c. 

PREGNANCY— Is the condition of a fe- 
male between the periods of conception and 
delivery. The state is to be considered, 
both as regards the symptoms which usually 
indicate its existence, and also with respect 
to the bodily disorders which are most com- 
monly associated with it ; some of the symp- 
toms, moreover, are also disorders. It is 
usually considered that pregnancy cannot 



PRE 



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take place before the establishment of men- 
struation, and, as a general rule, it does 
not, but eases are recorded in which it 
does. The suppression of the above func- 
tion is, also, always regarded as one of the 
most unequivocal proofs of pregnancy, but 
it is not by any means invariable ; cases 
have been known, in which the secretion 
has appeared during the whole period up to 
the time of delivery, and in many it is mani- 
fested for one, two, or three months after 
conception. The swelling of the breasts, 
another sign of pregnancy, does not always 
occur, in a marked manner,- if menstruation 
goes on, and it may also be excited sympa- 
thetically by the presence of tumours, or 
by other causes of irritation connected with 
the womb. The breasts, also, may increase, 
simply from accumulation of fat ; in this 
case they do not afford the somewhat knotty 
feeling to the hand that they do in preg- 
nancy, but are smoother and more uniformly 
increased in size; probably, too, the in- 
creased deposition of fat is general. For 
the first few weeks after pregnancy, the 
abdomen is flatter than usual, that is, be- 
fore it begins to enlarge. The countenance 
undergoes an alteration, better known than 
to be described ; the features look sharper, 
and the eyes larger than heretofore ; these 
appearances, however, are more strongly 
manifested in some women than others. 
Among the earliest and best known of the 
symptomatic disorders "of pregnancy is 
nausea, with sickness. This is sometimes 
developed very early in the condition, occa- 
sionally within the first few days, but more 
generally not for two or three weeks ; it is 
most usual in the morning, on the female 
first rising, but, in some cases, is almost con- 
stant, and is then very distressing. Tooth- 
ache is not an unfrequent attendant on 
pregnancy in all its stages. Salivation, 
that is, a constant flow of saliva into the 
mouth, causing constant spitting, is another 
though not very common sj-mptom. Irri- 
tability of the bladder is common. Heart- 
burn is most general in the latter stages of 
pregnancy, but may be suffered from in all. 
In many, there is no very definite symptom, 
but a general feeling of unrest, with irrita- 
bility of temper, &c. As pregnancy ad- 
vances, other symptoms, or symptomatic 
disorders show themselves ; but, frequently, 
after the first few months, the health which 
has been disordered, undergoes a remark- 
able change for the better, and continues 
good up to the period of child-birth. When 
this change occurs, as a sequence to symp- 
toms of the first stages of pregnancy, and 
the general symptoms of the condition re- 



main, any doubt of the true state of the 
case, if such has existed, may be laid aside. 
Some women never enjoy such regular good 
health, as they do during the entire nine 
months they carry their child. About the 
sixteenth week, a little before or after, the 
symptom of "quickening" occurs. This 
is popularly, but erroneously, thought to 
indicate the period when the child first be- 
comes endowed with life ; indeed, so fully 
has this error been embraced, that upon it 
a principle of English law involving life and 
death has been established. The child is 
living from the commencement of pregnancy. 
The symptom of quickening is occasioned 
by a sudden change of the position of the 
womb, consequent upon its increase in vo- 
lume ; after quickening, however, the move- 
ments of the child are more perceptibly 
felt. Quickening is generally accompanied 
with temporary sickness and faintness, and 
with a sense of alarm for a short time. After 
its occurrence, the abdomen enlarges more 
perceptibly. Milk is now, or even before 
this, found in the breasts, and the capability 
of its expression from them may be taken 
as a corroborative, but not as an absolute 
sign of pregnancy, for it may occur inde- 
pendent of that condition, and in women 
who have already borne children, milk is 
apt to linger in the breasts for a consider- 
able period. The nipple is sensibly enlarged 
after conception, and, in most cases, is sur- 
rounded by a more or less coloured ring, 
the "areola," as it is called by medical 
men. In some females, especially thos? 
with dark hair and skin, the areola is often 
extremely deeply coloured, of the deepest 
brown — from this shade it is of every va- 
riety, and in some is absent altogether; 
it, therefore, is not an invariable sign of 
pregnancy, for the reason, more especially, 
that it is sometimes witnessed without that 
condition. 

The urine is found to be in some cases 
altered during pregnancy, particularly in 
the later months. If a portion of the se- 
cretion is allowed to stand four and twenty, 
or six and thirty hours, a greasy-looking 
scum, with a cheesy smell, and presenting 
peculiar appearances under the microscope, 
is found on the surface. This does not show 
in all cases. 

From the remarks above made, it may be 
gathered, that although there are many 
signs and symptoms of pregnancy, there is, 
probably, not one which can by itself be 
depended upon in doubtful cases. In most 
instances, the combination and perfect de- 
velopment of a certain number of the above 
symptoms make the case certain ; but it 



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may happen, that there is much difficulty 
in coming to a satisfactory conclusion, espe- 
cially in the earlier stages, and if there is 
any desire for concealment. Medical men 
are often unjustly blamed, and now and 
then laughed at, for having, in the earlier 
stages of pregnancy, treated the disorders 
thence resulting as ordinary ailments, cha- 
racterized by the same symptoms. Where 
there is reason, as in the case of marriage, 
to expect pregnancy, this is not likely to 
be the case, for if the examination of the 
practitioner did not lead him to the fact, 
it is probable the female herself would in- 
timate the possibility of her symptoms 
arising therefrom. In those cases, how- 
ever, in which pregnancy can neither be ex- 
pected nor suspected, especially if there is 
reason for an attempt at concealment, it 
must be obvious to all how little, compara- 
tively, there may be to lead to a conclusion 
which is not looked for ; and, further, how 
delicate must be the position, and how 
guarded the opinions of a medical man 
so situated. Were these matters better 
understood, and their difficulties more ap- 
preciated, his — often only apparent — errors 
in these matters would be more charitably 
regarded. 

By the fifth month of pregnancy, all the 
symptoms have for the most part become 
evident, but there are disorders which more 
generally show themselves during the latter 
part of the pei'iod. One of the most frequent 
of these is costiveness, occasioned, doubt- 
less, in part, by the mechanical obstruction 
caused by the enlarged womb. The legs 
are apt to become swollen, or their veins to 
enlarge, from the same cause acting upon 
the large veins within the abdomen. The 
impediment to the flow of blood also ex- 
hibits itself in the formation of piles, which 
may cause much inconvenience during the 
last months of pregnancy. 

Cramp in the lower limbs, caused by the 
pressure of the enlarged womb upon the 
nerves, often causes much annoyance, and 
sympathetic nervous pains throughout the 
body are not uncommon. Irritability of 
the bladder is apt to be much increased at 
this time ; headaches, too, occur in some 
women, and may be of great severity, threat- 
ening convulsion. The above is rather a 
formidable array.of the ailments from which 
many pregnant women may suffer, and some 
unquestionably do suffer, and severely so ; 
but very many are free from the majority 
of them, except perhaps in slight degree. 
As said above, some women never enjoy 
such perfect health as they do when "in the 
family way." 



The proper management of the disorders 
incident to pregnancy will certainly do much 
to alleviate their inconveniences. 

The first which generally requires atten- 
tion, is the sickness. This may in some 
measure be prevented by attention to diet, 
■ and by the avoidance of all articles of food 
J which were known to disagree, or which 
J are found to disagree; for the rule which 
j holds good in the ordinary state does not 
always do so in pregnancy. Effervescing 
draughts, made with soda and tartaric acid 
or lemon-juice, (see Effervescing,) are useful, 
and to each may be added from half to a 
whole teaspoonful of sal-volatile. A me- 
dical man may possibly add a drop or two 
of the medicinal prussic aid to each dose, 
but this must be left to medical regulation. 
If there is much acidity, the bi-carbonates 
of soda, or potassa, or the fluid magnesia 
will be found useful, and at the same time 
check the vomiting. In cases of debility, a 
teaspoonful of calcined magnesia, in three 
parts of a wineglassful of sherry, may be 
given with advantage. In obstinate heart- 
burn and indigestion, with or without vomit- 
ing, a wineglassful of the infusion of co- 
lumbo, in combination with soda, potash, 
or magnesia, is one of the best remedies, 
and may be taken twice, or, if requisite, 
thrice a day. In cases of extremely obsti- 
nate vomiting, creasote (see Creasote) may 
be tried. The tincture of nux vomica, in 
twenty-drop doses, will very likely prove 
serviceable, but can only be given with 
safety by a medical man. 

The costiveness of pregnancy is often 
more troublesome to manage, as the usual 
convenient aperient pills are inadmissible, 
on account of the aloes they contain. 

Castor-oil is the most generally useful 
and safe aperient when it can be taken re- 
gularly, but very many find it impossible 
to continue its use for long, in consequence 
of the nausea it occasions. Those whose 
bowels are very easily moved, sometimes 
find the finest olive or salad oil answer well 
in tablespoonful doses. Senna infusion may 
be safely taken in the pregnant state, and 
in those who are of full habit, small, well- 
diluted doses of the neutral salts, such as 
Epsom or Rochelle, are extremely useful. 
Rhubarb and magnesia is a safe combina- 
tion, but generally too mild. The regular 
use of some form of clyster, (see Clyster,) 
which is found to be sufficiently efficacious, 
is one of the best methods of regulating the 
bowels in pregnancy, and regulated they 
must be in some way ; there is nothing 
more likely, not only to increase the uncom- 
fortable sensations incident to the condition 



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itself, but to render delivery more difficult, 
and recovery from it more liable to accident, 
than an habitually constipated condition of 
the bowels. When piles occur, it is gene- 
rally in connection with costiveness. — See 
Piles. Irritability of the bladder, charac- 
terized by constant desire to pass urine, is 
sometimes very obstinate, and, in the later 
stages, in which it depends on the mecha- 
nical pressure of the enlarged womb, very 
difficult to remove. It is most likely to be 
alleviated by the use of a broad belt or band 
passed round the abdomen, so as to give 
adequate mechanical support to the enlarged 
womb ; indeed, the belt will not only often 
relieve the above troublesome symptom, 
but will remove many of the other uneasy 
or painful sensations which accompany the 
latter stages of pregnancy. When, along 
with irritability of the bladder, the urine 
is scanty, high-coloured, and deposits red 
sediment on standing, ten-drop doses of 
the solution of potash taken in barley-water, 
twice or three times a day, will probably 
give much relief: In weakly and debilitated 
constitutions, ten drops of the tincture of 
muriate of iron, in a wineglassful of water, 
twice a day, will be perhaps a better re- 
medy. Malt liquor is apt to increase the 
urinary irritation, and must therefore be 
avoided ; and, if stimulants are required, 
wine and water, or weak brandy, or gin and 
water substituted. 

Cramp, being dependent on a mechanical 
cause, is difficult to remove. It may, how- 
ever be alleviated by the use of the abdo- 
minal belt, and by strict attention to the 
state of the bowels and digestive organs ; 
indeed, during the whole period of preg- 
nancy, carefulness and moderation in diet 
will be found to influence greatly for the 
better many of the casual inconveniences. 
— See Cramp. 

Swelling of the legs, and of their veins, 
being dependent, like cramp, on mechanical 
causes, is to be relieved by attention to me- 
chanical modes of treatment, particularly 
by care that no unnecessary accumulation 
in the bowels adds to the obstruction to the 
return of the blood through the veins, keep- 
ing the feet and legs up as much as pos- 
sible ; bandaging, friction, &c. are all useful 
in relieving the condition. — See Veins. 

The breasts should be left as free as con- 
sistent with appearance, and the nipples 
especially attended to. — See Nipples. Head- 
ache, if continued and severe in pregnancy, 
is a symptom which must not be over- 
looked ; it may simply be owing to costive- 
ness, or other slight temporary causes, and 
be easily removable. But if it is continued, 
2L 



I severe, accompanied with flushing of the 
\ features, fulness or redness of the eyes, 
| throbbing of the vessels of the head and 
! neck, medical assistance should be sought 
without delay ; in the mean time, the mea- 
| sures recommended in cases of threatened 
inflammation of the brain are to be carried 
out more or less actively, according to the 
severity of symptoms. Convulsions some- 
times occur in pregnancy : a medical man 
must see the case without a moment's un- 
necessary delay, if possible; but if delay 
must occur, the patient should be managed 
as recommended under article Convulsion, or 
as directed in the remarks upon the same 
affection after delivery. — See Child-birth. 
Fainting is a symptom which may be of 
grave import : its cause should be investi- 
i gated by a medical attendant; in the mean 
j while, it must be treated as fainting gene- 
rally, unless it is dependent on loss of blood, 
as in abortion. — See Abortion. 

Troublesome itching eruptions on the 
skin, sore and ulcerated mouth, are all apt 
to be attendant on the condition of preg- 
nancy ; they are to be treated in the or- 
dinary method, (see Aphtha — Skin, §c.,) but 
are often incurable, and disapppear only 
after delivery. 

The above are the chief physical con- 
siderations connected with this most im- 
portant phase of human life ; but this 
article would be very incomplete without 
some allusion to those moral disorders and 
requirements, which exert so powerful an 
influence over the well-being and well-doing 
of both mother and infant. And it may 
be remarked, that without attention to the 
physical health of the body, the moral 
atmosphere is much more liable to be dis- 
turbed, and that the mind is much more apt 
to become irritable, especially if the digestive 
organs are disordered — as they often are — 
by the too great indulgence in food, which 
is frequently thought to be not only allow- 
able, but desirable in the pregnant state. 
The same effect follows the indolent habits 
so often indulged in. Unless prohibited for 
cogent reasons, regular sufficient exercise 
ought to be taken daily, up to the time of con- 
finement — nothing tends more to preserve 
the health of the body or cheerfulness 
of the mind. It is not by any means de- 
sirable for a female, during pregnancy, to 
withdraw from the performance of the ordi- 
nary active duties of life ; the mental engage- 
ment resulting therefrom is most beneficial, 
and prevents the thoughts from reverting, 
as they will do sometimes, to disagreeable 
or gloomy subjects. At the same time, a 
woman, during pregnancy, ought to be freetf 



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from any of the severer and more harass- 
ing occupations, and, as much as possible, 
kept from mental uneasiness, and spared, 
as far as can be, those things which excite 
unpleasant emotions in the mind. That the 
infant is affected by the mental condition of 
the mother is undoubted ; she cannot be too 
careful in keeping guard over herself, not 
for her child's sake solely, but for her own 
in future years, when that child may dis- 
play tendencies which it owes to the ma- 
ternal influence in the first period of its 
existence. 

The morbid longings of pregnancy have 
been already alluded to. — See Longings. 
The probable extension of pregnancy is im- 
portant, if only as a matter of convenience, 
to enable the mother to calculate and make 
the necessary arrangements for her confine- 
ment ; but its precise duration, or the num- 
ber of weeks or days required to complete 
its term, not unfrequently becomes of the 
most serious moment as a point of law, on 
which may hinge the inheritance of fortune 
or of title, or the happiness and fair fame 
of families and individuals. The generally 
allowed calculation for the duration of preg- 
nancy is forty weeks, or 280 days, from the 
last menstrual period ; but, evidently, such 
a calculation must be liable to some varia- 
tion; in law, all births which occur before 
the thirty-eighth week of pregnancy are 
considered premature ; those after the for- 
tieth week, as protracted cases. It is cer- 
tain that cases are frequently protracted 
beyond the fortieth week of calculation at 
least, and that these generally prove male 
births. 

The subject of false pregnancy is of con- 
siderable interest and importance : the fol- 
lowing remarks from Dr. Montgomery's 
Signs and Symptoms of Pregnancy are instruc- 
tive, and may put some on their guard: — 
"It is necessary," says the author, "to 
notice a condition of the female system of a 
remarkable kind, most frequently observed 
about the turn of life, when the catamenia, 
becoming irregular, previous to their final 
cessation, are suppressed for a few periods, 
and at the same time, the stomach being out 
of order, nausea or vomiting is experienced, 
the breasts enlarge, become sensible, or even 
slightly painful, and sometimes a serous or 
sero-lactescent fluid exudes from the nipples 
and orifices of the- areolar tubercles. The 
abdomen grows fuller and more prominent, 
especially in women of full habit and con- 
stitutionally disposed to embonpoint; and 
the abdominal enlargement progressively in- 
creases, partly from deposition of fat in the 
integuments and in the omentum, but still 



more from distension of the intestines by 
flatus, which, passing from one part to an- 
other, communicates a sensation like that 
produced by the motion of a foetus. The 
nervous system is generally much disturbed, 
and the woman feels convinced that she is 
pregnant — an idea which, at the time of life 
alluded to, is cherished by the sex with ex- 
traordinary devotion, and relinquished with 
proportionate reluctance, and not unfre- 
quently at the end of the supposed gesta- 
tion, the delusion is rendered complete, and 
almost assumes the character of reality, by 
the occurrence of periodical pains strongly 
resembling labour." 

The occurrence of abortion during preg- 
nancy, and the precautions to be adopted 
when the tendency exists, or indeed at any 
time, having been already treated of under 
the head of Abortion, it is unnecessary to 
reiterate them here. 

Refer to Abortion — Child-bed — Pelvis, §c. 

PREMATURE BIRTH.— One which oc- 
curs before the thirty-eighth week of preg- 
nancy. In most cases the occurrence of 
premature confinement is to be sedulously 
guarded against, for it cannot be expected 
that children generally, born out of due 
time, can be as strong as those whose birth 
is in every respect regular. Cases, how- 
ever, do occur in which, both on account of 
the mother's safety and as the only possible 
chance of having a living child produced at 
all, it is necessary to induce premature 
labour. — See Pelvis. The induction of pre- 
mature labour can, of course, only be en- 
trusted to the hands of the skilful. — See 
Child-bed — Pregnancy , §c. 

PRESCRIPTION.— A medical prescrip- 
tion is the form, with directions, in which 
a medicine, or medicines, are ordered, or 
"prescribed," by a medical man. In Eng- 
land, both prescriptions and directions are 
usually written in Latin. In Scotland, [and 
in the United States,] the directions are 
very generally given in English ; and though, 
perhaps, the method is not so consistent as 
that which preserves the same language 
throughout, it is safer and more convenient. 
In former times prescriptions were much 
more complicated than they are now, gene- 
rally at least ; and certainly the simplicity 
may be regarded as a sign of increased me- 
dical knowledge, and of greater confidence 
in the action of medicines. Some persons 
even contend that in prescriptions there 
should be no intermixture of medicines, but 
that one only should be given with a cer- 
tain definite object, and allowed to operate 
unembarrassed by the presence of others. 
It is not difficult to show how materially 



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this would interfere with the efficiency of 
practical medicine, at least in the present 
state of our knowledge. Many persons 
seem to imagine that because a medical man 
can sit down and write off a prescription in 
a few minutes, it is quite as easy for him to 
give it when requested. This erroneous 
impression does not extend so much to phy- 
sicians practising only as such, but it often 
operates to the injury of the general practi- 
tioner, who is not unfrequently, when per- 
sons are leaving his vicinity either tempo- 
rarily or permanently, asked for his pre- 
scription of medicine they have been taking, 
while at the same time there is but little idea 
of its being paid for. A moment's reflection 
will show that this prescription is as much 
a work of skill, and tke result of previous 
labour, as the design of the artist, and 
that, moreover, in furnishing it, the medical 
man is probably interfering with his own 
remuneration at some future time, when the 
prescription is made to stand in lieu of his 
advice. Some general practitioners refuse 
their prescriptions altogether ; this they are 
not justified in doing ; but if they do furnish 
them, they are quite entitled to their guinea 
fee. Another error with respect to pre- 
scriptions is, that one, having been found of 
service at some former time, is very gene- 
rally had recourse to at another ; in some 
few cases the act may not be followed by 
any particular injury, but, generally, it is a 
very foolish system, and persons who can 
afford to fee a physician, but prefer, instead, 
to take advantage of some old prescription, 
deserve to pay in a little inconvenience for 
their stinginess. 

PRESERVED PROVISIONS.— The ten- 
dency of all dead organized matter which 
contains moisture is, at ordinary tempera- 
tures, to undergo chemical change, (see Pu- 
trefaction,) or, in other words, the various 
vegetable and animal products, when de- 
prived of life, decay. When these products 
are such as are employed for food, it of 
course becomes a matter of considerable 
importance to counteract this tendency to 
decomposition, by which the articles are 
speedily rendered useless. It becomes of 
importance to preserve them as perfectly, 
and for as long a period as possible. The 
preservation of provisions may be effected — 
1st. By cold, that is, by keeping them at a 
temperature below that at which putrefac- 
tion takes place. 2d. By heat, which acts 
by hardening and coagulating the albumen 
and other constituents so that they are 
more disposed to resist chemical change, 
or by heat and dryness combined, so that 
the water, which is essential for the pro- 



cess of putrefaction, is removed. 3d. By 
the use of certain agents, or antiseptics 
(see Antiseptics,) which impart the power of 
resisting decomposition; and 4th. By ex- 
cluding the action of the atmosphere, the 
oxygen of which is requisite for the putre- 
factive process. 

The preservation of articles of food by 
keeping them at a low temperature is suffi- 
ciently well known ; and among such nations 
as the Russians, whose climate during the 
winter months is one of unvarying frost, 
the preservative action of cold is largely 
taken advantage of. Cattle, poultry, &c. 
are killed at the commencement of frost, 
allowed to become frozen throughout, and 
in this condition are brought to market at 
the large winter fairs ; fish are treated in 
the same way, and are thus preserved for 
months in a perfectly fresh and wholesome 
state ; provisions thus preserved, only re- 
quiring the precaution of being gradually 
thawed before use, by immersion in cold 
water. In this country ice, as all know, is 
now largely used to pack salmon, and fish 
generally, in summer time. This mode of 
preserving provisions by means of cold is 
evidently, however, capable of but partial 
application, and is usable only under limited 
circumstances. 

The action of an elevated temperature, 
such as is employed in cooking food, must 
be regarded as retarding rather than com- 
pletely withstanding putrefaction ; it is 
therefore inapplicable, except as a mere 
temporary expedient. When heat is com- 
bined with dryness, it acts much more per- 
fectly as a preservative. This is exempli- 
fied in the preservation for years of the 
bodies of men and animals who have pe- 
rished in the African deserts ; and also in 
the practice, more especially of the Indians 
and others of the South American pampas, 
who preserve their beef by cutting it in 
strips and hanging it to dry in the hot sun in 
a current of air : preserved in this way it 
will keep for a considerable time. 

In the case of vegetables, which contain 
so large an amount of water in proportion 
to their solid and nutrient material, the pro- 
cess of drying is peculiarly applicable, and 
seems likely to be largely employed as the 
means of furnishing fresh vegetable food 
for ships, in a compact and easily carried 
form, when in addition to the desiccation, 
compression is also resorted to. This double 
process "appears recently to have been put 
into execution with very considerable suc- 
cess, under the patent of M. Masson, head 
gardener to the Horticultural Society of 
Paris. This gentleman has succeeded m 



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preserving in a very perfect manner various 
descriptions of vegetables and fruits; the 
substances thus preserved are dry and 
shrivelled, contain but little water, and it 
is evident from their appearance that a very 
essential part of the process of preservation 
consists in the abstraction of the water 
which forms so very considerable a portion 
of the weight and bulk of nearly all vege- 
tables and fruits. When vegetables thus 
prepared are immersed in water for some 
time they swell up, become soft and tender, 
and resume, to a great extent, the appear- 
ance, colour, and flavour proper to them in 
the fresh state. M. Masson has managed 
to preserve completely, spinach, Brussels 
sprouts, cabbage, beans, peas, sliced car- 
rots, parsnips, potatoes, apples, &c. 

"It is stated that a cubic yard of these 
dried and compressed vegetables contains as 
much as 16,000 rations, and that they are 
of better flavour and much cheaper than 
the vegetables preserved in canisters." 

The preservation of provisions by their 
impregnation with antiseptic agents, such 
as salt, is perhaps more extensively prac- 
tised than any other method. Salt, sugar, 
spices, vinegar, spirit, and fumigation by 
burning wood, which is in fact preserving 
by means. of creasote, are the most common 
preserving methods, and for many purposes 
answer perfectly, both as regards the agree- 
ability, and, within certain limits of use, the 
wholesomeness of the food to which they 
are applied. They have, however, the draw- 
back of being, in themselves, partly chemi- 
cal additions to food, and also of inducing 
chemical changes, which modify, at least, 
the quality and digestibility of the aliment. 
Moreover, salt extracts (" draws out") from 
meat some of its most important nutrient 
constituents. Liebeg, in his Chemistry of 
Food, remarks — "It is universally known 
that in the salting of meat, the flesh is 
rubbed and sprinkled with dry salt, and 
that where the salt and meat are in contact 
a brine is formed, amounting in bulk to 
one-third of the fluid contained in the raw 
flesh. I have ascertained that the brine 
contains the chief constituents of a con- 
centrated soup, or infusion of meat, and 
that, therefore, in the process of salting, the 
composition of the flesh is changed ; and 
this too, in a much greater degree than 
occurs in boiling. ' In boiling, the highly 
nutritious albumen remains in the mass of 
flesh ; but in salting, the albumen is sepa- 
rated from the flesh ; for when the brine 
from salted meat is heated to boiling, a 
large quantity of albumen separates as a 
coagulum. 



"It is now easy to understand that in 
the salting of meat, when this is pushed so 
far as to produce the brine above men- 
tioned, a number of substances are with- 
drawn from the flesh, which are essential 
to its constitution, and that it therefore 
loses in nutritive quality in proportion to 
this abstraction. If these substances be 
not supplied from other quarters, it is ob- 
vious that a part of the flesh is converted 
into an element of respiration — certainly 
not conducive to good health. It is certain, 
moreover, that the health of a man cannot 
be permanently sustained by means of 
salted meat, if the quantity be not greatly 
increased, inasmuch as it cannot perfectly 
replace, by the substances it contains, those 
parts of the body which have been expelled 
in consequence of the changes of matter ; 
nor can it preserve in its normal state the 
fluid distributed in every part of the body, 
namely, the juices of the flesh. A change 
in the gastric juice, and consequently in 
that of the products of the digestive pro- 
cess, must be regarded as an inevitable 
result of the long-continued use of salted 
meat; and if, during digestion, the sub- 
stances necessary to the transformation of 
that species of food be taken from other 
parts of the organism, these parts must lose 
their normal condition." 

From the above objections, the process of 
preservation by exclusion of the action of 
atmospheric air is free ; it does not preserve 
by inducing change, but, like cold, by pre- 
venting it. This mode of preserving food 
is yearly assuming more importance and 
being more largely practised. The action 
of the atmosphere may be prevented in 
various ways, as by covering the articles 
with melted fat, &c. ; but the most perfect 
method, and that which is most largely re- 
sorted to, is the enclosure of the food in 
cases from which the air is then expelled, 
and which are made so impervious as to 
prevent the access of air ; upon the perfec- 
tion of the air-excluding process, both at 
the time and permanently, depends entirely 
the preservation of the article. 

The following description is taken from 
the Lancet: — " The article to be preserved 
is placed semetimes in the raw state, but 
generally cooked, in a tin canister, the lid 
of which is soldered down, but is perforated 
with a small aperture or pin-hole. It is 
then subjected to the action of either steam, 
boiling water, or a muriate of lime bath, 
until the contents of the canister, if not 
previously dressed, have become about two- 
thirds cooked. The aperture in the cover 
is then closed, and the canister and its con- 



PRE 



425 



PRE 



tents are once more submitted for a shorter 
period — that is, until the article is com- 
pletely dressed — to the operation of heat. 
As soon as it has become cold the canister 
is covered over with a coating of paint ; its 
preparation is then complete, and it is then 
removed to the proving room. The proving 
room is simply an apartment, the tempera- 
ture of which has been raised to the degree 
most favourable to decomposition. If the 
operation has been well performed, the top 
and bottom of the canister, as also in some 
cases the sides, will have fallen in or have 
collapsed to some extent ; this indicates the 
exhaustion of the air within, and is regarded 
by the manufacturer as a tolerably correct 
proof that the process has been properly 
conducted. If, however, after some days' 
exposure in the proving room, the top and 
bottom of the canister first become flat and 
subsequently even convex, it is a certain 
sign that the contents have not been well 
cured, and that they are not in a condition 
to keep for any length of time : such canis- 
ters have therefore either to be rejected, or 
else subjected to the process over again. 
* * * It should be known that it is not 
only boiled provisions which may preserved 
by the above process, but roasted also, with 
but a little extra eare." 

The preparation and employment of pro- 
visions preserved in a fresh condition are 
important both in a sanitary and in an 
economic point of view, independent of the 
means of luxury which is thus afforded — it 
might be, and will probably be, a cheap 
luxury. 

In all situations, as on board ship, where 
access to fresh provisions in their usual 
state is necessarily curtailed or denied, the 
preserved provision store is most invaluable 
as a means of preserving health ; and those, 
such as emigrants, who meditate a long sea- 
voyage, unless they are satisfied that the 
ship they embark in is well supplied with 
fresh preserved food, ought, if possible, 
to have a small private store. The recent 
notorious disclosures in connection with the 
preserved meats provided for the use of the 
navy, might prejudice some against this 
description of food ; but there are many 
establishments at which preserved food can 
be procured of the most excellent kind ; 
and there is, perhaps, some reason to sup- 
pose that in the case of the navy provisions, 
the evil may have resulted partly in conse- 
quence of careless stowage. This ought, 
therefore, to be guarded against — an acci- 
dental blow, or corrosion of the solder by 
damp, which makes an aperture no larger 
2l2 . 



than a pin-hole, being sufficient to spoil the 
entire contents of a canister. 

As regards the economic advantages to 
be derived from the employment of pre- 
served provisions, it is sufficient to advert 
to the facts, that in South America, the 
cattle are slaughtered for the sake of their 
hides, horny parts, bones, &c, and that the 
flesh is wasted ; that in Australia, sheep 
have been boiled down for the sake of their 
tallow alone. How great would be the 
boon to England, could this locally super- 
fluous flesh be preserved fer use ! 

Charcoal, from its remarkable power of 
absorbing gases, is sometimes used as a 
preservative in which articles of food are 
packed. Lastly, such preparations as the 
"Patent Meat Biscuit," manufactured in 
the United States, which gained one of the 
medals at the Great Exhibition, offer other 
forms in which nourishment may be pre- 
served in a concentrated state. " This new 
and useful preparation of concentrated 
meat and bread can be prepared for use in 
the shortest time as a soup. One pound of 
this meat biscuit contains the nutriment of 
five pounds of the best beef, the extract of 
which is combined and baked with the 
finest flour, forming the most portable and 
convenient diet known. It is eminently 
adapted for emigrants, travellers, and for 
ordinary use in families, &c. Its easy di- 
gestibility and highly nutritious properties 
render it very valuable for invalids and con- 
valescents, and generally for use in hos- 
pitals." It is sold at the agency, 2 St. 
Peter's Alley, Cornhill, [and in the large 
cities in the United States.] 

Extract of beef, said to contain in one 
ounce the nutriment of a pound, as pre- 
pared by Mr. Robertson, of Manchester, is 
a somewhat analogous preparation. 

Pemican, which " consists of the mus- 
cular fibre of beef, baked and reduced to 
a coarse powder," is another form of pre- 
serving animal food worthy of attention. 
For much of the information contained in 
the above article, the author is indebted to 
the Lancet papers on the subject. 

Refer to Antiseptics. 

PRESSURE. — The effect of continued 
pressure upon the living body may be re- 
garded either as a cause of disease or as a 
curative agent. 

The effect of pressure in altering the 
shape, &c. of even the hardest portion of 
the animal frame, is well known. The sa- 
vage Carib employs it to flatten the skull of 
his children into a hideous deformity, by 
him thought beauty ; and the civilized fe- 



PEE 



426 



PHI 



male too often has recourse to it, with 
equally false ideas of proportion, to mould 
the ribs at her waist into a state of perma- 
nent contraction. Both instances show how 
even the bones may be affected by pressure 
from without, applied over an extended 
surface. When the surface of pressure is 
small the bone is absorbed, as evinced by 
the hollow often formed in the breast-bone 
of shoemakers who have for many years 
pressed the " last" against the one spot. 
The effect of pressure upon the surfaces of 
the body, if long continued, is to cause 
thickening, as seen in the horny hand of the 
labourer, or in the corn from the tight shoe. 
AVhen, however, pressure is too suddenly 
and continuously applied to surfaces unused 
to it, especially in debilitated states of body, 
instead of giving rise to thickening it is 
apt to occasion mortification, or at least 
ulceration. This effect of pressure is one 
of the most serious complications of most 
long-continued illnesses, in which the diffi- 
culty, and often almost the impossibility, of 
moving a patient, or at least of preventing 
continued pressure upon the most prominent 
points of the body, are a source of much 
suffering on the one hand, and of anxiety 
on the other. In a long case of fever it 
may happen, especially if there is neglect, 
and, at times, under even the most atten- 
tive management, that ulcerated or "slough- 
ing" spots form on the back of the head, 
the tips of the ears, the points of the 
shoulder-blades, between the hips, &c. To 
alleviate these effects there are the va- 
rious inventions of spring and water beds, 
elastic cushions, &c. — See Bed, Elastic — 
Fever, fyc. 

The effect of pressure, as a curative agent, 
is often valuable. Thus, when thickening 
of a part, or of a limb, has followed inflam- 
mation, the continued and even pressure of 
a bandage, or of an elastic covering, will do 
much to hasten its reduction. Tumours, 
such as bronchocele, will disappear under 
well-applied pressure. Bleeding which 
threatens life, may be stopped by pressure 
properly applied, (see Artery ;) and lately 
the power of pressure has been used — espe- 
cially in Dublin — as a remedy in aneurism, 
acting by interrupting the circulation of the 
blood through the vessel with which the 
aneurismal tumour is connected. The con- 
tinued pressure of the atmosphere upon the 
surface of our bodies at ordinary elevations, 
by its variation, as indicated by the changes 
of the barometer, probably exercises a 
greater influence upon our health and sen- 
sations than is generally suspected. The 
distressing effects experienced from the 



diminished pressure, in part at least, by 
those who ascend great heights, is well 
known. — See Air. 

PRICKLY HEAT— Is a peculiar affec- 
tion of the skin, which affects those who 
live in hot climates, especially when first 
resident, and which also occurs in hot sum- 
mers in this country. The following de- 
scription of the late Dr. James Johnson, 
from his experience of the affection in India, 
is often quoted: — -"The sensations arising 
from prickly heat are perfectly indescrib- 
able, being compounded of pricking, itch- 
ing, tingling, and many other feelings for 
which I have no appropriate appellation." 
"It is usually, but not invariably, accom- 
panied by an eruption of vivid red pimples, 
not larger in general than a pin's head, 
which spread over the breast, arms, thighs, 
neck, and occasionally along the forehead. 
This eruption often disappears in great 
measure when we are sitting quiet, and the 
skin is cool ; but no sooner do we use any 
exercise that brings out a perspiration, or 
swallow any warm or stimulating fluid, such 
as tea, soup, or wine, than the pimples be- 
come elevated, so as to be distinctly seen, 
and but too distinctly felt." 

In reference to the imagined dangers of 
repelling this eruption, Dr. Johnson con- 
tinues, "Indeed, I never saw it even re- 
pelled by the cold bath, and in my own case, 
as well as in many others, it seemed rather 
to aggravate the eruption and disagreeable 
sensations, especially during the glow which 
succeeded immersion. It certainly disap- 
pears suddenly, sometimes on the accession 
of other diseases, but I never had reason to 
suppose that its disappearance occasioned 
them. I have tried lime-juice, hair-powder, 
and a variety of external applications, with 
little or no benefit ; in short, the only means 
which I ever saw productive of any good 
effect in mitigating its violence, till the con- 
stitution got assimilated to the climate, were 
light clothing, temperance in eating and 
drinking, avoiding all exercise in the heat 
of the day, open bowels, and last, not least, 
a determined resolution to resist with stoical 
apathy its first attacks. To sit quiet and 
unmoved under its pressure, is undoubtedly 
no easy task ; but if we can only muster up 
fortitude enough to bear with patience the 
first few minutes of the assault, without 
being roused into motion, the enemy, like 
the foiled tigers, will generally sneak, and 
leave us victorious for the time." 

PRIVIES AND WATER-CLOSETS.— The 
faulty regulation, insufficient supply, or 
even total want of these necessary append- 
ages to every habitation, are the sources of 



PEI 



427 



PRO 



some of the greatest nuisances, especially of 
our large towns, are most fertile sources of 
disease in crowded localities, and have pre- 
sented, and still present, great difficulties in 
the way of sanitary reformation. In country 
places, the difficult}'- of procuring a sufficient 
supply and proper arrangement of the water 
requisite for a closet, renders privies almost 
matters of necessity. This, under the cir- 
cumstances, is a matter of less consequence, 
provided these places are situated at a suffi- 
cient distance from the house, and are kept 
properly regulated and cleansed ; though, 
too, they may, be rendered almost as conve- 
nient as water-closets, [by means of a pro- 
perly constructed pan, such can be obtained 
from most of the plumbers in the United 
States.] It is desirable, from time to time, to 
throw into the cesspool of a privy some dry 
absorbent material, such as earth, lime, &c. 
If peat charcoal could be more easily pro- 
cured, it would probably be found the best 
material for this purpose. These, and simi- 
lar places, should never be cleansed out in 
warm weather ; if they become offensive, 
chloride of lime in some form should be em- 
ployed about the place, or thrown into the 
cesspool, until cool weather permits the 
removal of the nuisance. 

In towns and crowded places, privies 
should never be permitted, but efficient 
water-closets, with icell-constructed drains, 
(see Drainage,) substituted ; and one should 
be attached to every house, both for the 
sake of cleanliness and of decency. 

The evils which result from the inade- 
quate provision of the accommodations in 
question, in the more crowded and poorer 
districts of "large towns and populous 
districts," are thus alluded to by the "Com- 
missioners of Inquiry," in the Report pub- 
lished in 1845. After describing the great 
deficiencies in such places as Nottingham, 
Manchester, Ashton, and London, it is re- 
mained, "It is unnecessary to dwell upon 
the extensive injury to health, decency, and 
morals, which such defective arrangements 
inevitably entail." These places being re- 
sorted to by great numbers, and under no 
regulations as to cleansing, are constantly 
in the most disgusting state of filth, and are 
the causes of as great injury to the health 
of the inhabitants in their immediate vi- 
cinity, as any of the numerous influences 
that we have already brought under notice. 
But the injury is not alone confined to the 
health of the occupants — the owners of the 
houses also suffer great losses. Many in- 
stances occur where the walls of the ad- 
joining houses are constantly wet with fetid 
fluid, which frequently affects the atmo- 



sphere of the rooms, so as to render it im- 
possible to keep food for one single night 
without its becoming tainted. The deteri- 
oration of property from these causes is 
very considerable. Added to this, a constant 
loss is incurred by the inability of tenants 
to pay their rents, from sickness. It is 
commonly alleged that it is useless to im- 
prove the houses inhabited by the poorer 
classes, because there are no public regula- 
tions to enforce attention to their constant 
cleanliness, and that, in the absence of such 
arrangements, they would soon recur to 
their former condition. 

These allegations have probably been 
drawn from the fact of such large numbers 
of the poorer classes being found to exist 
in their present miserable abodes, where 
they are obliged to tolerate the scenes of 
filth around them, to which they become 
inured by habit, and continue to live among, 
from the difficulty of finding better resi- 
dences. It is certain that, under such cir- 
cumstances, better habits cannot be ac- 
quired, nor, if in existence, are they likely 
to be retained. It cannot be denied, that 
the poorest classes would most readily ap- 
preciate any improvement which affords the 
means of speedily removing the present 
accumulations of filth from the vicinity of 
their houses, and which would free them 
from their injurious consequences. Such 
amelioration of their dwellings, by improv- 
ing their health, and enabling them to follow 
their employments with fewer interruptions 
from sickness, would also increase the means 
at their disposal for paying their rents, &c. 

Refer to Drainage. 

PROGNOSIS— Is the opinion of a medical 
man respecting the ultimate issue, (possible, 
probable, or certain,) of a case of disease. 
The formation of a prognosis involves a 
great variety of considerations. Independent 
of the nature of the disease itself, the con- 
stitutional tendencies of the patient, here- 
ditary or acquired, must be duly weighed : 
the age, the mental condition, the external 
circumstances, and many others have all to 
be taken into account. Thus, for instance, 
in a person threatenened with consumption, 
who has lost relatives, more or less, from 
the disease, the prognosis must be a more 
unfavourable one than when the disease is 
apparently — if we may so speak — accident- 
ally developed ; or, again, in a case of dis- 
ease of the heart, occurring in a man forced 
to engage in bodily labour for his bread, the 
prognosis will be of a graver character than 
when the same disease affects a man at ease 
as regards this world's goods. 

When a medical man sees a patient, if 



PllO 



428 



PRO 



the case be at all serious, either the indi- 
vidual or surrounding friends are usually 
very anxious for a prognosis, an opinion, as 
to the ultimate issue of the case. In many 
cases it is possible to give this decidedly 
and at once, and if it can be, it ought to 
be done ; but, in many cases, it is impos- 
sible to come to any conclusion, and at least 
a second visit, if not more, must be paid 
before a just idea of the termination can be 
approached. 

Some medical men are in the habit of 
giving, generally, a bad prognosis, that is, 
they express their opinion of the worst pos- 
sibilities. This may arise from constitu- 
tional tendency to regard the dark side of 
matters, but more generally it originates in 
a selfish wish to serve their own reputation ; 
if the patient dies, they are right ; if he 
recovers, they have the more credit in the 
cure. However politic the course, it is 
neither considerate nor honest, for it sacri- 
fices the feelings of relatives, at least, to a 
selfish expediency, and causes unnecessary 
anxiety. In some measure, however, the 
public are themselves to blame in the mat- 
ter, from the little consideration often shown 
to a medical man if his prognosis of a case 
turns out to be erroneous, especially if a 
favourable opinion has been given and an 
unfavourable event ensued. It ought to be 
remembered that even in health, day by day, 
sudden changes to severe and dangerous ill- 
ness, or to sudden death, are not unfre- 
quent ; and if in health, how much more in 
illness ? — changes which it is impossible for 
the most skilful and observant to foresee. 
Again, a medical man is often most unde- 
servedly censured in another way. A case 
is perhaps submitted to his examination at 
an early stage, before its more marked 
characteristics have shown themselves, and 
he perhaps gives an encouraging opinion ; 
after a time the case gets worse, more se- 
rious symptoms are developed, another 
opinion is taken, and this time the sentence 
of the first consulted is reversed ; the last 
given prognosis proves correct, and, too often, 
without reflecting upon the altered aspect 
of the case in the one and in the other ex- 
amination, the gentleman first consulted 
falls under the unjust imputations of those 
connected with the patient. The case is a 
common one. 

The habit of giving a favourable prognosis 
when not justified by the state of the case, 
cannot be too strongly condemned. It is 
often practised with a view to sustain the 
spirits of the patient and others ; but while 
every reasonable cheerful hope is to be held 
out, if death must close the case, for the 



sake of higher considerations than those 
of this world, for the sake of sparing the 
aggravated shock which must fall upon rela- 
tives when the fatal truth in all its intensity 
and all its nearness falls upon them, a tem- 
pered it may be, but yet a true prognosis 
should be given. 

Refer to Death — Diagnosis — Opinion, Me- 
dical. 

PROLAPSUS— Is a slipping or falling 
down of any internal portion of the body, 
so that it appears externally. The term is 
most commonly used with reference to pro- 
lapsus ("falling down") of the womb, (see 
Womb, #c.,) and also to prolapsus of the 
lower gut at the fundament, "coming down 
of the bowel," as it is often called. This 
accident is not uncommon in childhood and 
in the aged, but occurs at any age, fre- 
quently in connection with piles. Coming 
down of the bowel often happens from chil- 
dren being permitted to sit too long on the 
chamber vessel after a movement of the 
bowels ; it is often, too, a consequence of 
irritation from worms or from stone in the 
bladder. The extent to which the gut is 
protruded varies from the slightest pos- 
sible to a considerable length, causing a 
red or purplish swelling, according to the 
length of time the protrusion has existed. 

If quickly attended to, the protrusion is 
usually easily returned by pressure exerted 
by the fingers, through the medium of a 
piece of greased cloth, the person being of 
course laid in the horizontal posture. If, 
however, the protrusion has been neglected, 
and allowed to continue unreduced for some 
hours, it becomes in a measure strangulated, 
congested with blood, and consequently 
swollen, and is then sometimes very diffi- 
cult to return. In such a case a medical 
man will probably be required, and, indeed, 
ought to be called ; in the mean while, by 
gently squeezing the neck of the protrusion, 
and exerting gentle pressure upward, hav- 
ing previously freely applied grease of some 
kind to it, efforts may be made to effect its 
return. When protrusion of the gut occurs 
habitually, a medical man should investi- 
gate the cause, so that any source of irrita- 
tion may be removed ; the bowels should be 
kept perfectly lax, so as to prevent strain- 
ing, and in children, especially, too long 
sitting at stool prevented, the seat being 
made so high that the legs cannot touch the 
ground. 

Cold injections and astringent lotions in- 
jected into the bowel are often useful. As 
recommended by Mr. Vincent, a small quan- 
tity of a solution of one grain of sulphate 
of iron to the ounce of rain or distilled 



PRO 



429 



PKU 



water may be thrown into the bowel after 
each relief, and retained. Bathing the loins 
regularly with cold water -will be of service. 
Some cases of protrusion depend on causes, 
such as internal piles, which require a sur- 
gical operation for their removal. Persons 
liable to prolapsus of the gut, often expe- 
rience much comfort from wearing the form 
of bandage, fig. cvii. This consists of a 
Fi°r. cvii. 




sponge (1) which must be moistened — or of 
some soft or smooth hard material, which is 
applied to the fundament, and kept in place 
by means of straps, which are best made 
of elastic material ; the strap (2) fastening 
behind and (3, 3) in front to a belt passed 
round the body. A bandage something simi- 
lar to the letter T — article Bandage — will, 
with the requisite pad, answer the purpose. 

Refer to Piles — Rectum, $c. 

PROSTATE GLAND.— See Bladder. 

PROTEINE. — A name given to the sup- 
posed basic constituent of the animal prin- 
ciples — albumen, fibrine, and caseine. Much 
controversy has taken place respecting it. 

PROTRUSION— Of various portions of 
the body may take place either through 
natural or artificial openings. — See Prolap- 
sus — Rupture, Sfc. 

PROUD-FLESH. — See Granulation- 
Ulcer, &c. 

PROXIMATE CAUSE— In medicine, is 
the most immediately traceable cause of 
the symptoms of a disease ; thus, in British 



cholera, [cholera morbus,] the proximate 
cause of the vomiting and purging is the 
irruption of acrid bile in undue quantity into 
the stomach and bowels ; the remote cause is 
that which gives origin to the superabund- 
ance and acridity of the bile, probably excess 
of carbonaceous compounds in the blood. 

PRUNES— The dried fruit of the common 
plum contain a considerable quantity of 
sugar, and when cooked, as stewed, are 
wholesome, and at the same time laxative. 
— See Purgatives. Unless softened by stew- 
ing, prunes are indigestible. 

PRURIGO.— A papular affection of the 
skin, attended with troublesome itching. — 
See Skin. 

PRURITUS.— Itching of the skin.— See 
Skin. 

PRUSSIC ACID, or Htdro-cyanic Acid 
— Exists in the distilled waters, pi'inci- 
pally of the peach tribe, as of the bitter 
almond, but is usually formed artificially. 
It is a compound of the three elementary 
gases, nitrogen, hydrogen, and carbon. Al- 
though called an acid, its acid properties 
are but feebly developed. The odour of 
hydro-cyanic acid is powerful and peculiar, 
and pungent to the nostrils ; it is often com- 
pared to that of the bitter almond. Pure 
prussic acid is sometimes prepared, but 
quickly decomposes ; it is usually met with 
in a diluted form, and that which is used in 
medicine is, or ought to be, made of a cer- 
tain regular strength. The use of medici- 
nal prussic acid in the hands of a medical 
man are most valuable ; it acts as a power- 
ful sedative, allaying pain, sickness, and 
nervous irritability ; it is, too, a most ad- 
mirable addition to lotions for various pur- 
poses ; but in any form could not safely be 
had recourse to as a domestic remedy. 
Poisoning by prussic acid is, unfortunately, 
not of rare occurrence, and, in most cases, 
it destroys life so rapidly that little if any 
time is afforded for the employment of anti- 
dotes — at least by a medical man ; it is, 
therefore, important that the best remedies 
in such cases should be immediately had 
recourse to, although too often, from the 
powerful nature of the poison and the quan- 
tity swallowed, all is in vain. 

When a large dose of prussic acid has 
been swallowed, " the symptoms may com- 
mence in the act of swallowing, or within 
a few seconds. It is rare that their appear- 
ance is delayed beyond one or two minutes. 
When the patient has been seen at this pe- 
riod he has been perfectly insensible; there 
is convulsive respiration at long intervals, 
and he appears dead in the intermediate 
time. The breath commonly exhales a 



PSO 



430 



PUL 



Strong odour of the acid. The finger nails 
have been found of a livid colour, and the 
hands firmly clenched. When a small over- 
dose has been taken, the individual has first 
experienced weight and pain in the head 
with confusion of intellect, nausea, and a 
quick pulse ; although these symptoms are 
sometimes slow in appearing. It has been 
stated that those who die from a large dose 
of this poison uttered a shriek or scream — 
the fact is very doubtful."* 

Many antidotes have been proposed for 
employment in cases of poisoning by prussic 
acid, but few of them are likely to be avail- 
able in so sudden and, generally, so unlooked- 
for an emergency. The cold affusion — that 
is, water as cold as it can be procured — 
dashed freely over the body, the head and 
spine especially, is a remedy generally avail- 
able. Ammonia, either in the form of sal 
volatile, or hartshorn, &c, is to be given and 
its vapour inhaled ; or better still, but not 
so likely to be at hand, chlorine in some 
form. Thirty drops of the solution of chlo- 
ride of lime, or of chloride of soda, may be 
given at once in a little water, their vapour 
being at the same time inhaled ; this may 
be more abundantly evoked by the addition 
of an acid. Artificial respiration, (see 
Opium,) should be had recourse to, and 
galvanism, if available. To repeat : the 
best antidotes are — cold affusions ; chlorine, 
swallowed, and in vapour ; ammonia, swal- 
lowed, and in vapour ; artificial respiration. 

PSOAS.— Belonging to the loins. The 
psoae muscles are large muscles connected 
with the loins, &c. A psoas-abscess is one 
originating in the loins. 

Refer to Lumbar. 

PSORA.— The itch. 

PSORIASIS.— A peculiar disease of the 
skin. — See Skin. 

PTISAN, or Tisane.— A vegetable infu- 
sion or decoction, generally of a mucila- 
ginous character, which may be drunk freely 
by, and is given freely to the sick. Barley- 
water is a ptisan. Ptisans are extensively 
used in France, and in many different 
forms. 

PTYALISM.— The affection of the consti- 
tution by mercury. — See Mercury. 

PUBERTY — Is that important transition 
epoch in human life, when childhood passes 
into youth, the forerunner of manhood and 
womanhood. In English law, the time of 
puberty is considered in the male to be at 
fourteen years of age, in the female, two 
years later ; but these periods must be ge- 
nerally considered quite sufficiently early, 

* Taylor's Jurisprudence. 



as regards this latitude at least ; in warmei 
climates the period of puberty probably 
arrives a little sooner, but not so much so 
as generally has been imagined ; more de- 
pending upon the natural constitution of 
the individual, and upon the influence of 
external circumstances. The important 
changes and excitements undergone by the 
constitution at the period of puberty, ne- 
cessarily render it a critical period, when 
disease, to which a latent tendency exists, 
may be roused into activity. At this time, 
therefore, a stricter watch than usual should 
be kept upon the health of the young, and 
any unusual symptoms at once submitted 
to the judgment of a medical man. — See 
Menstruation. 

PUDDINGS— Are articles of diet, the 
principal ingredient of which is some fari- 
naceous material— at least such ought to be 
the case when they are made for invalids. 
The puddings most generally admissible and 
best adapted for the sick-room are the light 
egg and flour, or "twenty minute" pudding, 
as it is often called ; the simple rice, sago, 
or tapioca pudding, the boiled bread pud- 
ding, &c. In making baked puddings, the 
eggs are generally put in previous to baking, 
and in general cookery this may answer 
very well. But when nutriment, and at the 
same time extreme lightness, are requisites 
for an invalid, it is better to cook the fari- 
naceous article, such as sago, bread, or 
whatever it may be, thoroughly in the milk, 
and, while it is perfectly hot, to break the 
egg into it, and beat them well up together. 
In this way the egg is quite sufficiently 
cooked, but its albumen is not hardened, as 
it must inevitably be when baked along 
with the other materials. 

Of course, greasy puddings generally are 
unsuited for invalids, and for the same rea- 
sons butter or sauce must be forbidden. 

PUERPERAL. — Connected with child- 
bed. — See Child-bed. 

PULMONARY. — Connected with the 
lungs. 

PULSE. — The term pulse may be applied 
to the beating of the heart and arteries ge- 
nerally, but it is more usually restricted to 
the sensible beat or stroke of an artery 
which is felt by the finger placed over and 
slightly pressed upon the vessel ; popularly, 
the pulse is considered to be confined to the 
wrist alone. The pulse or beat of an artery 
is felt simultaneously, or nearly so, with the 
beat of the heart, which takes place as each 
contraction of that organ sends a wave of 
blood through the arteries — the elasticity 
and muscular properties of those tubes in- 
fluencing in a considerable degree the "cha- 



PUL 



431 



PUM 



racter" of the pulse. — See Artery — Circula- 
tion — Heart, §c. 

The sympathetic connection of the central 
organ of the circulation, and indeed of the 
circulating system at large, with changes 
and states of the whole system, render the 
pulse a most important guide in the inves- 
tigation of those states and changes ; it is, 
however, a guide which requires much edu- 
cation and no little practical experience 
fully to take advantage of. It may have ap- 
peared to some, that throughout this work 
generally, when different diseases have been 
treated of, the state of the pulse has been 
comparatively little noticed. The previous 
sentence affords the explanation, which is, 
that to feel a pulse properly, and to gather 
from the feeling any real, definite, trustwor- 
thy information, requires more practical 
knowledge than unprofessional persons can 
possess ; consequently, the author has pre- 
ferred directing attention, in most instances, 
to symptoms. more palpable, more easily ap- 
preciated, and less likely to mislead the 
uninitiated. If the frequency of the beats 
of the pulse was an unvarying indication of 
the state of the system, and if the know- 
ledge as to frequency, or the reverse, was 
all that could be gathered from feeling it, 
the case would be abundantly different ; but 
with certain reservation the frequency of 
the pulse is, in many cases, a far less im- 
portant piece of information to a medical 
man than its rhythm or tone ; whether it be 
full and bounding or jerking, or soft, or 
wiry, or compressible, feeble, or remittent, 
or intermittent, all these and other varieties 
of pulse convey impression to the mind of a 
medical man; but the ability to receive 
these impressions, and to form conclusions 
from them, is only the result of daily, almost 
hourly practice. It is unnecessary to say 
more to show how very slight and imperfect 
the information must be which a casual 
feeler of the pulse can gather from the ope- 
ration. At the same time, the author would 
not discourage persons, such as the clergy- 
man or the intelligent emigrant, from endea- 
vouring to gain some practical knowledge 
respecting the pulse ; but the above will 
show that useful knowledge must be at- 
tained, either assisted or unassisted, by 
practical attention and persevering avail - 
ment of opportunities. 

The average pulse of a healthy man in 
the prime of life may be taken as beating 
72 times in the minute ; but from this ave- 
rage there is every possible variation, and 
even in the same individual the pulse varies 
greatly, according to the period of the 
twenty-four hours; according to the time 



of meals ; to the posture, whether recum- 
bent, in which it is slowest, or sitting or 
standing, in which it is most frequent ; it 
varies also according to physical exercise 
or mental emotion, and also according to 
external temperature. 

In some persons the pulse is always quick, 
ranging at 90, or even more ; in others it is 
slow, perhaps does not exceed 40 beats in 
the minute. Age influences greatly the fre- 
quency of the pulse. The following is the 
table drawn up by M. Quetelet : — 

Average of Pulsations 
per minute. 



Age. 



Birth 

5 years 
10—15 .. 
15—20 .. 
20—25 .. 
25—30 .. 
30—50 .. 



136 
88 
78 
69 
69 
71 
70 



According to other observations, the pulse 
in many children is found not to be more 
frequent than it is in adults ; as a general 
rule, however, it is so. It is, moreover, a 
generally received opinion that the pulse of 
the aged is slower than that of the young : 
the reverse is the fact. 

As a general rule, when the system at 
large is in a state of excitement, feverish 
or otherwise, the pulse is increased in fre- 
quency and modified; in depressed states of 
the system, unless accompanied with irri- 
tability, the contrary takes place. In affec- 
tions of the brain, causing pressure on, or 
oppression of that organ, the pulse is usual- 
ly slow. If a particular portion of the 
body be inflamed, such as the hand or foot, 
the pulse in the artery going to the part is 
increased in force, or in the power of its 
beat, but of course not in frequency, unless 
the entire circulating system is equally ex- 
cited. 

Most persons are aware that the pulse is 
distinguishable at the wrist, about an inch 
above the wrist-joint of the thumb, the pul- 
sating artery lying by the side of the strong 
tendon of a muscle of the forearm. The 
pulse should be felt by the fore and middle 
finger together, [and not by the thumb.] 

Refer to Artery — Circulation — Heart, $c. 

PUMPS — For water — when made of lead, 
are apt to prove dangerous. — See Lead — 
Water, $c. 

PUMP, STOMACH — Is an instrument 
made on the principle of the enema instru- 
ment. — See Clyster, fig. xxxix. It ought only 
to be used by a medical man. 

PUMPKIN.— At one of the late meetings 
of the Medical Society of Bordeaux, M. 
Brunet communicated to the society several 



PUN 



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cases of tapeworm, where he had suc- 
ceeded in causing the expulsion of the 
parasite by means of a paste made of pump- 
kin seeds, stating that he had been told of 
the remedy by the captain of a ship. Since 
that period, an article published in the 
journal Universel of 1820 was discovered, 
where M. Mongeny, a physician of the 
island of Cuba, says — "I used to give to 
patients affected with tapeworm three 
ounces of a paste made with fresh pumpkin 
seeds, and afterward six ounces of honey, 
in three doses, the first an hour after the 
ingestion of the paste, and the others at the 
same intervals. Six or seven hours after- 
ward, the tapeworm was generally ex- 
pelled: and this remedy has succeeded in 
cases which had resisted all the means ge- 
nerally employed. The worm is ejected, 
not in fragments, but twisted upon himself, 
and where two parasites had existed, they 
were wholly and simultaneously voided."* 
[This article has been tried in the United 
States with most satisfactory results, and 
from its cheapness may be readily obtained 
by any who are suffering in this way.] 

PUNCTURED WOUNDS.— See Wounds. 

PUPIL.— See Eye. 

PURGATIVES— Are medicinal substances 
which excite and accelerate the muscular 
movements of the alimentary canal, and in- 
crease the discharge therefrom. For the 
sake of convenience, under the head of 
purgatives, aperients generally are treated 
of. These are divided into 

Laxatives — Purgatives — Drastic Cathar- 
tics. A further class of " hydragogue" 
cathartics is also recognised. — See Hydra- 
gogue. Laxatives, which gently increase 
the natural movements of the bowels, may 
be arranged as dietetic, mechanical, and 
medicinal. Dietetic laxatives are chiefly 
vegetables and fruits of various kinds, 
honey, treacle, preparations of the grains, 
cold water, malt liquors, bacon, &c. &c; but 
many of these act mechanically also. Most 
succulent vegetables and fruits act upon the 
bowels by virtue of their peculiar nature, 
but, undoubtedly, also by the mechanical 
bulk of their refuse. Of the mixed dietetic 
and mechanical laxatives, the farinacea or 
grain substances are the most important. 
These owe their property entirely to the 
presence, either whole or ground, of the ex- 
ternal covering or testa of the grain, as in 
the case of bran-bread, or of Scotch oatmeal. 
The flour of the Egyptian lentil, or Reva- 
lenta Arabica, is almost medicinal in its 
power of relaxing the bowels. The seeded 



Extracted from Lancet, July 10, 1852. 



fruits, such as currants, gooseberries, &c. 
fall under the head of mixed dietetic and 
mechanical laxatives. 

The purely mechanical aperients are not 
numerous. Whole mustard seed, and the 
common dried currant, as it is often given 
domestically, are examples of the class. 

Clysters may be classed under the head 
either of purely mechanical or of medicinal 
aperients, according to their nature. — See 
Clyster. The following table includes the 
principal aperient and purgative medicines 
which may be used domestically : — 

I. Laxatives. 

Almond-oil. 

Cassia pulp. 

Cream of tartar. 

Honey. 

Magnesia. 

Manna. 

Olive-oil. 

Phosphate of soda. 

Prunes. 

Sulphur. 

Tamarinds. 

II. Purgatives. 

Aloes. 
Castor-oil. 
Epsom salts. 
Glauber salts. 
Jalap. 

r Blue pill. 
Mercurials \ Calomel. 

( Gray powder. 
Rhubarb. 
Rochelle salts. 
Senna. 

III. Cathartics — Drastic. 

Colocynth. 
Scammony. 

The two cathartics put down may be used 
domestically — indeed, the first is every 
day used — in the form of the compound 
colocynth pill. Croton-oil, elaterium, gam- 
boge, are included in the drastic cathartics; 
but, except under peculiar circumstances, 
ought only to be administered by a medical 
man. For details respecting the various 
aperient agents above mentioned, the reader 
is referred to the individual articles. 

Purgative or aperient medicines are 
unquestionably much more generally had 
recourse to, both by medical men and the 
public, than any other form of remedial 
agents ; but while it is undoubted that their 
use is great, it is also certain that they are 
and have been very greatly abused. It is 
intended to consider, first, the use of ape- 
rients, and secondly, the abuse. Under such 
articles as "Alimentary Canal," "Diges- 
tion," &c. it has been sufficiently explained 



PUR 



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PUR 



how the food mass, after undergoing its 
principal digestion in the stomach, is gra- 
dually propelled through the entire tract of 
the bowels, and how, during this propulsion, 
its nutrient constituents are absorbed from 
it, the refuse being left for discharge. It 
has also been explained, that the discharge 
from the bowels does not consist simply of 
the food refuse, but contains also various 
secretions and excretions, thrown out into 
the bowels — from the general system — which 
excretions can not be retained in the system 
without injury to health. 

From these considerations, it must be ob- 
vious to all how great the importance, not 
only that the bowels should be active as 
regards the excretions into them, but as 
regards their own discharge, both of these 
excretions and of the food refuse. When 
the bowels are inactive in these respects, 
the state is termed constipation, or costive- 
ness. As, under the latter term, the reader 
will find the evils which result from this 
condition, and also its most frequent causes, 
&c, sufficiently explicitly stated, it is un- 
necessary to repeat the information here. 
Under the same article will be found an ex- 
planation of those general remedies which 
are most useful in removing the condition ; 
and, indeed, when they prove sufficient, are 
certainly to be preferred to medicinal agents. 
When they do not prove sufficient, either as 
temporary or permanent* means of relief, 
the purgative or aperient medicines must 
be employed — under the general rule, that 
they should never be used stronger than 
requisite. By this it is not meant, that be- 
cause manna, or sulphur, or magnesia, are 
classed in the laxatives, they are always, 
when possible, to be substituted for the 
purgative aloes, or castor-oil, or rhubarb, 
or senna : such a distinction could not be 
observed without other and greater coun- 
ter-balancing inconveniences. But the rule 
should be, that relief to the bowels is to be 
afforded with as small an amount of purga- 
tive action as possible, unless that purga- 
tive, or, in other words, lowering action, is 
called for as a part of the treatment, as it is 
in persons of very full habit of body, &c. 

Where aperient medicines are either taken 
or given domestically, there is often too 
little care in the selection. Unless it be in 
pregnancy, or in consequence of individual 
experience, the idea seems to prevail with 
many that one aperient is as good as 
another. This is far from being the case. 

Except in persons whose bowels are very 
easily acted upon, or in such cases as those 
where the aperient is taken rather to give 
additional action than to open the bowels, 

2M 



the "laxative" aperients are scarcely suffi- 
cient as general aperients. Those classed 
as purgatives, together with the cathartic, 
colocynth, under the form of its well-known 
compound pill, are in daily use. 

There are few ailments in which increased 
action of the bowels is called for, in which 
one or other of the aperient remedies in the 
list will not be applicable. Aloes is valua- 
ble for certainty of action on particular por- 
tions of the bowels, for the small bulk of its 
general dose, for its tonic bitterness and con- 
tinued effect even after frequent repetition, 
but must be used carefully in pregnancy, 
piles, and other affections situated about 
the lower part of the canal. Castor-oil is 
recommended by its safety in almost all 
cases, by its certain, perfect action, and, like 
aloes, by its not losing effect by repetition ; 
but unfortunately, it is too often the medi- 
cine most disliked and sickened at. Epsom 
salts require much discretion in use, but 
have deservedly thrown Glauber salts into 
disuse. Jalap is certain and active, but is 
apt to gripe and to sicken, and its bulk is 
an objection. Mercurials alone, or followed 
by castor-oil or senna, or combined with 
aloes, rhubarb, or colocynth, are most valu- 
able, but are most abused. Rhubarb is 
mild, and with some persons effectual ; it is 
also tonic, but is apt to heat, and its bulk 
and taste are an objection, especially with 
children. Rochelle salt is similar to Epsom 
salt in action, and is pleasanter. Senna, the 
medicine of the nursery, is invaluable, and, 
if properly prepared, is safe and certain. 

Colocynth, in its well-known compound 
pill, forms part of the most generally used 
and useful purgative in costive habits. 
Scammony is, in many of the affections of 
children, especially combined with a mer- 
curial, our most valuable purgative, and is 
recommended by the small bulk of its dose. 
— See articles on all the above mentioned. 

Purgation, however, is used, not only as 
a means of clearing the bowels of their con- 
tents, but also as an agent for the relief of 
those organs, such as the liver, which are 
closely connected with the bowels ; and 
further, as a remedy calculated to relieve 
distant parts, or the system generally. 
Thus, in many head affections, free purging 
is one of our most powerful remedies — in 
congestion of the liver it is most serviceable ; 
and in overfulness of the system at large, it 
relieves greatly. To the above facts nature 
strongly points in those cases in which sud- 
den and striking relief often follows an at- 
tack of spontaneous purging or diarrhoea. 

The abuse of aperient medicines owes it3 
origin, probably, to a variety of causes. 






PUR 



434 



PUR 



Constipation, either alone, or as a concomi- 
tant of disease, is so obvious and common a 
symptom, and so often occasions distress, or 
at least uncomfortable sensations, while its 
removal is generally so simply effected, and 
often so sensibly felt as a relief, that it 
cannot be matter of surpinse if both doctor 
and patient, almost habitually, look to the 
action of the bowels, by purgative medi- 
cines, as the requisite preliminary to all 
other treatment, and within certain limits 
they do right. But the fatal facility of the 
treatment, assisted moreover by the power- 
ful advocacy which it has received in years 
gone by, has certainly produced a far too 
general use of aperients as purgatives ; not 
simply in the treatment of acute disease, 
but as a general rule of daily life. If the 
question be put, Which is the greater evil 
of the two, to have the bowels habitually 
confined, or habitually to take aperient 
medicines ? there can be no doubt, if the 
choice must lie between the two evils, that 
the latter is the lesser one ; but there are 
few cases in which the choice is so circum- 
scribed. The bowels, probably, are confined ; 
but they are so because the general con- 
ditions requisite for their healthy action 
(see Costiveness) are neglected, and because 
the aperient medicine is used as the readiest 
substitute for a little trouble and perse- 
verance. Thus used, the aperient is abused, 
and more or less injury is inflicted upon 
the system, according to the nature of the 
medicine, the frequency of its use, and the 
strength of the dose. One most general 
effect of the abuse of aperients is the weak- 
ened digestive power of the stomach ; an- 
other, the weakness of the system at large ; 
and a third, not unfrequently, is continued 
irritation of some portion of the alimentary 
canal. The weakened digestion which fol- 
lows the abuse of aperients may not be 
obvious at first ; indeed, if the digestive 
organs have been overloaded and oppressed, 
instead of being weaker after an aperient, 
they are actually more active, and this ap- 
parent increase of activity is very apt to 
lead to a too frequent renewal of the remedy, 
and too often — trusting in the remedy — to 
a continuance of those habits of excess 
which caused the first disorder. (See Indi- 
gestion.) The debility of the system which 
follows the abuse of aperients is the natural 
result of the digested food mass being hur- 
ried too rapidly through the bowels, to ad- 
mit of its nutrient portion being taken up 
and conveyed into the system ; debility is 
also the result of the too frequent employ- 
ment of purgatives, such as the salines, 
which increase, unnecessarily, the dis- 



charges — especially of the serous portion 
of the blood — into the bowels. Further, 
the too frequent use of purgatives irritates 
the bowels, by depriving them of their na- 
tural protective mucus : in this way ulcera- 
tion may result. 

As a natural consequence of the food 
mass, and of the secretions and excretions, 
such as the bile, being hurried too quickly 
into and through the bowels, and also of 
the mucus being carried off too abundantly, 
the stools, under the continued use of pur- 
gatives, assume an unhealthy character ; 
perhaps contain too much bile, &c, and in 
consequence of this unhealthy appearance, 
and with a view to its correction, persons 
are too often induced to continue the very 
cause of its production, and go on purging. 
This is a very common case. 

In connection with the foregoing article, 
the reader is referred to Alimentary Canal — ■ 
Biliary Disorder — Digestion — Indigestion — 
Costiveness, $c. 

PURGING FLAX— The Linum catharti- 
cum — deserves especial notice from the fact 
of its being a plant commonly native to 
England, and often used as a domestic re- 
medy, although not generally prescribed by 
medical men, not, indeed, as much so as it 
might be, for the report of it is that of an 
" excellent cathartic." The purging flax is 
a slender plant, about six or eight inches in 
height, with smooth narrow leaves placed 
opposite upon the stem ; it blossoms about 
the end of June, and the flowers, which are 
small and white, are "gracefully drooping 
before expansion." Every part of the plant 
is bitter. One drachm of the dry powdered 
leaves, or two to three drachms of the fresh 
plant, in the form of infusion, will, according 
to Dr.Christison, act briskly upon the bowels, 
without causing either sickness or griping. 

PURPURA— Popularly "the purples"— is 
a disease in which the blood escapes from the 
smaller or capillary vessels. It is best known 
from its outward manifestations on the skin, 
on which account it is often, but erroneously, 
classed as a skin disease, whereas it is truly 
a constitutional affection, which, although 
most visibly manifest on the skin, yet ex- 
hibits its effects in various internal portions 
of the body. The attack of purpura may 
be sudden, or it may be preceded for a week 
or more by symptoms of general illness, 
lassitude, feebleness, &c. Purpura, gene- 
rally, first shows itself on the legs, in the 
form of red or purple spots, of various sizes, 
which do not elevate the skin, and do not 
disappear on pressure ; in the course of a 
few days, these spots become changed to a 
brown or greenish yellow ; in fact, they go 



PUR 



435 



PUT 



through the same changes in colour that we 
see in a bruise, in which, as in purpura, effu- 
sion of blood has taken place beneath the skin. 
The above description applies to purpura 
perhaps in its mildest form. When more 
severe, the spots or blotches are spread over 
the body, and blood is discharged from the 
mucous membranes of the nose, mouth, 
stomach, bowels, bladder, &c, constituting 
a most fatal affection, which may occur 
either alone, or in connection with other 
diseases, such as fever, measles, small- 
pox, &c. Such a disease as purpura is of 
course not one for domestic management, 
and ought, if possible, on its earliest ap- 
pearance, to be confided to proper medical 
care. It may occur in the strong and ple- 
thoric ; in which case, of course, lowering 
measures, perhaps bleeding, may be called 
for, or at least free purging, with calomel 
and jalap, or calomel and colocynth. The 
administration, two or three times a-day, 
of one or two drachms of Epsom salts, dis- 
solved in water, each close being acidulated 
with fifteen drops of diluted sulphuric acid, 
would be very suitable treatment. 

Most frequently, purpura is a disease of 
debility, and requires treatment the very 
reverse of lowering ; quinine, in grain doses, 
three or four times in the twenty-four hours, 
will be useful, along with strong animal 
broths, wine, or porter, and tonic remedial 
measures generally. Turpentine, in ten or 
fifteen drop doses, given three or four times 
in the twenty-four hours, has proved an in- 
valuable remedy. Having been found useful 
in different species of hemorrhage, the juice 
of the common nettle might, in places where 
other remedies are not procurable, prove of 
service. 

Where the tendency to purpura exists, 
with debility, means of strengthening should 
be resorted to, which have been recom- 
mended under article Debility. In every 
case, however, whether threatened or actual, 
a medical man must be called without delay. 

PURULENT.— Consisting of pus, or mat- 
ter. — See Pus. 

PUS, or Matter — Is, or rather ought to 
be, a smooth, yellow, cream-like fluid ; when 
warm it exhales a faint, sickly odour. Under 
the microscope, pus is seen to consist of gra- 
nules — somewhat larger than the globules 
of the blood — which float in a transparent 
serous fluid. The above are the properties 
of health}'' pus, which, however, may differ 
very greatly from the standard ; it may be 
thin, and serous, or flaky, as it is in a scro- 
fulous abscess ; it may be bloody, it may be 
fetid, &c. Pus is a consequence of inflam- 
mation; its formation is, in fact, the "ter- 



mination" of that process by " suppuration," 
(see Inflammation,) and may be formed in 
various situations and textures. It is the 
most general secretion from an ulcer. When 
contained in a cavity formed in the sub- 
stance of any of the bodily tissues, it con- 
stitutes an abscess. It is a frequent conse- 
quence of inflammation, either of mucous or 
of serous membranes, in the one case con- 
stituting a purulent discharge, in the other, 
a purulent effusion, such as takes place into 
the chest. In some cases it is extremely 
difficult to distinguish the mucous, purulent, 
and muco-purulent discharges from mucous 
membranes, from one another. Less im- 
portance is now attached to the distinction 
than formerly. 

Refer to Abscess — Inflammation — Ulceration. 

PUSTULES — Are elevations on, and 
partly in the skin, which contain matter. 
A pustule may commence as such, when it 
is usually conical in shape, or it may com- 
mence as a vesicle, as in the cases of small- 
pox or cow-pox ; the vesicle, in the first 
place, containing transparent lymph or fluid, 
and its contents afterward becoming puru- 
lent, constituting it a pustule. 

Refer to — Skin, Diseases of. 

PUTREFACTION, or Putrefactive Fer- 
mentation — Is the peculiar chemical change 
undergone by many organized bodies after 
death. The following extracts on this sub- 
ject from Liebig's "Letters on Chemistry" 
are full of interest and instruction : — " The 
proximate cause of these changes, which 
occur in organized bodies after death, is 
the action of the oxygen of the air on many 
of their constituents. This action only takes 
place when water, that is, moisture, is pre- 
sent, and requires a certain temperature. 
This influence of atmospheric oxygen is 
very distinctly seen in fruits and other soft 
parts of vegetables, when, by an injury to 
their surface, the juice comes into direct 
contact with the air. When an apple is 
bruised at one point, a process of decompo- 
sition begins from the injured part ; a brown 
spot appears, which increases in a regular 
concentric circle, till at last the whole apple 
becomes rotten, or is changed into a brown, 
soft, viscid mass." " In like manner, a pro- 
cess of decomposition sets in, after death, 
in the bodies of men and animals, which, 
begins in the inside, in those parts, such 
as the lungs, which are in contact with the 
air. When there are wounds, it spreads 
from them, and in diseases from the dis- 
eased part ; so that, in many cases, death 
itself is nothing else than the result of 
a decomposition going on in an inward 
part ; with the disease, of which it is 



PUT 



436 



PUT 



the proximate cause, this process "begins, 
and it continues after death. The most re- 
markable of these phenomena is certainly 
this, that in many cases, the change once 
begun in organic matters, continues when, 
after transient contact with the air, the at- 
mospheric oxygen is entirely excluded." 
" All these processes of decomposition which 
begin in a part of an organic substance, 
from the application of an external cause, 
and which spread through the whole mass, 
with or without the co-operation of that 
cause, have been called the process of pu- 
trefaction." " The number of substances 
occurring in nature which are truly pru- 
trescible — that is, capable of putrefaction — 
is singularly small ; but they are everywhere 
diffused, and form part of every organized 
being. Before all other substances, this 
property of putrescibility belongs to the 
highly complex matters of the animal and 
vegetable kingdoms, which contain nitrogen 
and sulphur ; such as albumen, fibrine, 
caseine, gelatine, and the like." One of the 
most remarkable properties of putrescible 
substances is their power of exciting fer- 
mentation in bodies capable of this change. 
— See Fermentation. 

"The grand natural process of putrefac- 
tion, of the dissolution of all compounds 
formed in living organisms begins imme- 
diately after death, when the manifold 
causes no longer act under the influence 
of which they were produced. The com- 
pounds formed in the bodies of animals 
and of plants undergo, in the air, and with 
the aid of moisture, a series of changes, 
the last of which are the conversion of their 
carbon into carbonic acid, of their hydro- 
gen into water, of their nitrogen into am- 
monia, of their sulphur into sulphuric acid. 
Thus their elements resume the forms in 
which they can again serve as food to a new 
generation of plants and animals. Those 
elements which had been derived from the 
atmosphere take the gaseous form and 
return to the air ; those which the earth 
had yielded return to the soil. Death, fol- 
lowed by the dissolution of the. dead gene- 
ration, is the source (medium ?) of life for a 
new one. The same atom of carbon, which 
as a constituent of a muscular fibre in the 
heart of a man, assists to propel the blood 
through his frame^ was, perhaps, a consti- 
tuent of the heart of one of his ancestors ; 
and any atom of nitrogen in our brain has, 
perhaps, been a part of the brain of an 
Egyptian or a negro. As the intellect of 
the men of this generation draws the food 
required for its development and cultivation 
from the products of the intellectual ac- 



tivity of former times, so may the constitu- 
ents or elements of a former generation pass 
into and become parts of our own frames. 

" Finally, by a knowledge of the causes 
of the origin and propagation of putrefac- 
tion in organic atoms, the question concern- 
ing the nature of many contagions and 
miasms becomes capable of a simple solu- 
tion, and may be reduced to the follow- 
ing:— 

"Are there facts which prove that certain 
states of transformation o.r putrefaction in 
a substance are likewise propagated to 
parts or constituents of the living animal 
body ; that by contact with the putrescent 
matter the same or a similar condition is 
produced on such parts as that in which 
the particles of the putrescent body are ? 
This question must be decidedly answered 
in the affirmative. 

"It is a fact that dead bodies in dissect- 
ing-rooms frequently pass into a state of 
decomposition, which is communicated to 
the blood in the living body. The slightest 
cuts with the scalpel used in dissecting 
often cause a very dangerous and even fatal 
disease. The observation of Magendie, 
that putrid blood, brain, bile, or pus, when 
laid on flesh wounds, produce in animals 
vomiting, languor, and death, after a longer 
or shorter interval, has not yet been con- 
tradicted. 

" Further, it is a fact, that the use of 
various articles of food, such as flesh, ham, 
sausages, if in a certain state of decomposi- 
tion, is followed in healthy persons by the 
most dangerous and even fatal symptoms. 

" These facts prove that animal matter, 
in a certain state of decomposition, is capa- 
ble of exciting a morbid action in the body 
of healthy individuals. Now, since by the 
term products of diseased action, nothing 
else can be meant than parts or constituents 
of the living body, which are in a state of 
change in form and quality different from 
the normal one, it is evident that so long as 
this state continues, and the change is not 
completed, the disease may be communi- 
cated to a second or third individual, and 
so on. 

"Besides, when we consider that all 
those substances which destroy the com- 
municability, or arrest the propagation of 
contagions and miasms, are likewise such 
as arrest all processes of putrefaction or 
fermentation ; that under the influence of 
empyreumatic bodies, such as pyroligneous 
acid, which powerfully oppose putrefaction, 
the diseased action in malignant suppurat- 
ing wounds is entirely changed ; that in a 
number of contagious diseases, especially 



PUT 



437 



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in typhus, ammonia, free or combined, is 
found in the expired air, in the liquid and 
solid excreta — in the latter as ammonio- 
phosphate of magnesia— it seems impossible 
any longer to entertain a doubt as to the 
origin and propagation of many contagious 
diseases. 

" Finally, it is an observation universally 
made, and which may be regarded as esta- 
blished, that the origin of epidemic diseases 
may often be referred to the putrefaction of 
great masses of animal and vegetable mat- 
ters ; that miasmic diseases are found epi- 
demic, where decomposition of organic sub- 
stances continually goes on in marshy and 
damp districts. These diseases also become 
epidemic, under the same circumstances, 
after inundations ; and also in places where 
a large number of persons are crowded to- 
gether with imperfect ventilation, as in 
ships, in prisons, and in besieged fortresses. 
But in no case may we so securely reckon 
on the occurrence of epidemic diseases as 
when a marshy surface has been dried up 
by continued heat, or when extensive inun- 
dations are followed by intense heat." 

In connection with the above, the follow- 
ing instructive anecdote is related in the 
appendix to the publication from which the 
foregoing extracts are taken: — 

"In order to procure a roast for Easter, 

C , in R , desired his family to set a 

snare for a roebuck. Accordingly, one of 
these poor animals was caught in the snare, 
which, as its head and breast had passed 
through, held it by the hinder part of the 
body, the abdomen and pelvis being en- 
closed in the cord, so that it must have 
succumbed after a most agonizing struggle. 
It was found next day dead. 

"The master and mistress of the family 
eat on Easter-day the best part of the 
dainty ; the servants had little ; the re- 
mainder was laid in vinegar, but not eaten. 

" On the same day, all in the family who 
had eaten of the venison observed a strik- 
ing dryness of the mouth, oppression at the 
stomach, and nausea ; the features in all 
became anxious and pale ; all complained 
of oppression of the head, giddiness, and 
great weariness of the limbs. The master 
lost his sight for several days, and in short 
there now began a series of remarkable 
symptoms, requiring in many ways the 
assistance of a medical man. The husband 
was only restored to health in July, but 
the wife never recovered ; she lingered 
more than two years, and at last died 
after severe sufferings. The daughter, the 
man-servant, the maid, who had eaten little 
of the tortured animal, were soon cured. 
2m2 



The symptoms in many respects recalled 
those of the eiFects of the bite of rabid 
animals, and of the sausage poison of Wir- 
temburg." 

With respect to that theory which regards 
the putrefaction of animal matters as pro- 
duced by microscopic animalculge, Liebig 
remarks — " To ascribe putrefaction to the 
presence of animalculas is as irrational as 
it would be to ascribe to the beetles, whose 
food is derived from animal excreta, or to 
the mites in cheese, the state of decomposi- 
tion of the excreta or of the cheese. The 
presence of animalculae, which are often 
found in prodigious numbers in putrefying 
matters, cannot, in itself, be considered 
wonderful, since these animals find there 
the conditions of their nutrition and de- 
velopment combined. It is quite certain, 
howevei-, that in their presence putrefaction 
is exceedingly accelerated. Their nutrition 
presupposes the consumption of particles 
of the putrefying body for their own de- 
velopment. Its more rapid destruction must 
be the necessary consequence." 

The extreme interest and importance 
which surround the processes of putrefac- 
tion must be the apology for the length of 
the above extracts on the subject from per- 
haps the first living authority on these mat- 
ters. Whether we regard putrefaction in a 
sanitary or hygienic point of view, as the 
originator of disease, when favoured by 
mail's ignorance or carelessness, or as the pro- 
cess by which the material atoms of a gene- 
ration which has passed away are again 
started on their mission to furnish material 
clothing for a generation living or to live, 
our attention is alike deserved. 

Refer to Fermentation, 3,'c. 

PYLORUS. — See Alimentary Canal — 
Stomach. 

PYROLIGNEOUS ACID— Is acetic acid 
obtained by the " destructive distillation" 
of wood. 

Refer to Acetic Acid. 

PYROSIS.— See Water-brash. 

QUACK, QUACKERY, and QUACK ME- 
DICINES. — The origin of the term quack is 
doubtful ; it is sometimes derived from 
"quack-salber," the German for quicksilver, 
or mercury, which was first used by irregu- 
lar practitioners. However that may be, 
the terms "quack" and "quackery" are not 
now confined to medical matters, but are 
applied generally to those who pretend to 
exercise functions of which they are inca- 
pable, and who support their pretensions 
with deceit, and generally with impudence. 

History has proved, and facts of the pre- 



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sent day testify, that of all the openings for 
deception and chicanery in connection with 
the dealings of man with man, medicine 
opens one of the widest. 
< r In former times, when even the learned 
entertained most crude and erroneous ideas 
of much of the structure, and of most of the 
functions of the living body, and when the 
mass of the people were in the most perfect 
ignorance on these points, — when, moreover, 
superstition was rife, when charms and 
king's touches were trusted to cure disease, 
when occult virtues, dependent upon all 
sorts of fancied and fanciful conditions and 
circumstances, were considered to be active 
or not according to the observance of these 
conditions and circumstances, — when, it is 
observed, these things prevailed, it cannot 
perhaps be matter of surprise that people 
believed the man who could lie most glibly, 
and who held out the most specious pro- 
mises, in connection with that dearest pos- 
session of man — dearest, at least, when lost 
— his health. The most natural thing for 
ignorance and superstition was to believe 
the tricked-out mystery. But is it natural, 
or, rather reasonable, that the foolish be- 
lief in mysterious cures and quack panaceas 
should still prevail at the present day, and 
that the most notorious quacks should amass 
immense fortunes, simply by gulling the 
many foolish ? Seasonable or not, the fact 
is incontrovertible ; reasonable or not, it is 
to be accounted for by the almost perfect 
ignorance which still prevails, even among 
the most educated classes, of the structure and 
functions of their own frames, of the re- 
quirements of their own constitutions, and 
of the true principles on which the latter 
are to be preserved in soundness and health, 
or to be treated when afflicted with disease. 
Moreover, the principles of health, in health, 
also extend, or ought to extend, to the ma- 
nagement of illness when health is sought 
to be restored. These principles are too 
frequently dwelt upon in the various sani- 
tary articles in this work to require reite- 
ration here, but, it is once more repeated, 
they ought to be part of the education of 
all. The diffusion of such knowledge will 
and can put an end to quackery ; and yet 
the diffusion of such knowledge is dreaded 
and condemned even by some medical men, 
who seek legal enactments against the irre- 
gular practitioner and his practices, in the 
vain idea that these will prevent the credu- 
lous and ignoi»ant from resorting to the 
man who lies most to their ignorance, or 
flatters their blind prejudices most unscru- 
pulously. 

Quacks, generally, may be divided into 



those who quack for profit and those whi 
are merely amateurs, — the latter class in- 
cluding the Lady Bonntifuls and others, who, 
not content with using such simple means 
of alleviating disease or suffering among 
their neighbours as can be safely employed, 
must, without necessity, get to handling such 
edged-tools as antimony, calomel, &c. &c, 
and with considerable vigour too, very often, 
without having given themselves much 
trouble to get any idea of the proper mode 
of, and reasons for the administration of 
what they prescribe. Such practices cannot 
be too strongly condemned. When such a 
combination of circumstances occurs that 
the immediate care of a dangerous accident 
or illness devolves upon some intelligent or 
responsible individual, in the absence of, or 
at least until the arrival of a medical man, 
it is quite admissible to use even active 
measures, such as are often recommended 
in the present work, if proper precaution be 
observed ; but this is very different from 
persons, without necessity, and for the mere 
love of amateur quackery, taking upon them- 
selves the management of cases of serious 
disease. "Without entering upon that dif- 
ficult ground which correct professional 
knowledge and educated judgment can alone 
permit to be safely trodden, there is a wide 
and extensive field for exertion and for use- 
fulness open to the unprofessional, in the 
kindly offices of a true domestic medicine, 
and in the timely help and solace of a simple 
household surgery." 

"But when it .is remembered how the 
nicest judgment that observation and expe- 
rience can form, the most patient attention, 
aided by practised ear and eye, by micro- 
scope and test-tube, are frequently neces- 
sary to enable the conscientious physician 
to judge of his case before he can apply the 
remedy, it is evident how great must be the 
responsibility of those who, in rashness or 
ignorance, venture upon the treatment of 
serious disease, either in their own persons 
or in those of others : incapable of judging 
of its nature, still less capable are they of 
selecting the appropriate treatment. There 
is, however, a vast difference between the 
management of real disease and of ordinary 
ailment — between endeavouring to strike at 
the root or only to relieve the symptoms. 
Any unprofessional man, or woman either, in 
England, [or America,] who, with all the 
facility that there is for procuring skilled 
advice, ventures to take the medical manage- 
ment of a case of real illness, acts most unwar- 
rantably. Still less justifiable is interference 
with cases upon which a medical man is 
already in attendance. — See Advice, Medical. 



QUA 



439 



QUA 



The quacks, whose sole object is gain, are 
divisible into those who sell some nostrum, 
and those who profess to investigate and 
prescribe for diseases. 

The quack medicine, sold as such under 
the seal of government, [or of a patent, in 
the United States,] are of every variety. 
Some profess to cure every thing, and there- 
fore carry absurdity so plainly on the surface, 
that it is difficult to imagine any persons 
being sufficiently credulous to employ them ; 
others are more circumscribed in their pro- 
fessions, but yet, as far as they go, are ad- 
vertised as infallibles. One instance will 
demonstrate the danger of trusting to them. 
Under such articles as "Debility," &c. &c, 
it has been pointed out, that there is a false 
weakness, to be distinguished from that 
which is really dependent on actual debility, 
both being accompanied with languid de- 
pression. For such a condition many quack 
pills and the like are advertised — they re- 
lieve "languor, nervous depression, &c." 
Such pills are generally powerful purga- 
tives, and by their strong action in this 
way, perhaps, relieve some individual suf- 
fering under the languor of an oppressed 
system ; he is delighted at the change, .and 
meeting his invalid friend, who is suffering 
from the real debility of incipient consump- 
tion, or from some other disease, persuades 
him to try the wonderful pills — need it be 
said, with how great probable, perhaps 
irremediable injury. It would be easy to 
multiply instances — one is enough. 

Of the prescribing quacks, some are so 
wonderfully skilful as not to require to see 
their patient; these include the "water 
doctors" — not the hydropathists, but the 
" casters" of the urine — those who require 
merely to see the urine, and therefrom pro- 
nounce the verdict of life or death, or send 
medicines accordingly. The chemical and 
microscopic examination of the urine is, in- 
deed, to the physician a most valuable aid 
in the investigation of disease, when taken 
in conjunction with the other symptoms of a 
case. But to imagine that its inspection 
yields any definite or trustworthy informa- 
tion to the ignorant and illiterate "water 
caster," ignorant alike of the nature of the 
secretion from which he or she — for there 
are female quacks of this kind — professes to 
derive information, ignorant of the sti-ucture 
or functions of the animal body, is too ab- 
surd. In such cases — as, indeed, in those of 
the prescribing quacks generally — the sys- 
tem of fraud is supported by lying assertions 
and promises, and by working upon the 
fears of the unfortunate dupes : this is espe- 
cially the case in those who profess the venereal 



department, and who cannot be too carefullj 
shunned. The most shameful impositions 
are practised by this description of quack, 
and the consequences are very serious. The 
conduct of newspaper publishers in giving 
currency to announcements connected with 
this obscene and disgusting phase of quack- 
ery is most reprehensible. Some quack 
prescribers follow their business on the 
strength, real or pretended, of having re- 
ceived the "receipts," as they are popularly 
called, of some predecessor, regular or irre- 
gular. Even supposing such "receipts" were 
good for any thing, it would be difficult to 
prove that their possession gave the faculty 
of applying them ; but the fact is, with the 
exception of a few general medicines, such 
as the common aperient pills, every case of 
disease, and almost every constitution, re- 
quires some modification in the medicines 
prescribed, and the same prescription is no 
more applicable to three or four different 
individuals than the same coat would be. 
Moreover, almost every case of illness calls 
for changes and modifications of medicine, 
to meet the ever-changing symptoms which 
occur ; but the quack panacea ignores such 
distinction, and professes, by its wonderful 
property of curing at once, to cut the Gordian 
knot — well if it does not do this by cutting 
the thread of life at the same time. 

As it is impossible for any man to treat 
disease with full advantage unless he has 
acquired by education a sufficient amount 
of the very varied knowledge, both theo- 
retical and practical, which is now em- 
braced within the limits of medical science ; 
so, every man who undertakes the treatment 
of disease as a practitioner, without such 
knowledge,, necessarily falls under the de- 
signation of a quack, because he pretends to 
that which he does not possess — he deceives. 
It is true, many receive the necessary edu- 
cation, and yet follow out irregular theories 
and modes of practice : if, in doing so, they 
do wrong, it is unfortunate ; but if the error 
is followed in sincerity, the follower cannot 
justly be called a quack. On the other 
hand, the upholder of the most orthodox 
medicine may do so in a quackish manner, 
if, in his practice, he makes a display of 
methods, either of investigating or of treat- 
ing disease, which are not requisite. Such 
things flourish because -ignorance abounds. 
As any system of medical practice may be 
converted into one of quackery, so may any 
medicinal agent, even that which is safest 
when properly used, become, in the hands 
of the unprincipled empiric, an agent for 
evil. In fact, quack medicines generally 
are compounds of drugs which are regularly 



QUA 



440 



QUA 



and daily prescribed by medical men. It is 
not in the composition, but it is in the ap- 
plication of the compound, that mischief is 
done. If it be a matter of indifference, when 
a purgative, an anodyne, or any other me- 
dicine is required, what article is selected, 
so that it belongs to the class ; or, if it mat- 
ters not whether its peculiar action is suited 
to the case and constitution of the patient 
or not, or if the same doses are suitable 
to all, then may quack compounds — each 
professing to do more than another — be 
permitted to go forth unchallenged on their 
errands of mischief under the sign and 
seal of government, [as in a patent medi- 
cine.] But, if a medical adviser requires 
to investigate his patient's case, to weigh 
in his own mind his constitution, circum- 
stances, and tendencies, and, finally, to se- 
lect from the stores of his own experience 
and that of others, the remedy or remedies 
best adapted to him, it must be evident to 
every reflecting mind, either that these 
latter necessities enjoined upon the man of 
educated mind and sense are a tissue of 
deceptions and shams, or that the whole 
system of quack medicines must be founded 
upon fraud, and that it flourishes upon the 
credulity which believes specious lies, or 
puts- trust in the easily obtained testimo- 
nials of some weak-minded individuals, such 
as are to be found in all ranks and classes. 
It is difficult to account for the eager 
credulity and secure indifference with which 
persons, otherwise sensible, swallow or use 
what they believe to be agents capable of 
acting powerfully upon their own bodies, 
while all they know of these agents is that 
they are put forth by those of whom they 
know nothing beyond the advertisements 
filled with assertions so impudent, or at- 
tempts at deception so palpable, that the 
wonder is they do not defeat their own 
ends. Few would be inclined to trust an 
individual whom they had detected in the 
attempt to cheat them by offering a forged 
check, with, perhaps, the precaution taken 
to place the would-be deceiver out of the 
reach of the law by the change of a letter 
in a name ; and yet people are daily gulled 
by some such devices, eminent names, with 
some slight alteration in spelling, being 
made the attractions by which an unprin- 
cipled vendor seeks to puff off his wares. 
Come from what authority it may, as soon 
as a medicine, or combination of medicines, 
is held forth as a " cure," irrespective of 
contingent circumstances, it becomes a quack 
medicine ; in other words, it becomes a 
source of danger to some, probably to many. 
The passion for gambling is a very widely 



distributed one ; and, as men will risk the* 
fortunes and their liberty upon the throw of 
the dice, so it can be only the same love of 
hazard that induces many of them to risk 
the possibility of injury against the recovery 
of some of those prizes of health which they 
have thrown away time back, but which are 
now held out as the tempting baits of the 
speculator. 

Solomon's Balm of Gilead realized a 
handsome fortune for its promulgator, of 
whom the following anecdote is told : — 
Being asked how it was that people bought 
his medicine so freely, he replied, " Of ten 
men who pass my door, nine, at least as far 
as medicine is concerned, are fools ; if you 
will give me the nine fools for customers, 
the regular practitioner may keep the one 
who is wise in these matters." 

In advocating the doctrine that quackery 
is only to be successfully combated by im- 
parting to the people generally the informa- 
tion necessary to enable them to see through 
the deceptions of the charlatan, the author 
does not by any means dissent from the 
suppression of quackery by the strong arm 
of the law, at present, as a means of pro- 
tecting the people till they can protect 
themselves. But as it must be long before 
information is sufficiently diffused to effect 
the end proposed, the external guard ought 
to be substituted in the mean while, till the 
dictates of educated intelligence are suffi- 
cient for the purpose. Governments ought 
to protect the poor and ignorant in these 
matters, instead of throwing the " patent" 
protection over deleterious compounds which 
destroy annually so many of the people. A 
case in point of the injurious effects of 
quackery has come under the author's no- 
tice lately. A labouring man, suffering 
from obscure internal disease, for which 
he has been treated without relief, both in 
private and in the wards of a general hos- 
pital, is induced by the fair promises and 
lying opinions of an itinerant quack to re- 
sort to him for advice (?) given him gratis, 
while the medicine is paid, for at the rate 
of five shillings a bottle, and paid for at the 
time ; at the same time the poor man is 
applying for parish relief, and his family 
in want. He is to be cured in three weeks ; 
that is, he is to pay fifteen shillings, and by 
the time the quack has reaped that amount, 
got together somehow, the patient may open 
his eyes, if he likes, to the fraud. 

"Refer to Medicine, Practice of. 

QUARANTINE— Is derived from the Ita- 
lian word signifying forty ; forty days hav- 
ing been the usual space of time that per- 
sons or goods coming from places in which 



QUA 



441 



RE A 



infectious diseases, or diseases thought to 
be infectious prevail, or that have been ex- 
posed to the influence of any such disease 
during a sojourn on board ship. The qua- 
rantine or isolation, is either "performed" 
on board the vessel, which none are allowed 
to leave, or in a building called a "laza- 
retto," set apart for the purpose, and cut 
off from all communication with the sur- 
rounding country. There has of late pre- 
vailed a strong feeling toward the modifi- 
cation of the laws of quarantine. The 
term of isolation is often much less than 
the forty days. 

QUARTAN. — A term applied to an ague, 
the paroxysms of which occur every fourth 
day. — See Ague. 

QUASSIA. — The quassia wood is obtained 
from a tree, native to Jamaica and other 
West India Islands. It is named the " quas- 
sia excelsa," from its height, which is often 
one hundred feet. Quassia wood is usually 
sold in the form of chips or raspings of a 
lightish yellow colour ; it is intensely bitter, 
and forms a valuable tonic and stomachic 
remedy. It is best given in infusion, made 
by soaking two scruples of the raspings in 
one pint of water for a couple of hours. The 
dose is one to one and a half fluid ounces 
twice daily. The root bark of another 
species of quassia, or at least what was 
formerly ranked as a quassia, is also some- 
times used in medicine. 

QUICKENING.— See Pregnancy. 

QUICKLIME.— See Lime. 

QUICKSILVER.— See Mercury. 

QUINCE SEEDS— When boiled in water, 
yield a mucilaginous decoction,- which is 
not, however, in any way superior to other 
more common preparations. Two drachms 
of the seeds are ordered to be boiled in two 
pints of water for ten minutes, and the de- 
coction strained. [When boiled for half an 
hour, or when simply soaked, it forms what 
is termed " Bandoline," and is then used at 
the toilet to keep the hair smooth and in 
place.] 

QUININE.— See Bark. 

QUINSY.— See Throat, Sore. 

QUOTIDIAN. — A term applied to an 
ague, the paroxysms of which occur daily. 
— See Ague. 

RABIES — As a term, is usually synony- 
mous with hydrophobia, or canine madness. 
— See Hydrophobia. 

RADISH — The Raphanus sativus, like 
other vegetables which are eaten uncooked, 
is not suitable for persons of weak digestive 
powers. 



RADIUS. — One of the bones of the fore- 
arm. — See Forearm. 

RANUNCULUS.— The various species of 
ranunculus, or "butter-cup," so common in 
this country, are chiefly remarkable for 
their acridity, as any one may prove who 
will chew a small portion of one of the 
leaves. Their action is emetic, and also, 
when bruised and applied to the skin, irri- 
tating, acting like a mustard-plaster or 
blister — a fact the knowledge of which might 
prove useful. These plants completely lose 
their acridity by drying. 

RAISIN. — The dried grape, in which the 
mucilaginous and perhaps acid constituents 
of the fresh fruit have been converted into 
grape sugar in the process of desiccation. 
Raisins are used in various medicinal pre- 
parations. As an article of diet they are 
unwholesome only if the tough, indigestible 
skins are eaten. In the case of children, 
much disorder is frequently caused by the 
undigested skins of raisins passing into the 
bowels, and lodging in the sacculi, or little 
pouches of the larger intestines, where they 
cause much irritation, and probably trou- 
blesome diarrhoea, which is only relieved 
when a dose of castor-oil, or of some other 
aperient, clears out the offending accumu- 
lation. Raisin-skins may thus remain in 
the bowels for weeks. 

RASH — Is a popular term' for eruptions 
on the skin, more especially such as scar- 
latina, nettle rash, &c, which do not pre- 
sent either vesicles or pustules. 

RASPBERRY— The Rubus idceus, is indi- 
genous to England, [and the United States,] 
and grows wild in many situations, especially 
in Scotland, amid the stony banks of streams. 
The raspberry is one of the most wholesome 
fruits we possess, either in its fresh state or 
preserved. In the latter form it is a most 
grateful addition to the sick-room comforts. 
In fever, and feverish diseases generally, 
when the acid is not an objection, the well- 
known raspberry vinegar is both an agree- 
able and salutary beverage. When the acid 
is inadmissible, a pleasant drink is made by 
mingling the preserve or jam with water. 

REACTION— In medicine, is the resist- 
ance of the animal system to depressing 
causes — a resistance, however, which tends 
not only to restore to the ordinary level of 
action, but to go farther, and to stimulate 
to action above that level ; thus, after the 
cold stage of fever, the reaction to the hot 
gives a, skin, hotter than usual, a pulse 
quicker and probably stronger than usual. 
The same effect occurs in reaction after de- 
pression from other causes, such as after 



RE A 



442 



REG 



accident. In combating, therefore, especial- 
ly by means of stimulants, the depression 
which in such cases at first seems almost to 
threaten life, the after reaction must not be 
lost sight of, and the means of relieving the 
depression administered with a sparing and 
judicious hand. When reaction can be pro- 
cured by the natural powers or resilience 
of the system, by external warmth, and by 
warm, comparatively unstimulating fluids, 
such as tea, &c, it is better effected than 
by the use of more powerful excitants. In 
some cases, however, the latter are abso- 
lutely necessary to preserve life, and then 
ammonia in some form, but especially as 
sal-volatile, alcoholic stimuli, such as wine 
and brandy, and the others, are all powerful 
promoters of reaction. In some peculiar 
cases, emetics of mustard, by rousing the 
system, greatly assist reaction. 

READING ALOUD— And speaking aloud 
for a length of time are wholesome exercises 
for the strong; but if carried to excess, or 
even if only practised moderately, may pro- 
duce, in the predisposed, injury to the lungs, 
spitting of blood, or affection of the throat. 
— See Clergyman' s Sore-throat. The modi- 
fication of the respiration and circulation 
produced by continued loud speaking or 
reading, is also apt to produce unpleasant 
symptoms in those predisposed to apoplectic 
or head affectfons. The exercise of reading 
aloud has been recommended as useful in 
cases of hysteria and nervous disorders. 

RECREATION— Or the renovation of the 
powers of body or mind, after they have 
been exhausted by toil, is one of the highest 
pleasures enjoyable by man; a real plea- 
sure, because it can only be purchased by 
those previous exertions, in the performance 
of which, although they are exertions, man 
feels that he is fulfilling the ends of his 
being. Those who live in a constant round 
of what is called pleasure, the idle, the 
saunterers after their work, do not know 
what true recreation is, cannot realize the 
thorough enjoyment with which the man 
who works in the true sense of the word, 
who, "whatever his hand findeth to do," 
does it "with all his might," throws off his 
toil, and takes to recreation in the same 
hearty spirit that he brings to his daily 
effort, whatever that may be. 

Recreation is the enjoyment of man espe- 
pecially, and the higher he rises in the scale 
of true intellectual being, the more tho- 
roughly must he enjoy it — the active plea- 
surable excitement of both mind and body, 
in contradistinction to "rest," which is the 
passive enjoyment of repose after exertion. 

The animal enjoys rest, but can scarce be 



said to enjoy recreation ; the man of physi- 
cal toil enjoys rest, and, if the mind be dull 
and untutored, finds his chief enjoyment, in 
the intervals of labour, in rest, like the 
animal ; rest, which recruits the physical 
powers, while the mind is comparatively va- 
cant. But when the mind is at all inclined 
to activity, after the rest which follows 
action, comes the desire for reaction, (for 
recreation,) an active state, more useful in 
many respects than rest, because it is a state 
of stimulation, of wholesome excitation, if 
kept within proper bounds. Such a condi- 
tion of moderate pleasurable excitement of 
the mental and physical powers, which act 
and react on one another, is highly condu- 
cive to health — is, in fact, a means of pre- 
serving health, to which man, except in a 
very artificial state, is periodically, almost 
instinctively impelled. 

The subject of recreation involves a great 
practical truth. Those who do not work 
cannot know recreation ; without the action 
there can be no reaction, for the one follows 
the other as effect follows cause, and, when 
all is in order, as a necessary cause. 

Again, recreation must alternate with work, 
if the power of working is to be retained. 
If recreation cannot be enjoyed without work, 
neither can work be enjoyed or vigorously 
pursued without recreation. But the fact 
has been greatly overlooked in this busy 
age, and work is pursued unceasingly, until 
either body or mind sink under the never- 
ending tension, or, if they do endure, until 
the power of taking recreation is lost — until 
the mind becomes so immersed in its daily 
engagements, in its daily routine, that it 
cannot divest itself of the trammels thrown 
around it. The man becomes so bound down 
in the pursuit of money, of power, of repu- 
tation, that he is a slave to his own desires 
— he grudges every moment abstracted from 
the advancement of his darling cares — he 
cannot recreate. Here is neither the time 
nor place to point out how far this inordi- 
nate slaving is removed from the true ends 
of man's being in this world, or how little 
it is in accordance as a preparation for an- 
other. It is a system but little calculated 
to afford either continued health, or happi- 
ness, or usefulness, in man's daily life ; the 
physical powers must eventually give way 
under it if persevered in, and dyspepsia, 
miserable hypochondriasis, paralysis, and 
cerebral disease be the probable conse- 
quences ; or, without the presence of . tan- 
gible disease, the power of exerting the 
mind be lost. A man who thus feels him- 
self enslaved by work, should, by an effort, 
break through the restraint — an effort it will 



EEC 



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require, to cast off the morbid state of mind 
which is generally connected with the con- 
dition; but the effort must be made — and 
those from whom it is most required, are 
generally those who most have it in their 
power to avail themselves of the means of 
recreation to the utmost, — they are our 
wealthy (but overtasked in mind and body) 
merchants, lawyers, men of business, and 
in some cases medical men. They think 
they cannot leave their posts without every 
thing going wrong, without risk or loss ; 
risk of some rival taking up an investment, 
a cause, or a patient ; and it may be so, but 
is the chance of such petty losses a reason 
for sacrificing health, and life, and real hap- 
piness too? For that cannot be real happi- 
ness which is dependent for its continuance 
upon the same mill-horse round of actions. 
It is, therefore, repeated that recreation is a 
duty which the man of real work owes to God, 
to society, to himself, and to his family, and it 
is a duty which he cannot altogether neglect, 
without risking the loss of both mental and 
bodily health. 

The kind of recreation in which a man 
should indulge must of course depend 
greatly upon circumstances, but, generally 
speaking, a complete change of scene and 
air is desirable, such as will break in upon 
old trains of thought, give new ideas, and 
afford pleasurable recollections, when the 
active exertions of life are again returned 
to. It argues well both for the physical and 
mental elevation of the population at large, 
that the means of recreation, the cheap trips, 
the excursion trains, &c. are so abundantly 
taken advantage of, and are becoming yearly 
more common, for these must be regarded 
as part of the great sanitary movements of 
the age, the means of affording cheap and 
thorough recreation to classes, who, some 
years ago, scarcely dreamed of such a thing. 
It ought to be the duty of all, of every go- 
vernment, of every master, to give abundant 
facility for pure healthy-minded recreation 
to the people ; to do so is true economy of 
that real wealth, social and political, the 
healthy mind and healthy frame of every 
individual of the community. 

Recreation, reaction after toil, or in other 
words periodical stimulation of mind and 
body, in those who work, is so strongly in- 
stinctive, that it will be sought, and if not 
found in one way, in the reading-room, the 
lecture, the concert, the garden, or even in 
the cricket-ground, if not afforded in the 
fete or the excursion, will be procured in 
the tap-room, or in degrading and vicious 
pursuits. [This sentiment is well worthy of 
the serious consideration of the sons and ad- 



vocates of temperance in the United States.] 
To sum up, the stimulus of recreation is 
one of those stimuli necessary for the con- 
tinued healthy tone of both mind and body, 
it cannot be neglected without injury to 
both, but its gratification ought to be di- 
rected into those channels which will pre- 
serve its utility, because they preserve it in 
order, in moderation, and in purity. 

Refer to Exercise — Dancing — Pleasure — 
Rest, §c. 

RECTUM.— The rectum is the terminat- 
ing extremity of the large bowel which opens 
at the anus or fundament. It derives its 
name from its straight course as compared 
with the tortuosity of the other portions of 
the intestines. It is about nine inches in 
length, lies in front of the "sacrum," (see 
Pelvis,) and expands into a dilatation just 
above the external opening, or " anus," at 
which it is closed by a "sphincter" muscle, 
which retains the contents of the bowel, 
unless when, under the influence of the will, 
it permits their expulsion, the latter act 
being effected by means of the muscular 
fibres of the gut itself, aided by the down- 
ward pressure of the diaphragm and other 
muscles of the abdominal boundaries. The 
rectum is of course lined by a continuation 
of the mucous membrane which lines the 
intestines throughout. The rectum is sub- 
ject to various diseases, which generally 
require efficient surgical assistance for their 
safe and speedy cure. 

Infants are occasionally born with what 
is called " imp erf oration" of the rectum; 
that is, the gut, instead of being an open 
canal, is closed wholly or partially, either at 
the external opening or higher up. When 
"imperforation" of the rectum in an infant 
is either evident or is suspected, from the 
non-passage of the natural contents of the 
bowel downward, from the belly becoming 
tense and full, and from vomiting the con- 
tents of the bowels, the child should at once 
be seen by a surgeon, for it is possible that 
a simple operation, adopted without loss of 
time, may rectify the evil and preserve life. 

Obstruction of the rectum, painful or 
otherwise, may occur either in adults or 
children, in consequence of the presence 
either of hardened "faeces," in consider- 
able quantity, or of foreign bodies which 
have descended after being swallowed, and 
become fixed in the gut, just above the 
lower opening, or which have been intro- 
duced directly into the canal, either by ac- 
cident or design. 

The dilatation of the rectum just above the 
anal opening rather favours in some cases 
the accumulation of the hardened faacaj 



REC 



444 



REF 



contents of the bowels, especially in the 
aged — a condition which is apt to occasion 
much suffering and inconvenience. Such 
an accumulation generally requires the aid 
of the surgeon, who removes it by mecha- 
nical means, such as scoops and such-like 
instruments ; or the handle of a spoon is 
sometimes used in the absence of the above. 
In proper hands the case is of course safe, 
but it would not be well for unprofessional 
persons to attempt such interference ; much, 
however, may be done by the persevering 
use of mild clysters, of about half a pint of 
fluid at a time, which will first soften and 
finally induce the discharge of the mass. 
Foreign bodies lodged in the rectum may 
produce distress simply from their bulk, or 
they may produce much suffering by lace- 
rating the lining membrane by sharp edges 
or points, causing intense pain on any at- 
tempt being made to evacuate the bowels. 
Children not unfrequently suffer in this way, 
from the stones of plums, &c. which they 
have swallowed, and the author has seen a 
case in which the greatest agony was appa- 
rently caused in a child, by the hard core 
of an apple becoming fixed at the opening. 
In all such cases it is advisable to get pro- 
per advice at once ; but in the absence of 
this, clysters of tolerably thick gruel may 
be used, or the finger well greased may be 
carefully introduced within the gut, to as- 
certain, if possible, the presence, and assist 
the removal of any small body within reach ; 
but no instrument can be safely used except 
by a medical man. 

Obstruction of the rectum may likewise 
be the result of disease which causes nar- 
rowing or " stricture" of its canal. This 
disease, which generally occurs after middle 
life, and which may either be of a simple 
or of a cancerous nature, is thus described 
by Mr. Syme, a high authority on the sub- 
ject: — "The symptoms of simple stricture, 
are slow, painful, and imperfect evacuations 
of the bowels, the desire to empty the rec- 
tum continuing after the most powerful and 
prolonged efforts of expulsion, the dis- 
charge of fluid matters with great force, as 
if from a squirt, the appearance of the solid 
evacuations in the form of slender cylinders, 
or small round masses, and the admixture 
of a large quantity of mucus, often bloody, 
with the feculent excretions. The disease 
generally manifests itself very insidiously, 
and before long is- usually accompanied 
with a distended state of the abdomen, 
which is owing partly to retention of the 
intestinal contents, and partly to a tym- 
panitic condition, induced by the irritation 
.thus occasioned. The desire to empty the 



bowels becomes at length almost incessant, 
and the frequent attempts which are made 
to do so, Toeing seldom followed by any eva- 
cuation, except of fluids, there is a risk of 
erroneously supposing that the patient 
labours under diarrhoea, and, with this view, 
of prescribing medicines which have a ten- 
dency to increase the distension of the intes- 
tines." It is only requisite to add, that when 
such symptoms as the above show themselves, 
there is but one course left — that of procur- 
ing the best advice as soon as possible. 

Ulceration of the lining membrane of the 
rectum, fissure at the anal opening, and 
other diseases, especially the last named, 
which produce painful sensations, when the 
bowels are evacuated, can only be properly 
investigated and treated by a surgeon. 

Falling, or "prolapsus" of the bowel, 
and piles, have already been considered 
under their proper articles. 

Fistula is a disease connected with the 
rectum, which often causes much incon- 
venience. It is the result of abscess, which 
having formed, and discharged at the side 
of the gut, remains unhealed and unhealing, 
and often opens both externally and into 
the bowel, forming as it were a side passage, 
by which wind and fluids are apt to escape 
along with the discharge peculiar to the 
artificial passage. As may be imagined, 
such a state of matters gives rise to much 
annoyance, and calls for speedy removal, 
which .can only be procured with certainty 
by operative procedure on the^part of a 
surgeon. The sooner, therefore, this is sub- 
mitted to the better, the bowels being in the 
mean while kept lax, and the disagreeables 
of the condition alleviated as much as pos- 
sible. Fistula is far more common in males 
than in females, and is often associated with 
consumptive tendencies. 

REFRIGERANTS— In medicine, are re- 
medies employed to reduce the existing tem- 
perature of the bod}'', either locally or ge- 
nerally. Internal remedies, such as the 
vegetable acids, nitrate of potash, or salt- 
petre, &c, have been used under the name 
of refrigerants, but it is difficult to trace to 
them any direct action. Indirectly, they 
probably act by reducing the force and fre- 
quency of the circulation. The best and 
most direct refrigerant is the obvious one, 
cold itself, used through the medium of cold 
air, cold water, or ice, and in most cases, 
when the animal temperature is raised above 
the natural standard, in some of these forms 
cold is useful. The late Dr. Currie, of 
Liverpool, established the practice of treat- 
ing fever by the refrigerating action of cold, 
used very boldly, in the form of cold water 



REG 



445 



RES 



dashed freely over the patient, and the 
practice was at one time considered most 
successful, but either from timidity, or 
some other cause, it has fallen into compa- 
rative disuse among medical men at the 
present time. 

Refer to Cold — Ice, fyc. 

REGIMEN — Is the regulation of the 
habits of an individual with reference to 
health. Diet is properly included under 
the term, but is generally spoken of sepa- 
rately. The proper regulation of the regi- 
men of an invalid is obviously a matter of 
great importance. It includes the prescrip- 
tion of the hours, and kind of employment, 
of exercise, or of amusement, of the times 
of meals, and of sleep, of dress, &c. &c. 
As the particulars of regimen are sufficiently 
entered into under the various articles, it is 
superfluous to notice them further here. 

RELAXATION.— See Recreation. 

REMITTENT FEVER.— See Fever. 

RENAL. — Appertaining to the kidney. 

RESINS — Are vegetable juices, which 
are solid, are not soluble in water, but dis- 
solve in alcohol. They are generally brittle, 
and more or less transparent. The resins 
best known, and which are used in medicine, 
are left after the distillation of the essential 
oil of turpentine. They vary in appearance, 
according to the mode in which the distilla- 
tion has been conducted. Resin is only 
used in medicinal practice, at present, as an 
addition to plasters. It enters into the 
composition of the well-known basilicon 
ointment. 

Refer to Basilicon — Plaster, fyc. 

RESOLUTION. — The term is used in 
medicine to designate that termination of 
the process of inflammation, by which the 
affected part is left without obvious change 
of structure, in other words, is left in the 
same condition as it was previous to be- 
coming inflamed. — See Inflammation. 

RESPIRATION.— Breathing, in its widest 
sense, is the process by which atmospheric 
air is brought into contact with the fluids 
existing in the interior of organized beings, 
whether vegetables or animals. In man, it 
is the function by which atmospheric air is 
introduced or drawn into the lungs or re- 
spiratory organs, and again expelled, after 
its oxygen has been exchanged for the car- 
bonic acid with which the venous blood is 
loaded as it enters the lungs. Thus the 
process of respiration in man comprises, 
first, the act of drawing in the air, or " in- 
spiration ;" and secondly, that of expelling 
the air, or " expiration." As the reader 
will find all requisite information upon this 
vital function under articles Aeration — 
2N 



Blood — Chest — Circulation — Lungb, §c, it ig 
unnecessary to repeat it here. 

RESPIRATORS— Are instruments used to 
protect the air-passages from the direct 
effect of the air, especially when it is cold. 
They are undoubtedly most valuable when 
used with proper discretion. The first in- 
strument, probably, to which the name of 
respirator was applied, was Jeffrey's well- 
known one, constructed upon the principle 
that the warm breath passing out from the 
lungs should impart its heat to a number of 
small, closely-set wires, this heat being 
taken up at the next inspiration by the cold 
air, in its passage through those wires to 
the lungs. Jeffrey's respirators are made 
so as to protect the mouth alone, the nose 
alone, or mouth and nose together. There 
is also a form of hand-respirator, intended 
for temporary use, such as when passing 
from room to room, &c. In many cases of 
chest affection, these instruments furnish a 
means of protection of the highest value, 
particularly for those who, suffering from 
delicacy of the lungs, cannot, by reason of 
their avocations, avoid exposure after night- 
fall, or to cold or foggy air of any kind. 
With warm clothing, and a respirator, an 
invalid may almost defy climate, particularly 
as the instrument not only protects the air- 
passages from the direct influence of the 
cold, but seems to assist in preserving the 
animal heat of the body generally. The nose 
respirator is principally intended to be worn 
during sleep, and enables persons who suffer 
from delicacy of chest, to occupy, during 
winter, bedrooms much more freely venti- 
lated than they could without its assist- 
ance. 

The chief objection urged against many 
respirators is, that they keep the air of 
respiration in too artificial a state of warmth, 
and thus render the wearers peculiarly sus- 
ceptible on the slightest accidental exposure 
— in fact, render them so sensitive of cold as 
to be almost entirely dependent on the in- 
strument for comfort, and health, and even 
for life. Notwithstanding these objections, 
when as full protection as possible from 
cold air is required, Jeffrey's respirator is 
the best instrument, care being taken, of 
course, that it is not unnecessarily had re- 
course to. When a minor degree of pro- 
tection only is required, it may be attained 
by some protective material worn across the 
mouth, which acts upon the same principle 
as the respirator above named. A hand- 
kerchief of silk or of woollen material is at 
once a simple and efficient respiratory pro- 
tector ; and various forms of respirators, 
made of woven materials, may be procured 



RES 



446 



K H E 



at the shops. Some persons find respirators 
of any close material so confining as to 
cause difficulty of breathing. For such 
cases, open-knitted protectors of Shetland 
wool are well adapted. Vails of the same 
material are made, which form an additional 
protection for females. 

Persons who are not very delicate, but 
who yet find it requisite to wear a respira- 
tor, will often find it a relief, when walking, 
to slip the instrument off the mouth when 
they turn away from the wind, or, in very 
sheltered situations, readjusting it when- 
ever they again meet the wind, or pass into 
a more exposed situation. 

REST.— Refer to Sleep. 

REST-HARROW.— This well-known and 
common weed has some repute as a remedy 
in chronic rheumatism, and might safely be 
tried. In the British and Foreign Revieio for 
October, 1840, it was stated, subsequently to 
some other observations, that "It was not in- 
variably successful, but it never did harm, 
and cured many cases that had long resisted 
other means." The form of administration is 
a concentrated decoction of the fresh bark 
with its roots, or of the roots and stems 
dried, and a quart of the decoction must be 
taken daily. Its immediate effect is power- 
fully diuretic. 

RESUSCITATION— The restoration to 
sensibility of persons apparently dead, is 
sufficiently treated of under articles Car- 
bonic Acid or Choke-damp — Cold — Drowning 
— Hanging, fyc. 

RETE-MUCOSUM.— The internal layer 
of the outer or scarf skin. — See Skin-. 

RETINA.* — The retina (fig. cviii. 1) is 
Fig. cviii. 




the expanded sheet of nervous substance de- 
rived from the optic nerve (2) which forms 
the inner coat of the eye. It is the essential 
portion of the visual organ, the mysterious 
link between material appearances and 
mental impressions, without which, or in a 
diseased state of which, all other arrange- 
ments for vision, however perfect, must be 
futile. The eye may seem as lustrous as 



ever, its depths as clear, but if the retina 
or its nerve fail, all is dark, 

" And knowledge from one entrance quite shut out." 

The retina (fig. cix.) does not extend quite 
Fig. cix. 




to the forepart of the interior of the eyeball, 
but only as far as what is called the "ser- 
rated line." (4;) In front of this serrated 
line lie the ciliary foldings (5) of the coloured 
coat of the eye, and more anterior than 
these the " iris," (1,2,) the posterior view of 
which as well as the pupil (3) is represented 
in the drawing. 

Blindness from disease of the retina con- 
stitutes the disease named amaurosis. — See 
Amaurosis. 

In a living, or perfectly fresh eye, the re- 
tina is transparent, but soon after death 
acquires an opacity somewhat resembling 
that of ground glass. The minute structure 
of this portion of a wonderful organ is, in 
itself, most wonderful and complex. 

RHEUMATISM.— Under this well-known 
name are comprehended two forms of dis- 
ease, differing greatly from each other — so 
greatly, indeed, as to be distinguished even 
by the unprofessional. The acute form of 
rheumatism, frequently called "rheumatic 
fever" by medical men, is popularly named 
the "rheumatics," while the chronic form, 
the "chronic rheumatism" of the physician, 
is known to the public as simply "rheu- 
matism," or in vulgar parlance, as "the 
rheumatiz." "Muscular rheumatism" is 
also included under the term rheumatism. 

Acute rheumatism, or rheumatic fever, is 
characterized by symptoms of high inflam- 
matory fever ; there is shivering, great heat 
of skin, followed by profuse sour-smelling 
perspiration ; the pulse is rapid and full ; 
the tongue, covered with a white, creamy- 
looking fur, is red at the tip and margins ; 
there is much thirst, and the appetite is 
deficient. Delirium does not often occur, 
unless the heart becomes involved. Coin- 
cident with the above constitutional symp- 
toms, one or more of the large joints, or 



RHE 



447 



RHE 



some of the tissues in the neighbourhood of 
a joint, become exquisitely tender, swollen, 
and inflamed, the skin over the affected part 
turning red. "Whatever may be the part or 
joint first affected in a case of acute rheu- 
matism, it rarely becomes the fixed seat of 
the disease, -which, before long, almost in- 
variably transfers the site of its manifesta- 
tion to some other joint, leaving the one 
previously affected entirely free, or nearly 
so. This shifting from one place to another 
goes on during the whole period of the dis- 
ease, and, indeed, constitutes its most cha- 
racteristic and well-marked feature. Few 
diseases are accompanied with more pain 
and suffering than acute rheumatism, the 
slighest movement often causing the most 
exquisite torture ; the patient lying in a state 
of helplessness more or less complete, ac- 
cording to the extent of the affection of the 
joints. A disease which, like acute rheu- 
matism, can thus shift its local indications 
from one part of the body to another, must 
evidently be a constitutional one, and there 
can be no question that it is a blood disease ; 
that is, that it is dependent on a morbid 
condition of the blood, or the circulation of 
a poison generated in that fluid. The near 
resemblance in many of their circumstances 
between gout and rheumatism renders it 
probable that a similarity, at least of cause, 
may be expected. In the former disease, 
the blood poison, the "uric acid," not only 
separates itself spontaneously under the 
form of chalk-stones, but it has been sepa- 
rated from the blood itself by Dr. Garrod. 
That a superabundance of peculiar acid, 
probably lactic acid, does exist in the sys- 
tem during an attack of acute rheumatism 
is unquestionable. So long as an attack of 
acute rheumatism confines itself to the j oints, 
and to the parts in their vicinity, it is a 
disease devoid of danger. But, unfortunately, 
in a very considerable proportion of cases, 
there is a tendency of the disease to attack 
some of the "fibrous" structures connected 
with the heart, which resemble those fibrous 
tissues, which, in the neighbourhood of the 
joints, are the common seat of the disease. 
This inflammatory rheumatic affection of 
the heart, included under the term carditis, 
(see Carditis,) having already been suffi- 
ciently entered into, does not require further 
detail here. Suffice it to remark, that it is a 
complication of an attack of rheumatic fever 
which is always to be anxiously watched for, 
and its first appearance treated with the 
utmost activity. It is more liable to occur 
the younger the subject; and, indeed, the 
author has reason to believe, from a case 
which has come under his own notice, that 



where strong hereditary predisposition to 
rheumatic affection exists, the heart in a 
child may become affected rheumatically, 
and the foundation laid of future organic 
and incurable disease, without any of the 
usual joint affection of rheumatic fever 
being mixed up with the first attack, which 
has probably been passed over as a feverish 
cold. Probably, such cases are not common, 
but their possibility should put parents, who 
are aware of hereditary predisposition to 
acute rheumatic disease, upon their guard 
as respects their children. In considering 
the causes of acute rheumatism, the strong 
predisposition that exists in individuals and 
families, hereditarily, is most important ; 
for, in such persons, extra care is always 
requisite : they are liable to become the 
subjects of the disease from contingencies 
which would leave others quite unaffected. 
This circumstance of hereditary predispo- 
sition to acute rheumatic affection ought 
always to be considered by parents in di- 
recting or advising upon the future destina- 
tions of their children, who ought never to 
engage in any occupations which may in- 
volve much exposure to the vicissitudes of 
weather ; for if they do, they almost certainly 
become the victims of rheumatic fever, in- 
volving long and painful present illness, 
and in all probability laying the foundation 
of years of future suffering and of half 
usefulness from heart disease. Indeed, so 
serious are the considerations involved in 
hereditary predisposition to acute rheumatic 
disease, as to make it a question whether 
persons thus predisposed would not find it 
their best plan to leave the changeable and 
often damp climate of Britain, and make their 
home in one, such as that of Australia, free 
from such objections ; provided, of course, 
that after the move, — occupations are not 
engaged in, which involve exposure. The 
question of hereditary predisposition to acute 
rheumatism is one which no life-assurance 
company should overlook. 

Of the direct causes of acute rheumatism, 
there can be no question that cold and damp 
combined are the most usual — out of all 
proportion ; consequently, the poor and ill- 
clad are they who suffer most frequently 
from the disease, although any person ex- 
posed to such influence is liable to be simi- 
larly affected. For the above reason, acute 
rheumatic affections are most prevalent 
during cold, wet weather; they are, how- 
ever, by no means uncommon during the 
prevalence of extreme heat. This circum- 
stance is perhaps traceable to the fact, that 
persons are apt to have the free action of 
the skin, the profuse perspiration, checked 



EHE 



448 



EHE 



by incautious exposure in hot weather. 
Whatever the cause, the disease prevails. 
The author likewise believes he has traced 
attacks of the affection in the predisposed 
to unusual exertion, without any appreciable 
check having been given to the perspira- 
tion. The disease is most generally met 
with between the age of puberty and the 
fortieth year; it is more common among 
males than females. 

The treatment of acute rheumatism is 
not either likely, or desirable, to be trusted 
to unprofessional management, except under 
peculiar circumstances. The long continu- 
ance of the disease, its painful nature, and 
above all the possibility, almost probability, 
of so serious a complication as an affec- 
tion of the heart arising during its progress, 
all combine to render proper medical assist- 
ance from the first highly desirable. 

When an individual who has either suf- 
fered from an attack of acute rheumatism, 
or is hereditarily predisposed to it, or indeed 
when any one, after exposure likely to pro- 
duce an attack, suspects the disease to be 
impending, the first effort should be to ex- 
cite the free action of the skin. If a warm 
or vapour bath can be procured, it is highly 
desirable ; if it cannot, the best substitute 
will be a well-warmed bed with hot bran 
bags, or hot bottles, and the free use of 
warm diluent drinks. A draught composed 
of half an ounce of spirit of mindererus, one 
drachm of paregoric, and fifteen drops of 
ipecacuanha wine, in a wineglassful of wa- 
ter, may be given every four or five hours, 
or a drachm of sweet spirit of nitre may 
be substituted for the mindererus. To the 
above draught, fifteen minims of liquor po- 
tass;©, or ten grains of the bicarbonate of 
potash may be added with advantage. Under 
the above circumstances, any stimulant dia- 
phoretic may be given with benefit, even a 
little gin, or other spirit, or wine, well di- 
luted with hot water; these stimuli being 
used, of course, only at first, and while 
fever is not yet present. 

When an attack of acute rheumatism cha- 
racterized by the symptoms detailed at the 
commencement of this article is unequi- 
vocally established, if medical assistance is 
not immediately procurable, the patient 
must be kept in bed, moderately warm, the 
thirst quenched by the free use of simple 
diluent drinks, and the diet reduced to a 
very low scale, any thing like alcoholic sti- 
muli, or animal preparations, being strictly 
forbidden, except in the case of very debi- 
litated persons, when animal broths, such 
as beef-tea, may be permitted in moderation. 
If fever runs high, tartar emetic, in from 



an eighth to a fourth of a grain dose, may be 
given every four, five, or six hours, and with 
this, from six to ten drops of laudanum may 
be combined, to alleviate the pain. This will, 
however, under the circumstances, be better 
effected by the use of from one grain to two 
grains of solid opium, given at bedtime, 
along with five grains of calomel, the dose 
being followed in the morning by a purga- 
tive, a black draught, or senna alone, or, in a 
strong subject, senna combined with Epsom 
salts. The safest way of managing the 
opium will be to give a grain the first night, 
and if that does not procure sleep, gradually 
to increase the dose. If the mouth becomes 
affected by the calomel, it must of course 
be discontinued. Instead of simple opium, 
Dover's powder, in doses of from ten to 
twenty grains, may be given, likewise com- 
bined with calomel, and followed in the same 
manner by the purgative. The above mea- 
sures might with safety be adopted, under 
peculiar circumstances, in the absence of me- 
dical assistance. There are, however, many 
other modes of treatment — bleeding was 
formerly much employed — it has fallen into 
comparative disuse ; at all events it could 
only be had recourse to legitimately by a 
medical man. The treatment by large doses 
of nitrate of potash, or saltpetre, has had 
its advocates, and may be tried : the mode 
of administration, as laid down by Dr. Ba- 
sham, is to dissolve two ounces of the salt- 
petre in two quarts of water, and to give 
this quantity in the course of the twenty- 
four hours. This treatment, which is said 
to be very successful at times, might be 
available in the absence at least of other 
remedies ; of course, if symptoms indicative 
of irritation of the stomach or bowels came 
on, it would require to be abandoned. More 
recently the treatment of acute rheumatism 
by lemon-juice, as introduced by Dr. Owen 
Rees, has come into practice, and seems in 
many cases to answer extremely well: on 
this point the author can speak favourably 
from his own experience. This treatment 
has the advantage of being perfectly safe, 
and therefore, where the lemon-juice can be 
procured, may, without danger, be pursued 
in the absence of a medical man. One table- 
spoonful, or half an ounce of lemon-juice, is 
to be given every four hours. The "alka- 
line treatment" of acute rheumatism is fol- 
lowed by some, fifteen to thirty grains of bi- 
carbonate of potash being given, well diluted 
in water, every four hours. Most persons 
have heard of colchicum in connection with 
the treatment of rheumatism, and in proper 
hands, properly used, it is at certain times 
most valuable ; but its employment requires 



KHE 



449 



RHE 



too much discrimination to make it safely 
usable, in this disease at least, by unprofes- 
sional persons. Many other modes of treat- 
ing acute rheumatism might be detailed, 
but the foregoing are sufficient; sufficient 
at least as provisional means in the hands 
of an unprofessional person till the case is 
seen by a medical man, which it ought to 
be as quickly as possible. The reader is 
again referred to "Carditis" in connection 
with this article. As regards the local treat- 
ment of the inflamed joints, little is to be 
done in a disease which shifts its site as 
rapidly as acute rheumatism ; for even if it 
can be driven from one joint, it must, as 
long as the poison is in the constitution, 
show itself elsewhere, it may be in the 
heart. Above all things, leeching the joints, 
unless under peculiar circumstances, of 
which a medical man only can judge, is to 
be avoided. Hot bran bags sometimes give 
relief, but probably the following plan, laid 
down by Dr. Bentley Todd, will be the most 
advantageous local method of treatment : — 
When the joints are much swollen and pain- 
ful, much ease may be given by enveloping 
them in a large quantity of the soft carded 
cotton — "cotton wool" — over which there 
is wrapped completely a piece of oiled silk.* 
By this air-tight covering, the joints are 
kept in a perfect vapour bath, and when it 
is removed after twelve or twenty-four 
hours, the wool will be found saturated with 
moisture which is strongly acid. Dr. Todd 
says, this treatment affords great relief, 
supports and keeps the limb steady, and at 
the same time promotes sweating. It is 
also serviceable in gout. 

There are few diseases so tantalizingly 
tedious as acute rheumatism : it may disap- 
pear quickly, possibly in a week, or it may 
extend its visitation, ebbing or flowing, to 
ten, twelve, or fifteen weeks, in spite of 
treatment apparently the best directed; but 
yet, provided the heart, the diaphragm, the 
brain remain unaffected, it is free from dan- 
ger, and, generally speaking, does not leave 
joints which have been severely affected 
worse than they were before. It is very 
rarely the case that matter forms in conse- 
quence of rheumatic inflammation. It has 
been said that there is a rheumatic predis- 
position : not only does this show itself in 
a tendency to attacks of acute rheumatism 
properly so called, but it tends to modify 
any inflammatory action in the body, as 
for instance in the eye, when it gives rise 
to the peculiar "rheumatic inflammation." 
The causes of acute rheumatism already 



* Sheet gutta-percha -will 
2n2 



pointed out will suggest to most persons 
the precautions to be adopted, especially 
when liability to the disease exists. Cold 
and wet are particularly to be guarded 
against, and, after exposure, the preventive 
measures already laid down adopted. Flan- 
nel or woollen, worn next the skin, must 
always be regarded as one of the chief pre- 
ventives ; it should of course be propor- 
tioned in thickness to the season and tem- 
perature. Some persons imagine that their 
liability to rheumatism, either acute or 
chronic, is increased by flannel. If it is, it 
is probably because the wool keeps the skin 
in too excited a state, and, by increasing 
perspiration, increases the risk of suppres- 
sion. In such cases, woven silk, when it can 
be afforded, is useful, or spun cotton may 
be used in winter. Many rheumatic patients 
find their chief protection in an under dress 
of chamois leather. At all events, perfectly 
warm clothing and protection against sup- 
pressed perspiration is essential in all such 
cases. Many of the above precautionary 
measures apply likewise to chronic rheuma- 
tism. Persons of full habit, liable to rheu- 
matic attacks, should eschew malt liquor 
generally, should take animal food sparing- 
ly, and avoid violent exertions which heat 
the body. Persons of spare or feeble habit, 
may live better, and indeed require to keep 
up the condition of the body to as good a 
pitch as possible. 

By chronic rheumatism, in the proper 
sense, should be meant a disease somewhat 
resembling the acute form, accompanied 
with but slight febrile derangement, if there 
is fever at all, and affecting one or more of 
the joints, generally the smaller ones, which 
continue for a greater or less length of time 
swollen and tender, the inflammation either 
subsiding without effect, or, after long con- 
tinuance, causing permanent thickening 
around the joints, probably with permanent 
distortion ; the process being more or less 
accompanied with pain. In this form of 
rheumatism, instead of heat, there is often 
a sensation of cold around the affected parts. 
The chronic nature of this disease must ge- 
nerally place it under proper medical con- 
trol; the chief efforts of the unprofessional 
must be to correct any slight deviations 
from the general health, to protect the 
affected parts especially from cold by means 
of warm clothing, and to use friction, either 
with simple oil, or by means of the soap 
and opium liniment. Much comfort is not ' 
only, derived from friction, but if combined 
with proper exercise of the joint or joints, 
it may do much to prevent permanent de- 
formity. In chronic rheumatism, warmth 



29 



RHE 



450 



EHU 



of climate is of much importance, and as 
much should be done toward the attainment 
of this as circumstances will permit. Sir 
James Clark recommends Nice and Rome 
as the best European climates, but these, 
of course, are the resources only of the 
wealthy. Australia, however, is open to the 
poorer classes. Warm bathing, especially 
the saline bath, such as is furnished by 
Bath or Buxton, or Ashby-de-la-Zouch, [or 
any sea-shore,] is of the highest service in 
cases of chronic rheumatism, and in all 
cases of long standing, should, if possible, 
be had recourse to. The charities connected 
with many of the baths are available to the 
poor. 

Chronic rheumatism, properly so called, 
is such as above described ; but the term 
rheumatism, or rheumatic pain, is also used 
to a great variety of anomalous pains, and 
from this has arisen considerable confusion. 
The best marked of these is "muscular 
rheumatism," which affects chiefly the thick 
muscles, such as those of the shoulders, 
arms, neck, loins, &c. This form of rheu- 
matism often comes on suddenly, after ex- 
posure to a current of cold air — sometimes 
after cold bathing ; its chief characteristic 
is severe pain, when the affected muscles 
are thrown into action. This muscular 
rheumatism seems to be a purely local affec- 
tion, and is generally removable by purely 
local remedies. Of these, the best is a large 
hot bran poultice, or some other means of 
applying heat and moisture, applied over 
the affected part, for eight or twelve hours ; 
this often at once cures — care must of course 
be taken, to protect the part to which the 
heat has been applied by a covering of flan- 
nel. After the hot application is removed, 
if the heat does not entirely cure, and even 
instead of it at times, the soap and opium 
liniment, either alone or combined, with 
one-third turpentine added, may be used 
with advantage ; two or three teaspoonfuls 
being well rubbed into the part every six or 
eight hours. In situations where other means 
are wanting, counter-irritation, by means 
of pieces of metal dipped in boiling water, 
and applied to the skin, or by means of Dr. 
Corrigan's hammer, (see Counter- Irritation, ) 
may be resorted to. In rheumatism of the 
thick muscles about the shoulder, the use 
of the acupuncture needles often removes 
the affection in a strikingly rapid manner — 
indeed, sometimes in a few minutes. 

Any notice of rheumatism at the present 
day must be imperfect, without some allu- 
sion to electric and galvanic agencies, gal- 
vanic rings, electric chains, &c. That these 
appliances are at times of apparent service 



in cases of chronic rheumatism is undoubted, 
and if such is the case, we are not justified 
in rejecting their aid because we cannot 
exactly explain the why and wherefore of 
their action. The effect of the acupuncture 
needles, above alluded to, in curing mus- 
cular, and also nervous rheumatism, such as 
sciatica, is sometimes almost magical; but, 
how the simple introduction of a needle into 
the substance of the body acts so as almost 
instantaneously to remove a most painful 
affection, it is very difficult to say. In using 
electric or galvanic appliances for the use 
of chronic rheumatism, those apparently 
which keep up a slight but continued elec- 
tric excitement, are most useful. The electric 
chains of Pulvermacher seem well adapted 
for this purpose. 

Refer to Acupuncture — Carditis — Gout, §c. 

RHUBARB, MEDICINAL — Rhubakb 
Root. — Well known as this valuable medi- 
cine is, there is yet considerable uncertainty 
respecting which of the many recognised 
species of rheum, or rhubarb, yields the true 
medicinal drug. A species known as the 
Rheum palmatum, is considered to be the 
most likely source of the best rhubarb, but 
it is not improbable, that other species of 
the genus rheum yield much of the rhu- 
barb root imported from the East ; and it is 
certain that different species of rhubarb are 
cultivated in this country, and on the con- 
tinent, both for adulterating the genuine 
article, when in the form of powder, and for 
simulating it in substance, being "dressed 
up" in a manner similar to the real root. 
Dr. Royle says, " The greater part of the 
rhubarb of commerce grows in Chinese 
Tartary, and is gathered in summer from 
plants six years old. When dug up, it is 
cleansed, peeled, cut into pieces, bored 
through the centre, strung on a string, and 
dried in the sun." A portion of this rhu- 
barb goes to China, the remainder passes 
through Russia, and is known in this coun- 
try as Russian or Turkey rhubarb. When 
genuine, this rhubarb is always a superior 
drug, chiefly on account of the care be- 
stowed upon the examination of the sam- 
ples, before they pass the Russian factory, 
through which they are transferred to the 
European markets. At this factory the 
inferior samples of the root are, or ought 
to be rejected. Russian or Turkey rhubarb 
" varies in shape, being irregularly roundish 
and angular, from the bark having been 
shaved off with a knife; some pieces are 
cylindrical, a few flattish, many of them 
pierced with holes. Externally smooth, of 
a yellow colour ; internally, the texture is 
rather dense; fracture uneven, irregularly 



RHU 



451 



RIB 



marked with white and red veins, having 
a strong and peculiar slightly aromatic 
odour, a bitter, rather astringent taste, feels 
gritty when chewed, and produces a powder 
of a bright yellow colour."* The grittiness 
is owing to the presence of numerous crys- 
tals of oxalate of lime, that salt being found 
in the rhubarbs generally. Chinese, or East 
Indian rhubarb, is probably derived from 
the same source as the Russian, which it 
resembles in essentials, although less uni- 
formly good. English rhubarb is cultivated 
chiefly near Banbury, in Oxfordshire. " It 
it is the kind frequently sold by men dressed 
up as Turks, as genuine Turkey rhubarb. 
The pieces vary in shape, some being ovoid, 
others cylindrical, smoothed externally, and 
rubbed with a yellow powder, light, rather 
spongy, with a reddish hue. It is rather 
mucilaginous in taste, and a little astrin- 
gent. Its odour is feeble, but unpleasant." 
Few medicines are more extensively used 
than rhubarb — few are more valuable or 
safer. The most characteristic action of 
rhubarb is that of a mild, but effectual 
aperient, the action depending upon the 
amount of the dose ; it rarely gi'ipes ; it 
exerts, moreover, a beneficial tonic action 
upon the stomach. On account of its astrin- 
gency, rhubarb is apt to leave a tendency 
to constipation, after its purgative effect is 
over. 

Rhubarb may be taken alone, as an ape- 
rient, in closes of from ten to thirty grains, 
either simply mingled with water, or made 
into pills. Some persons habitually carry 
a piece of the root in their pockets, and cut 
off small fragments as they think them re- 
quired. Infusion of rhubarb is made, ac- 
cording to the London Pharmacopoeia, by 
infusing for two hours three drachms of 
the sliced root in a pint of boiling water. 
The preparation is too weak for an efficient 
aperient, but may be used as a stomachic. 

The compound rhubarb pill, one of the 
best forms of common aperient we possess, 
has been already considered. — See Pills. 

The compound rhubarb powder is better 
known as Gregory's Powder, or Gregory's 
Mixture. — See Gregory'' s Powder. The tinc- 
ture or compound tincture of rhubarb is an 
extensively used and most valuable remedy, 
chiefly as a stomachic cordial and anti- 
spasmodic. It ought rarely to be given as 
an aperient, on account of the large amount 
of spirit which must necessarily be taken 
with it in this form by most persons ; a 
few individuals, however, of weak habits, 
whose bowels are very easily acted upon, 

* Royle's Materia Medica. 



find it beneficial, not only for its aperient 
action, but for its subsequent tonic and 
astringent powers. When increased action 
is required in such cases, the tincture of 
rhubarb and aloes is a useful preparation. 
To make the " tincture of rhubarb :" — Take 
of rhubarb, sliced, two ounces and a half — 
saffron, three drachms — liquorice root, 
bruised, six drachms — ginger, bruised, six 
drachms — proof spirit, two pints — macerate 
for a week and strain. 

For infants and children, rhubarb alone, 
or combined with calomel or gray powder 
when requisite, forms a most excellent me- 
dicine : the chief objections are the bulk 
and taste, which render it sometimes diffi- 
cult to administer. It should be remem- 
bered, that in persons who are taking rhu- 
barb, the urine acquires a deeper colour 
from the drug. Rhubarb is sometimes 
thought to be injurious to persons who suf- 
fer from head affections, such as a tendency 
to apoplexy, or epilepsy. The fact is not 
confirmed. 

RHUBARB, GARDEN— Is too well known 
in its numerous varieties to require descrip- 
tion : its agreeable acid depends on the pre- 
sence of the oxalic and malic acids, which 
it contains abundantly. As a cooling ar- 
ticle of diet, it is wholesome for most per- 
sons; but some cannot take it without suf- 
fering after from stomach disorder, and 
others, who have any tendency to certain 
urinary disorders, must most strictly avoid 
it ; indeed, if garden rhubarb is too freely 
indulged in, it may give rise to urinary 
irritation. 

When used as food, garden rhubarb ex- 
erts an aperient action upon the bowels. 
This is increased, if shortly after it has been 
eaten a moderate dose of magnesia be swal- 
lowed. 

Refer to Oxalic Acid. 

RIBS. — The ribs are the curved bones 
which enclose the chest (fig. ex.) and upper 
part of the abdomen. They are twelve in 
number on each side. Of these the first 
seven on each side (fig. ex. 1, to 7) are di- 
rectly connected with the breast-bone or 
"sternum," (fig. ex. 13,) and are called the 
true ribs : the remaining five are called the 
false ribs — of these the upper three are in- 
directly connected with the breast-bone, by 
means of cartilages attached to the carti- 
lage of the last two ribs ; the lowest two 
(fig. ex. 11, 12) are unconnected with the 
breast-bone, or other ribs in front, and are 
therefore called floating ribs. The "car- 
tilages" (fig. ex. 14, 14) by which the seven 
superior ribs are connected with the breast 
bone, and by which the three upper false 



KIB 



452 



RIG 



Fig. ex. 




ribs are connected with the cartilage of the 
last true rib, are very elastic in early life. 
As, however, age advances, they become less 
so, and ultimately are converted into bone. 
The posterior extremity, or head of the rib, 
is attached to the spine (fig. cxi.) by means 

Fig. cxi. 




of ligaments (fig. cxi. 1) which admit of a 
certain amount of movement. These liga- 
ments are so strong as completely to resist 
displacement of the bone by violence — frac- 
ture, generally about the angle, taking place 
instead. — See Fractures. The ribs are like- 
wise attached in front to the breast-bone, 
by means of ligaments, and are connected 
to each other by short ''intercostal" mus- 



cles, which act in the efforts both of inspira- 
tion and of expiration. 

RICE. — This well-known grain, although 
far below most others of the class in actual 
nutritive power — not yielding more than 3 
or 4 per cent, of plastic nutriment — forms 
the staple article of food to millions, in 
warm climates, especially in Asia, and is 
largely used as an occasional article of diet 
in this country, [and in many districts of the 
United States.] Its chief constituent is 
starch, of which it contains 80 per cent., 
and when it is cooked in water, it absorbs 
that fluid so largely, as to swell to many 
times its bulk in the dry state. It is un- 
questionable that rice is well adapted as 
food to the inhabitants of those warm cli- 
mates in which it flourishes so luxuriantly, 
and that its unstimulating nourishment 
must be conducive to health, while at the 
same time its blandness to the palate and sto- 
mach can be corrected by the aromatic con- 
diments which usually grow under the same 
climate as that which brings the grain to 
perfection. In climates like that of Eng- 
land, rice, probably, could not form a staple 
article of food; but as an addition to other 
food, it is of the highest value, and espe- 
cially to the food of the young, in the form 
of puddings, &c, care being taken that the 
grain is thoroughly cooked, a point not always 
attended to. Nothing can be more indigest- 
ible than half-cooked rice. In puddings 
and the like, this is less likely to occur 
than when the grain is dressed as a vege- 
table, and required to present the distinct- 
ness of grain. 

The property of rice, in tending to con- 
fine the bowels, renders it a valuable adjunct 
to sick-cookery, when such an effect is re- 
quired. In this case it is most beneficial in 
the form of "ground rice," or of rice flour. 
In cases of diarrhoea, or of irritability of 
the stomach or bowels, rice-water, that is, 
water prepared from rice, as barley-water 
is from barley, is very useful as a drink. It 
may be flavoured with lemon-peel, or any 
other condiment. If the case is a severe 
one, the solution of a teaspoonful of isin- 
glass or gelatine in every pint of the " wa- 
ter," is a useful addition. 

Arrack, a spirit used by the Orientals, is 
made from rice. 

Refer to Grains. 

RICKETS — Is a disease in which the 
bones lose their earthy constituents, and 
consequently their natural hardness, becom- 
ing soft like gristle, and somewhat brittle, so 
that they are not only easily bent, but easily 
broken. The term rickets is usually ap- 
plied to this softening, when it occurs in 



EIC 



453 



BIN 



childhood, but a similar disease also attacks 
adults, especially females. Rickets is a 
constitutional disease, and is very generally 
associated with a tendency to scrofula, 
either hereditary, or engendered by poor 
living and unhealthy influences, such as de- 
ficient ventilation and light, impure damp 
air, and bad food. Rickets may show itself 
within the first few months after birth, but 
is more generally perceived when the child 
first attempts to walk, and the limbs give 
way under the weight of the body. Coinci- 
dent with, or rather preceding the evidence 
of weakness in the bones, the child's gene- 
ral health is observably impaired ; there is 
languor and pallor, with dingy complexion, 
loss of flesh, tumidity of the belly, impaired 
or fickle appetite, and unhealthy secretion 
from the bowels. In fact, the child pre- 
sents the evidences of progressive scrofulous 
disease. Not unfrequently there is an ap- 
proach to the cretin head and features. — 
See Cretin. It need scarcely be said, that 
a child, showing the symptoms above 'de- 
tailed, cannot too soon be placed under pro- 
per medical attendance, for life and future 
well-being are at stake. Every means for 
improving the constitution will be requisite. 
If the situation is an unhealthy one, re- 
moval, if possible, should be effected. If 
the child is still at the breast, unless there 
is positive evidence that the milk is of good 
quality, it should be weaned. Animal broths 
will probably be required even for infants — 
certainly, along with animal food, for older 
children. Clothing will require attention 
as regards its warmth, and tonic and other 
medicines, especially iron, must be requi- 
site. For a child of a year old, powders, 
containing half a grain of gray powder, and 
three grains of carbonate of iron in each, 
are a very useful remedy, given twice a day 
for some time. The above are only general 
directions, for such a disease as rickets 
ought always to be under proper medical 
care. In the later stages, when the bones 
are very soft, much care will be required in 
moving, to avoid inflicting either pain or in- 
jury. Very many children who become 
rickety, die, but a certain number recover, 
and though perhaps with distorted limbs, 
yet become robust in health, the bones be- 
coming quite firm and strong, even more so 
than those of other persons. 

Many children, without becoming the 
subjects of confirmed rickets, yet exhibit 
the tendency in an enlarged state of the 
extremities of the long bones, especially 
those of the forearm, at the wrist. Such 
an indication ought never to be neglected : 
every possible means, by change of air, by 



diet, clothing, and medicine, should be used 
to improve the child's general health. The 
powders above recommended will be useful, 
or five drops of the tincture of muriate of 
iron may be given twice a day in water, the 
bowels being regulated by simple aperients, 
and an occasional dose of gray powder. To 
resume, it must be borne in mind that 
rickets is a disease of debility, and of an 
enfeebled constitution, which every means 
must be used to counteract. The deficiency ( 
of earthy matter in the bones, naturally' 
suggests the use of lime, which may be 
given in the form of lime-water, along with 
milk. The use of salt by the affected 
children should be insisted on. 

Rickets or softening of the bones in 
adults, occurs, as might be expected, in the 
debilitated, and in those of depraved consti- 
tution. It is most common in females, and 
the pregnant state seems to favour its esta- 
blishment and progress. It has also been 
thought to be dependent on the gouty and 
rheumatic constitution. The disease is often 
preceded by severe pains in the limbs and 
bones, which are apt to be considered as 
rheumatic. 

As in the case of children, rickets or bone- 
softening in adults requires every means to 
be used for invigorating the constitution, 
but the proper remedies, and their applica- 
tion, must be regulated by a medical man. 
When a female has at any period of life been 
the subject of rickets, the fact may seriously 
affect the capability of her becoming a mo- 
ther, either with safety to her own life or 
that of her child. For as the bones of the 
pelvis (see Pelvis) partake of the general 
softening, and yield under pressure, the exit 
of the child into the world may be rendered 
impossible, or nearly so. The fact should 
not be lost sight of. Refer to Scrofula, §c. 

RIGOR — Is the sudden sensation of cold 
accompanied with shaking, or, in other 
words, the "shivering" which precedes the 
inflammatory stage of many acute diseases. 
It is probably a nervous affection, for it 
occurs likewise in many states of the body 
in which there is neither fever nor inflam- 
mation. It is a common symptom of the 
presence of bile on the stomach. It is a 
concomitant on the passage of gall-stone or 
of gravel.. It often occurs at the commence- 
ment of labour, and may even be caused in 
a slight degree by certain sounds. — See 
Shivering. 

RING-FIXED.— See Finger. 

RINGWORM.— The real nature of this 
very troublesome affection of the skin has 
been the subject of much dispute. By 
some it has been classed as essentially a 



RIN 



454 



EOS 



"pustular" disease, but the probably cor- 
rect view is that which regards it as an af- 
fection of the hair, and of the hair follicles, 
and that when pustules do arise, they are 
the product of continued irritation. The 
most usual site of the disease is the scalp, 
but it is apt to appear on, or to extend to 
the forehead, the neck, the arms, and hands. 
Generally, the first indications of the pre- 
sence of ringworm are the falling or break- 
ing off of the hair, which leaves a bald (gene- 
rally circular) patch, and the itching which 
accompanies the disorder. If examined at 
this time, the patch will be found scurfy, 
slightly red, with the irregularly broken 
hairs protruding. If the disease be un- 
checked by treatment, it goes on extending, 
until at last it involves almost the entire 
scalp. The hair, which is not detached, on 
the affected parts, becomes lighter in colour, 
and woolly in character. If pustules form, 
the discharge from them dries upon the 
surface in the form of scurfy scabs, or in 
crusts. That the disease is highly conta- 
gious there can be no question. It is fre- 
quently, too, extended to different portions of 
the same head, by combs, brushes, &c, or 
by the nails, which children are apt to use 
freely on account of the itching. 

Few diseases give more trouble or vexa- 
tion in the management than ringworm, for 
it often resists for months the best directed 
treatment, and that which succeeds admi- 
rably in one case often fails to make any 
impression in another. Frequently, power- 
ful stimulant applications are too soon had 
recourse to when soothing measures, poul- 
tices, &c, would be more serviceable in 
allaying irritation. The safest treatment is 
to employ soothing means in the first place, 
and gradually to have recourse to stimu- 
lants. To enumerate the various applica- 
tions which have been used with varying 
success in ringworm would be a very lengthy 
business. The late Dr. A. T. Thomson 
says, in his work on Diseases of the Skin — 
" The application which I have found most 
beneficial is a solution of one drachm of 
nitrate of silver in half an ounce of dilute 
nitric acid. The diseased circles, after the 
scalp has been shaved, should be pencilled 
over with the solution, and in ten or fifteen 
minutes afterward, the parts should be 
well sponged, first with tepid water, and 
then covered with pledgets of lint dipped 
in cold water, and, the evaporation dimi- 
nished, by covering the wet lint with oiled 
silk. In India, an ointment composed of 
a drachm of powdered nut-galls, a scruple 
of sulphate of copper, and an ounce of simple 
cerate is said to prove most beneficial." 



Mr. Erasmus Wilson, another high autho- 
rity in skin diseases, lays more stress than 
many others on the constitutional treatment 
in this affection. He remarks — " Improper 
food is a frequent predisposing cause, and 
one of the common causes in schools. I 
have seen it in children fed too exclusively 
on a vegetable diet." For these and simi- 
lar reasons he advocates particular atten- 
tion to clothing, ventilation, exercise, and 
to the nutrition, aided by tonic medicines, 
such as iron, bark, and mineral acids. 
With regard to external remedies, after 
irritation has been subdued, the same au- 
thor remarks — " An ointment which I have 
found of great service is one composed of a 
drachm of sulphate of zinc to an ounce of 
simple cerate." Sulphate of zinc in lotion 
may also be used. " It is beneficial to 
wash the head with soap once a day, and 
when dried to anoint it with pomatum : 
keeping the scalp constantly moistened with 
some oleaginous > matter is an important 
adjunct to cure." An application made by 
dissolving a drachm of powdered borax in 
an ounce of vinegar, is said often to prove 
of service. The tarry oil which distils 
from the end of a piece of coarse brown 
paper, when rolled up in the form of a 
match and lighted, is said, if allowed to 
drop upon the diseased patch, to effect a 
cure when other means have failed. When 
ringworm is present the hair should either 
be cut very short or the scalp shaved. An 
oil-silk cap is frequently recommended to be 
worn, but one of linen is preferable, beingless 
heating and exciting to the skin. [Another 
kind of ringworm exists which is more simple, 
and is often cured by domestic treament.] 

ROASTING— Like broiling, is one of the 
most primitive methods of cooking ; in the 
latter process, however, the surface of the 
meat is more quickly hardened, and the 
juices and fat more effectually retained. 
During roasting, the watery portions of the 
meat evaporate, and much fat is melted 
out; at the same time, the coagulation of the 
albumen, the usual result of heat on animal 
food, takes place. The loss of fat in roast- 
ing renders meat thus cooked more diges- 
tible. It retains, moreover, the gelatine, 
which is greatly dissolved out in the pro- 
cess of boiling. If, however, the cooking 
is carried too far — the meat overdone — its 
nutritious properties are impaired. On the 
other hand, if meat is underdone, although 
more nutritious, it is certainly less diges- 
tible. "By enveloping small pieces of 
flesh with a covering of lard, the extraction 
of the sapid constituents from the flesh by 
its juices, and the evaporation of the water, 



ROC 



455 



KUL 



■winch causes hardening are prevented, and 
the surface as well as the subjacent parts 
are kept in the tender state which is other- 
wise only found in the inner portion of 
large masses of flesh. "* 

Refer to Boiling — Broiling, §c. 

ROCHELLE SALT.— Tartrate of soda 
and potash. — See Potash. 

ROLLER. — See Bandages. 

ROOM. — See Bedroom — Houses — Ven- 
tilation, &c. 

ROSE. — An old popular name for erysi- 
pelas. — See Erysipelas. 

ROSE-RASH.— See Skin, Diseases of. 

ROSE PETALS, or Leaves.— The petals 
of the red rose are used in medicine, partly 
on account of the colour they yield ; but 
their most valuable preparation is the con- 
serve made by beating up one part of the 
fresh petals or flower-leaves with three 
parts of refined sugar. The principal ap- 
plication of the conserve is the formation 
of pills, for which it is well adapted, being 
less apt to harden than other materials 
used for this purpose. — See Pills. 

When the petals of the red rose are dried 
for use, the white "claws" at one end 
should be cut off, and the red portion dried 
as quickly as may be, without too great 
heat being used. The petals should then 
be sifted to remove dust, &c, and packed 
in vessels closed against light and air. 
" Dried rose-leaves" are used in the form 
of infusion, which may be made with three 
or four drachms of the leaves to a pint of 
boiling water. The infusion is slightly 
astringent, but its colour especially, com- 
bined as it usually is with diluted sulphuric 
or other mineral acid, is its chief recom- 
mendation. 

ROSEMARY — Is chiefly used on account 
of its fragrant volatile oil, which is stimu- 
lant and anti-spasmodic. The oil may be 
added to liniments as a fragrant stimulant 
addition to these applications. A spirit of 
rosemary is made which may be used as an 
anti-spasmodic, in doses of thirty drops, in 
water or on sugar. 

RUBEFACIENT.— An application which 
reddens the skin. According to this defini- 
tion, a great variety of agencies must be 
included in the class. When the irritant 
effect of any agent upon the skin amounts 
to blistering, or causes discharges of pus 
or matter, the action is* said to be vesicant 
or suppurative. All these agencies, there- 
fore, are included under the one term, 
counter-irritants, the rubefacient action 
being the mildest of the three, and de- 



Liebig's Chemistry of Food. 



pendent, generally, upon the form and dura- 
tion of the application ; as, for instance, 
heat, mustard, ammonia, or other excitant 
agents, may be used so as to produce only 
the most transient redness, or may be made 
to cause either blistering or suppuration. 
The most commonly used rubefacients are — 

Ammonia, or hartshorn. 

Friction. 

Heat. 

Mustard. 

Spirit of wine. 

Turpentine, &c. &c. 
Refer to Counter -Irritation. 
RUE. — The Ruta graveolens. This plant 
is too well known to require description. 
It is valuable, and much used in domestic 
practice, on account of its powerfully stimu- 
lating volatile oil, w T hich is strongly anti- 
spasmodic. Medical men certainly too much 
neglect r,ue as a medicinal agent. In accu- 
mulations of flatulence in the bowels, " tym- 
panitis," a strong infusion of rue, given as 
an injection, is often of the highest service, 
and second only to assafoetida : in worms — 
the thread worm — in the lower bowels, the 
infusion of rue, also used in injection, is 
serviceable. In suppressed menstruation, 
when stimulants are required, (see Menstru- 
ation,) the rue clyster may prove of much 
use. Rue is abused, when given as it fre- 
quently is, by nurses to new-born infants. 

RULE, LIVING BY.— There are few de- 
partments of practical medicine which have 
been carried out to a more mischievous 
extent of refinement than that which is 
noticed in this article. Mischievous, be- 
cause an important principle has been over- 
looked in the prescription or following out 
of petty detail. That principle is, that 
there is nothing more likely either to create 
or to keep up disorder in any of the organs 
of the body which usually act independently 
of the will than the continued and especial- 
ly anxious attention directed to them while 
in active operation. It is unquestionable 
that in some diseases, such as diabetes, 
dysentery, &c, the strictest regulation of 
diet and regimen is absolutely necessary; 
neither can it be doubted that in most ail- 
ments, even in those of a trivial character, 
some general regulations as to living are 
required: it is not against such as these 
that these remarks are directed, but against 
the absurd "living by rule," the worse than 
useless clockwork regulation of every action 
of daily life, eating, sleeping, walking, &c, 
which many dyspeptic and hypochondriac 
patients either adopt for themselves or are 
advised into. * In such cases, instead of a 
wholesome varied diet, the nature of the 



RUM 



456 



RUP 



food is confined within an unwholesomely 
narrow compass, and its amount, if not 
weighed physically, is at least so mentally, 
by the trammelled invalid, who trembles 
lest, inadvertently, half an ounce more than 
the prescribed quantity should find its way 
into his stomach ; and then, after his meal, 
disturbs the digestive process by thinking 
how it is going on, and, by directing his at- 
tention to the sensations of his stomach, 
which is petted and considered, and allowed 
to choose its own work and mode of work- 
ing, till, of itself, it nauseates the uniformity 
of too regulated a diet, and sours even 
to the tenderest of mutton, and the most 
unexceptionable brown bread. At last, 
forcing its miserable possessor to the con- 
clusion that he is yet over-taxing its powers, 
the animal diet is perhaps eschewed, and 
farinaceous foods of different kinds are re- 
sorted to as more digestible by the " very 
weak stomach." As already remarked, 
rules of life, and stringent ones too, must 
often be laid down by medical men for per- 
sons labouring under serious disease — nor 
can they be too strictly attended to; but 
these cases are abundantly different from 
that numerous class of nervous and dys- 
peptic complaints which are fostered by 
the too close attention to health, by the 
"living by rule," the weighing and mea- 
suring and considering every morsel of 
food, and every action of the body or mind. 
As said under article "Indigestion," the sto- 
mach, and other organs too, must, in part 
at least, be brought up to their work by 
observation of the rules of health generally; 
the endeavour to bring the work down to 
the organs is worse than useless. 

Refer to Indigestion. 

RUM. — This well-known spirit is distilled 
from the products of the sugar-cane ; when 
genuine it contains about 53 per cent, of 
alcohol. New rum is apt to contain lead, 
dissolved off the leaden worm of the still 
in which it is made. When this is the case, 
the rum of course is unwholesome, and 
may give rise to symptoms of colic ; but 
after the liquor has been permitted to stand 
some time in casks of oak wood, it becomes 
freed from the lead, which forms an inso- 
luble compound with the tannin of the oak, 
and falls to the bottom. Rum is a favourite 
domestic remedy in cases of incipient cold. 
It possesses, probably, no advantage over 
other stimulants, and in such cases, the use 
of an alcoholic stimulant at all may do harm. 

Refer to Colic — Lead, $-c. 

RUPTURE— By medical men called Her- 
nia, is the protrusion of some portion of 
the bowels, or of the viscera usually con- 



tained within the abdomen, through any 
part of the " walls" of that cavity. Unless 
the skin is wounded from without, the 
rupture remains covered by it, and by cer- 
tain tissues which lie beneath it at the 
points where the accident usually occurs, 
these points being at those portions of the 
walls which are naturally thinner and 
weaker than others, or at which there are 
openings, naturally, for the passage of 
blood-vessels, &c. 

The existence of rupture is always a 
serious matter, and on the first suspicion of 
it, medical advice should at once be sought ; 
it is, moreover, an accident much more 
common than is generally imagined. It 
has been calculated that ten per cent, of 
the population in England are the subjects 
of rupture. 

It is sufficient here to notice the three 
principal kinds of rupture : of these, one 
occurs at the navel, two in the groin. Rup- 
ture at the navel is a very common accident 
soon after birth; its nature and manage- 
ment have been fully entered into in article 
" Children." When it occurs in adults, it 
is not unfrequently the result of neglect in 
early life, but it may be of recent origin : 
in females it may be the result of pregnancy 
and child-bearing. Rupture at or near the 
navel is known by the presence of an elastic 
or doughy swelling, which is usually capa- 
ble of being "reduced,' 1 pressed back into 
the cavity of the abdomen. When this 
form of rupture is discovered to exist, a 
truss should be applied without delay, under 
the direction of a medical man. The essen- 
tial part of the truss is a pad made to fit 
over the site of the protrusion, this pad 
being kept in place by different contrivances 
of springs, or of elastic belts, &c. — Fig. cxii. 

Fig. cxii. 




represents " Salmon and Ody's" truss for 
the purpose — 1 being the pad which is fit- 
ted over the rupture ; — 2 a pad which is 
applied to the spine ; — 3 the steel spring ; 



RUP 



457 



RUP 



— and 4 the strap which helps to fix the 
apparatus. The pads are made of various 
materials, sometimes of ivory, sometimes 
of padded materials, and also of caoutchouc 
bags inflated with air, &c. [The variety 
of trusses in the United States is very great, 
Hull's, Chase's, &c. being the more com- 
monly resorted to ; but as there is much 
quackery often connected with the popular 
treatment of hernia, the sufferers should be 
cautious whom they consult.] 

Rupture in the groin in adults is of two 
kinds ; in one, the swelling first appears 
above the fold of the groin — in the other, 
below it. The former is most common in 
males, the latter in females. ' The affection 
is, however, much more common amid the 
former sex, the calculation being, that four 
men are the subject of hernia for one female. 
Rupture in the groin also occurs in infants 
— -it is "congenital." 

It is found that rupture prevails most 
among those whose occupations involve 
strong muscular efforts. Rupture may 
come on gradually, or suddenly during some 
violent exertion. "When its formation is 
gradual, it is preceded by some amount of 
pain and fulness in the part; at last, or 
when its invasion is sudden, a decided 
swelling generally shows itself more or less 
painful, varying in size, and elastic or 
somewhat doughy under the pressure of 
the fingers ; the swelling becoming tense 
and larger, and as it were pushed forward, 
when the person coughs or sneezes, and 
usually disappearing during lying down in 
sleep. It is proper, however, to caution 
our readers against the supposition that 
rupture must always be accompanied with 
swelling. Sometimes the tact of the expe- 
rienced surgeon is insufficient satisfactorily 
to detect the tumour, especially in stout 
people, and he is forced to base his treat- 
ment upon the general symptoms, when that 
accident which constitutes the danger of 
rupture occurs, that is, when rupture be- 
comes " strangulated," or assumes such a 
condition that it cannot be returned into 
the abdomen, and is so tightly grasped at 
its " neck," by the sides of the ring or 
opening through which it is protruded, 
that the natural functions of the part are 
interfered with. A rupture may assume 
this condition at any moment if it be per- 
mitted, for want of a truss, to continue 
" down," as it is usually called, that is, in a 
protruded state. When a rupture becomes 
strangulated, distressing symptoms very 
quickly follow ; all motion of the bowels 
downward is prevented, and, their natural 
movements becoming inverted, their fecu- 
20 



lent contents pass upward into the stomach 
and are rejected by vomiting; at the same 
time there is severe pain, especially of a 
dragging character, from the back; and there 
is thirst and depression of the bodily powers. 
If the above state of matters be not speedily 
rectified, either by the return of the bowel 
into the abdomen, or by a cutting operation, 
the person speedily dies, generally in con- 
sequence of the protruded portion of bowel 
becoming mortified. 

It is needless to remark that, upon the 
first symptoms of strangulated rupture 
showing themselves, efficient medical advice 
should at once be sought. Every minute is 
precious. Until medical assistance arrives, 
however, some methods of relief may safely 
be tried. 

When a surgeon first sees a case of stran- 
gulated "hernia," or rupture, if it has not 
been of so long continuance that he sus- 
pects the possibility of the bowel having 
become tender and liable to be burst, he 
makes an effort to return the protruded 
bowel ; this effort, conducted in a peculiar 
manner, is technically named the " taxis" — 
it is in fact skilful manipulation. The first 
step in the exertion of the taxis is to place 
the individual in the position most favour- 
able to the return of the bowel : this posi- 
tion is the horizontal one, with the shoulders 
half raised, and the legs and thighs bent 
upon the body, so as to relax as much as 
possible the walls of the abdomen, and the 
rings through which the rupture passes, 
and by which it is so tightly constricted. 
The above position having been assumed, 
the neck of the rupture, that is to say, the 
portion of it next the opening from which 
it protrudes, is to be compressed by the fin- 
gers of the left hand with moderate firm- 
ness, while the right hand is used as gently 
as consistent with the requisite effort to 
knead or mould, as it were, the protruded 
bowel through the opening. At first, this 
process perhaps, seems to have little, if any 
effect, but if the rupture is returnable at all 
in this way, and if the taxis is properly made, 
after a time a perceptible diminution of 
the swelling takes place, which goes on till 
at last the rupture passes suddenly as it 
were back into the abdomen — frequently 
with a gurgling sound. 

Such is the process of reducing a rupture 
by means of the taxis : it is one which, to 
perform well, requires both skill and prac- 
tice ; but it is one which may be safely tried 
for a short period by an unprofessional per- 
son, if medical aid is far distant in point of 
time. Indeed it is a process which persons 
who have suffered from rupture for some 



RUP 



458 



RUP 



time not unfrequently perform for them- 
selves. In a case of strangulated rupture, 
if medical assistance is quickly procurable, 
the best course is, with the exception of 
laying a person in the horizontal position, 
and the administration of twenty or thirty 
drops of laudanum, to leave the case en- 
tirely alone, and to avoid handling the 
swelling ; for this only places it in a more 
unfavourable condition for the manipula- 
tions of the surgeon. When, however, as 
said before, medical aid is far distant, the 
taxis may be tried, but must not be con- 
tinued for more than twenty minutes or 
half an hour. In almost all cases, eiforts 
are made by the patient, or by the persons 
around, to return the rupture ; it is better 
that these should be made in an intelligent 
and efficient manner. If, by the taxis 
simply, the surgeon does not succeed in 
" reducing" a " strangulated hernia," he 
probably has recourse to other methods 
with a view of assisting it. These methods 
are such as either assist the relaxation of 
the muscular parts around the rupture, or 
such as tend to diminish the size of the 
swelling. To effect relaxation, the surgeon 
may bleed, may give nauseating medicines, 
may administer chloroform or opium, or 
put his patient in a warm bath till faintness 
comes on, when he again has recourse to 
the taxis. Many of the means had recourse 
to by a medical man, are of course quite 
inadmissible for the unprofessional ; the 
two last-mentioned, however, they may use 
carefully. Opium given so as to affect the 
system will sometimes greatly facilitate the 
reduction of an hernia; for this purpose 
twenty drops of laudanum, or one grain of 
solid opium may be given to an adult, the 
former every hour, the latter every hour and 
a half, till three doses have been administer- 
ed, taking care, of course, after the second 
dose, that the system does not seem too 
powerfully affected. The warm bath will 
generally produce faintness in less than 
half an hour. During the condition an at- 
tempt should be made to return the rup- 
ture ; some surgeons, however, object to 
the use of the warm bath. 

The chief means of facilitating the return 
of a rupture, by reducing the swelling, is 
the application of cold. For this, the best 
agent is snow, or pounded ice, put in a 
bladder, which is laid upon the swelling. 
If snow or ice are unavailable, cold may be 
artificially produced,' by mingling five parts 
of muriatic acid with eight parts of glauber 
salt in powder, or by mixing two parts of 
Oil of vitriol with two parts of water, al- 
lowing the mixture to cool, and then min- 



gling with five parts of glauber salt, or by 
mixing equal parts of muriate of ammonia 
and nitre (saltpetre) in water. Cold may 
likewise be produced by the continued eva- 
poration of ether dropped upon a piece of 
lint laid over the swelling, or the cold 
douche may be used with advantage. Under 
the continued application of cold for from 
half an hour to an hour and a half, a rup- 
ture may possibly " pass up," without any 
manipulation at all: if it does not, however, 
manipulation should be tried. 

Such are the principal means which may 
be resorted to by unprofessional persons, in 
the event of a case of strangulated rupture 
occurring at a distance from medical aid. 
They are pointed out, not to induce any one 
to hazard one moment's delay in procuring 
proper assistance, but as a resource, when 
that assistance is far distant, and when 
the suffering and danger of this serious 
affection render it advisable not to wait 
entirely its arrival. In a case such as 
might occur, when a surgeon could not be 
procured for many hours, it might be some 
days, the author thinks the treatment by 
opium most calculated to relieve : it is, at 
least, the most likely to afford comfort to 
the patient under so fearful a contingency. 
If the stomach will not retain opium given 
by the mouth, it can of course be admi- 
nistered in clysters. 

It sometimes occurs that purgative medi- 
cines are administered in cases of rupture. 
This should never be done. They may 
greatly increase the distress of the patient, 
and they afford very little chance of relief. 
Neither can any good, but only harm, result 
from frequent efforts to return the rupture 
by manipulation after the first well-directed 
efforts have failed — neither is it well to be 
too hasty in giving purgative medicines 
after a rupture which has been strangulated 
is reduced. Very frequently the bowels act 
of themselves soon after ; if they do not in 
the course of a few hours, a clyster, or a 
gentle dose of castor-oil, or of rhubarb and 
magnesia, will be the most suitable aperients. 
The fact must be kept in mind, that after 
the existence of strangulated rupture, there 
is always danger of inflammation of the 
bowels generally, and that, consequently, 
perfect quiet, and low diet for several days, 
is requisite. 

As soon as, from the symptoms as detailed 
in the first part of this article, any one 
suspects he is ruptured, however little incon- 
venience he may suffer, not a day should elapse 
without medical advice being sent for. Till 
this is obtained, quiet in bed is the safest 
plan. Many a rupture has been strangu- 



RUP 



459 



RUP 



lated in a long walk to the doctor. The same 
rules should be observed after the reduction 
of a rupture which has been strangulated. 
Every minute in the upright posture, passed 
without the protection of a truss, is one of 
peril. If there is any necessary delay be- 
fore a proper truss can be procured, a pad 
composed of cloth, wrapped round some 
firm material, and held in its place by a 
spica bandange, (fig. xvii., art. Bandage, ) will 
be of some service during the confinement 
to bed. The selection of a truss is always 
better left to the judgment of a medical 
attendant. Where price is an object, the 
old form of truss (fig. cxiii.) may be used : 

Fig. cxiii. 




it answers extremely well. In some cases, 
however, a Salmon and Ody's truss, some- 
what similar to fig. cxii., but modified to fit 
the groin, is found more useful. The pecu- 
liar feature of this truss is that the circular 
or oval pad is attached to the spring by a 
ball and socket joint. In some persons, 
owing to flatness of the back, it is difficult, 
almost impossible, to make a spring truss 
fit at all. For such and other difficult cases, 
the spiral supporters of M. Bourjeaurd 
(fig. cxiv.) may probably be found of- use. 
There are many advantages connected with 
this elastic form of truss, particularly the 
extended support which it gives to the walls 
of the abdomen, at those parts where they 
are weakest and most apt to give way. 
This, it need scarce be observed, the simple 
steel springs cannot do. The use of air 
pads is an additional comfort. In the case 
of labouring men, and others, who perspire 
much, the springs of the steel trusses are 
constantly breaking, in consequence of the 
corrosion caused by the sweat. The author 
has suggested covering the springs with 
sheet gutta-percha as a preventive. In a 
few cases, it is necessary to wear a truss 
even during the night, for some time at 
least, but generally it may be dispensed 
with during the horizontal posture, being 



Fig. cxiv. 




put on before getting out of bed. It is im- 
portant that a truss fit well — otherwise it is 
of little actual service, and is apt to cause 
excoriations, &c. It is also requisite that 
the strength of the spring be proportioned 
to the nature of the case. Further, it is im- 
portant that the truss should not be put on 
while any of the hernia is "down." When, 
as sometimes happens, a rupture is " irredu- 
cible," that is, cannot be entirely returned 
within the abdomen, a bag-truss suited to 
the nature of the case is requisite. 

The causes of rupture are various. In one 
sense it may be said to be hereditary, that is, 
some individuals inherit a tendency to weak- 
ness about those parts which are the usual 
seat of rupture. The direct causes are 
such as induce undue pressure by the walls 
of the abdomen upon its contained viscera : 
hence the disease is most frequent among 
those who have to make strong exertions. 
Soldiers, whose belts compress the upper 
part of the abdomen, and cavalry soldiers, 
who at certain times ride without stirrups, 
are not unfrequently the subjects of the dis- 
ease. It is also brought on by hard riding, 
or by leaping in the hunting field. Hence, 
those who are in the least liable, should 
avoid all such causes ; and those who wear a 
truss should bear in mind, that if the natural 
support has given way, the artificial may 
also. It may become a question with a rup- 
tured individual, how far the hazard of sea- 
sickness, and the consequent mechanical 
action of vomiting, is to be incurred. Strict 
attention to the state of the bowels is im- 
perative, by all who are the subjects of rup- 
ture, more especially as nothing is more 
likely either to cause or to aggravate the 



EYE 



460 



S AI 



affection than the straining of constipation. 
At the same time strong purgatives are not 
advisable. The danger of a rupture is not 
in proportion to its size. When small and 
recent, it is more liable to become strangu- 
lated. Ruptures may of course occur in 
both groins of the same person. In this 
case a double truss is requisite. 

When rupture in the groin occurs in in- 
fants, it is usually of considerable size, de- 
scending into the scrotum, and becoming 
very tense whenever the child cries. In the 
early periods of life, spring trusses cannot 
very well be worn : those made of elastic 
material will answer best : frequently no truss 
is used. Strict attention to the bowels, and 
bathing the loins of the child every morning 
in cold salt water, will do much to prevent 
the disorder getting worse, and will some- 
times effect a cure. 

RYE. — This hardy grain possesses a nu- 
tritive power about equal to that of barley. 
It has slight aperient properties. The chief 
point of interest connected with this grain 
is the peculiar diseased or fungus growth 
(the ergot of rye) which is apt to be deve- 
loped upon the seed. — See Ergot. 

SACCHARINE— Of the nature of sugar. 
— See Sugar. 

SACRUM, on Os Sacrum — Is the bone of 
the pelvis, which fits in like a wedge be- 
tween the two irregular lateral bones ; upon 
it the spine rests. — See Pelvis. The bone 
derives its name from having been formerly 
offered in sacrifices, whence it was consi- 
dered sacred. 

SAVINE.— See Juniper. ' 

SAFFRON— Is procured from the blue 
autumn- flowering crocus, which is cultivated 
extensively for the sake of the drug, both 
in this country and in France, Spain, &c. 

Fig. cxv. 




In the centre of each crocus-flower rises the 
"style," which terminates in three wedge- 
shaped, notched divisions, (fig. cxv.,) which 
are called "stigmata" — these stigmata, 
with a portion of the upper part of the style, 
constitute saffron, being clipped off when 
fully developed, and dried carefully. Saffron 
is sold either in the form of "hay saffron" 



or of " cake saffron," the former being com- 
posed of the loose dried stigmata — the latter, 
of these parts beaten into a cake, before 
they are quite dry. In Eastern countries, 
saffron is still largely used medicinally ; in 
this, except as a colouring matter, it is little 
employed. It is stimulant and anti-spas- 
modic. [In the United States it is often 
employed as a domestic remedy in measles 
and similar complaints, when the eruption 
is "not out sufficiently;" but it often in- 
creases the fever, and does harm. It is better 
to trust to nature, till medical advice can 
be obtained.] Saffron is liable to much 
adulteration. 

SAGE — Like other plants which contain 
essential oil, is stimulant and carminative. 
It is a good deal used domestically in the 
form of " tea," or infusion, especially as a 
gargle, combined with vinegar. 

SAGO. — This well-known dietetic article 
is the produce of various species of the 
palm-tree, being obtained from the cellular 
substance contained within the stems of that 
tribe of plants. The stem is split, the cel- 
lular substance scooped out, and stirred up 
with water to separate the fecula or starchy 
matter, which, while suspended in the water, 
is passed through a sieve, then allowed to 
subside, and, being dried, forms the "sago- 
meal" of commerce. This sago-meal, after 
having been made into a paste with water, 
"granulated," and again dried, constitutes 
the sago of the shops — common or "brown 
sago," or white or pearl sago, according to 
the mode of preparing. Sago is nearly pure 
starch, and closely resembles arrow-root — 
for which it is a frequent and cheap substi- 
tute — in composition. The remarks made 
upon the nutritive properties and dietetic 
uses of arrow-root apply equally to sago : 
the chief difference is in the former being 
the more agreeable preparation of the two, 
and requiring a somewhat different mode of 
cooking. — See Cookery — Starch. 

SAINT ANTHONY'S FIRE.— A popular 
name for erysipelas. — See Erysipelas. 

SAINT VITUS'S DANCE— Known to me- 
dical men by the name of "chorea," is a 
disease strongly indicative of nervous dis- 
order ; its precise nature, however, is at 
present obscure. Probably it may be occa- 
sioned by direct causes, that is, by causes 
seated in the great centres of the nervous 
system, or by indirect causes, which act by 
" reflex action," (see Nervous System,) in the 
same way that teething in infants produces 
convulsion ; that is to say, irritation in 
some portion of the body, as in the bowels, 
may, in the first place, give rise to func- 
tional irritation of the brain and spinal 



S A I 



461 



SAL 



chord, which irritation, acting as if its ori- 
ginal seat was in these great centres, is 
"reflected" on the body generally, or, at 
least, upon some portion of it, causing the 
irregular muscular movements of the dis- 
order in question. St. Yitus's dance is, for 
the most part, a disease of youth, occurring 
before puberty, and usually disappearing at 
that period of life, if it has continued so 
long. It is more common* in girls than in 
boys, in the proportion of three to one. It 
may, however, continue into adult life. 
It rarely proves fatal ; indeed, in those sub- 
jects of the disease who have died during 
its existence, it has been a question whether 
death has not been the result of other co- 
existing maladies. 

The most manifest symptom of St. Yitus's 
dance is continued involuntary actions of 
the voluntary muscles, to a greater or less 
degree — the extent of the muscles affected, 
and the intensity of their affection, varying 
with the severity of the disease. The move- 
ments, however, generally cease entirely 
during sleep, and in all cases certainly are 
diminished. The ordinary voluntary move- 
ments are still capable of being performed 
after a fashion ; that is, in an unsteady, 
uncertain, and somewhat grotesque manner. 
It seems as if, after the voluntary impulse 
had been communicated to them, an addi- 
tional involuntary one interfered to throw 
the limb or other part out of the usual 
steady movement. 

The disease generally commences with 
twitching about the face or neck, or in a 
particular limb, gradually extending to one 
side of the body, or to the whole body, as 
the case may be. Pain is seldom complained 
of, but it does sometimes occur in the head. 
The appetite may remain quite good, but 
the bowels are possibly confined, and their 
secretions unhealthy. To this depraved 
state of the bowels, or to constipation, or 
to the presence of worms, the disease is 
often traceable. In females it is not unfre- 
quently connected with the menstrual func- 
tion, especially if it be delayed, or imperfect. 
The irritation of the coming of the second 
teeth has been assigned as a cause ; and 
there is no doubt that imitation, especially 
among females, may spread the disease, 
which is most general, as might be expected, 
in persons of a nervous tendency ; and it is 
said, those with dark hair and eyes are more 
liable to it than those of a blonde com- 
plexion. The duration of the attack varies 
from ten days or a fortnight, to months ; but 
having once existed, it is, up to the age of 
puberty at least, apt to recur, or to be re- 
excited. 

2o2 



As regards the treatment of chorea, the 
best plan is as soon as possible to submit 
the case to a proper medical examination, 
for, as already explained, it may be depend- 
ent merely on some casual irritation, which 
skill will at once detect and remedy. The 
disease, moreover, is one devoid of danger, 
and as there can be no question that many 
cases of it will get well without any treat- 
ment at all, it evidently is better without 
active unprofessional interference. 

Dr. Watson says that when pain in the 
head exists, he finds benefit from the mode- 
rate abstraction of blood by leeches ; and if 
persistent pain does exist, the application of 
four or five leeches might be had recourse 
to, if the individual is of full, florid habit. 
In any case, no harm, but almost certain 
benefit will result from acting on the bowels 
freely — more moderately, of course, in a 
weak subject than in a strong one. For 
this purpose, the compound colocynth pill 
simply, or combined for two or three doses 
in succession with calomel or blue pill, will 
be of service, or the blue pill and black 
draught, or the compound decoction of aloes 
draught may be given. After the bowels 
have been well cleared, if the subject of the 
disease be weak and pallid, iron will be re- 
quired. In the disease in question, the red 
carbonate of iron, as given by Dr. Elliotson, 
has been found extremely useful in large 
doses, from a drachm upward, given twice 
or three times a day ; other preparations of 
iron, however, may be given, or quinine. 
The author has found the oxide of zinc of 
much service, but these are remedies which 
ought to be given under medical sanction. 
The shower-bath is often serviceable in St. 
Vitus's dance, but for some individuals 
the shock is too powerful, and seems rather 
to increase the disease ; for such, the douche 
down the spine may be substituted. In all 
cases attention to the general health is re- 
quired. Good diet, exercise, change of air, 
and attention to the hours of sleep, and to 
free ventilation of sleeping rooms, are all 
circumstances to be kept in mind in such 
cases. 

Refer to Convulsion — Nervous System, fyc. 

SALADS — Generally, being composed of 
raw vegetables, are unsuited to persons of 
weak digestion. "When, however, the sto- 
mach is capable of digesting them, the 
general effect on the system appears to be 
beneficial, particularly in salads derived 
from the tribe of the cruciferous plants, to 
which the water-cress, radish, mustard- 
cress, scurvy-grass, &c. &c. belong. 

Many persons with whom raw vegetables, 
such as salads, cucumbers, &c, invariably 



SAL 



462 



SAL 



disagree, if eaten "undressed," find the 
addition of the ordinary salad or "Flo- 
rence" oil, correct the tendency. In this 
country, some individuals have a prejudice 
against the use of oil. It is difficult to see 
■why it should extend to the beautiful pre- 
paration in question. 

SALEP — Is prepared from the "bulbs of 
the Orchis mascula. It is imported chiefly 
from the Levant, but some is brought from 
India. It consists of a peculiar kind of gum, 
termed bassorin and fecula. It is more 
nutritive than either arrow-root or sago, 
and consequently is better adapted for the 
convalescent than for the sick. It is pre- 
pared by dissolving the powdered salep in 
hot water, with assiduous stirring, and add- 
ing to the solution sugar and milk.* 

SALICINE — Is a " peculiar bitter cry stal- 
lizable principle," obtained from the bark 
of the willow or of the poplar. In some 
respects it resembles quinine, and has been 
brought forward as a cheap substitute for 
that expensive medicine, especially in the 
treatment of ague, neuralgia, &c. That 
salicine is a most excellent tonic remedy 
there is no doubt, and it is one, moreover, 
which is applicable to cases in which qui- 
nine is inadmissible, the former remedy be- 
ing less likely to heat or to cause headache. 
In such cases, however, as ague or neural- 
gia, it does not seem to exert the same 
powerful curative effect, although it might 
well be used, either in its prepared form, or 
in the form of an infusion of the willow bark 
itself, in the absence of quinine or of cin- 
chona bark. The dose of salicine as a tonic, 
is from one to two grains, given as a powder 
or dissolved in water, or if a stimulant be 
required, dissolved in a little sherry. For 
neuralgia it should be given in the same 
doses as quinine. 

SALINES — Or salts, are distinguished 
from other bodies by their general proper- 
ties of incombustibility, aptness for combi- 
nation, and a peculiar taste generally known 
as a saline taste. Salines are better illus- 
trated by their many well-known examples, 
such as common salt, potash, soda, Epsom 
salts, &c, than by any description. 

SALIVA — Or spittle, the fluid which 
moistens the mouth, is secreted by glands 
disposed around that cavity. These glands 
are three on each side. The principal, or 
parotid gland, (see Parotid,) is situated be- 
neath the angle of the lower jaw, the sali- 
vary fluid secreted ' by it being conveyed 
into the mouth by a duct which opens be- 
tween the gum of the upper jaw and the 



* Thomson's Siclc-Room, 



cheek, opposite the second double tooth. A 
second salivary gland lies deep below the 
tongue, its duct opening by the side of the 
bridle, or tie of the tongue, just behind the 
corresponding front "incisor" tooth of the 
lower jaw. Where the duct opens there is 
a perceptible eminence, from which, when 
some individuals gape, a small jet of saliva 
is apt to be projected at least a foot beyond 
the mouth ; ihii is caused by the muscles 
exerted in gaping compressing the gland 
and its duct. The third salivary gland, the 
" sub -lingual," lies partly just below the 
duct of the last mentioned, its small ducts 
conveying the saliva into the mouth close to 
the other. As, therefore, these glands are 
situated on each side of the mouth, there 
are six salivary glands in all. The saliva, 
or spittle, for the supply of which such 
ample provision is made, contains about one 
per cent, only of solid matter, which con- 
sists partly of animal constituents, and 
partly of saline. The saline constituents 
are similar to those contained in the blood, 
with the addition of a peculiar salt, a sul- 
phocyanide. The animal principle, known 
by the name of " ptyalin," resembles in 
action the vegetable principle "diastase," 
in possessing the power of converting the 
starchy constituents of the food into saccha- 
rine aliment. — See Digestion. When food is 
not being taken, the secretion of saliva is 
very greatly diminished, and in sleep seems 
to be almost suspended altogether ; no 
sooner, however, is the appeasement of hun- 
ger by food commenced — and indeed pre- 
vious to the food being taken — than the flow 
of saliva begins, the secretion continuing to 
be poured out as long as the meal continues. 
The amount of saliva secreted in the period 
of four and twenty hours, has been esti- 
mated at from fifteen to twenty ounces ; but 
it is very difficult to ascertain the precise 
quantity, and probably it varies. 

The importance and the functions of the 
saliva in the process of digestion have been 
variously estimated by different observers. 
Its action upon starchy matter has been 
already noticed. The experiments of Dr. 
Wright, of Birmingham, detailed in his valu- 
able papers on the saliva, tend to show that 
its alkaline properties are necessary to the 
perfect fulfilment of the digestive process 
generally. Dr. Wright observed, that after 
a full meal, the saliva became more strongly 
alkaline, and that if, instead of swallowing 
this alkaline saliva, he spat it out, there 
was manifestation "of abundance of acidity, 
with much pain at the stomach;" but that 
if he neutralized the acid on the stomach 
by a dose of carbonate of soda, the alkaline 



SAL 



463 



SAL 



condition of the saliva quickly diminished, 
as if, being no longer required, the alka- 
linity was withdrawn. The saliva, however, 
is not constantly alkaline — it is frequently 
acid, especially during fasting ; the acidity 
has been attributed to the mucus of the 
mouth, with which the secretion is necessa- 
rily intermingled. Dr. Wright performed 
a variety of experiments with the view of 
determining the influence of the saliva in 
the digestive process. From these experi- 
ments he formed the following conclusions : 

" That saliva has the power of modifying, 
and to a certain extent of digesting vegeta- 
ble and animal substances. 

"That it has a more powerful action 
upon vegetable than upon animal matters. 

"That acids or alkalies, added to saliva, 
diminish or destroy its digestive properties. 

"That the presence of saliva in the sto- 
mach is essential to healthy digestion." 

Of course the saliva performs other func- 
tions beyond the simple assistance of diges- 
tion ; it facilitates especially all the move- 
ments connected with mastication and 
speech. The " tartar" which accumulates 
about the teeth is a mixture of the earthy 
salts and animal matter contained in the 
saliva. 

The influence of the mind upon the secre- 
tion of saliva is very considerable : the po- 
pular saying of the "mouth watering," at 
the sight of tempting food, is an illustration 
of its increase from this cause : its diminu- 
tion under the influence of painful emotion, 
such as fear, is well ascertained, and in- 
deed, in some Eastern countries, is practi- 
cally acted upon as a means of detecting 
crime. If a crime, such as a theft, is com- 
mitted, and a number of persons, such as a 
staff of servants, are generally suspected, 
the whole of the suspected are placed toge- 
ther and caused to chew and then spit out 
a handful of rice, in the presence of the ex- 
aminer : it is said that such is the feeling in 
these countries with regard to the test, that 
the fear of the real criminal diminishes the 
secretion of his saliva to so great an extent, 
that the portion of rice chewed by him re- 
mains comparatively unmoistened. There 
is a peculiar affection of the salivary secre- 
tion, to which some dyspeptic persons are 
liable, which the author has never seen de- 
scribed in any medical work, and which he 
believes is generally confounded with pyrosis 
or water-brash ; it consists of the rapid flow 
of a quantity of limpid saliva into the 
mouth, or from it, in a stream, if permitted, 
accompanied with a sense of constriction 
about the jaws ; the flow continues for a 
minute or two at a time. It is generally 



preceded by symptoms of indigestion, of 
heartburn, or of irritation in the stomach. 
It is in fact a symptom of indigestion, and 
an instance of "reflex" action, (see Nervous 
System — Indigestion,) or of irritation in the 
stomach acting upon the salivary glands, 
which seem to be peculiarly susceptible to 
irritation from such causes. The above 
remarks upon the uses of the saliva may 
explain, in some measure, the disordered 
digestion from which many smokers, who 
waste this fluid, suffer. Indigestion is a 
very common malady in America, and may 
in part be occasioned by the well-known 
habit of "spitting," peculiar to the country. 
[Except among the tobacco-chewers, this 
habit is not common in the United States, 
though otherwise represented by superficial 
tourists.] 

SALIVATION — Is the excessive secretion 
of saliva from any cause. The term is best 
known in connection with mercurial saliva- 
tion. — See Mercury. Salivation may, how- 
ever, arise from other causes. A course of 
iodine medicines may occasion it, and nitric 
acid has the same effect ; it also arises from 
constitutional causes. Salivation, that is, 
simple increase of the flow of saliva, is not 
an unfrequent concomitant of the first stages 
of pregnancy. 

Kefer to Indigestion. 

SALMON — Like the other oily fishes, is 
less digestible than white fish generally for 
persons of weak stomach. Like other arti- 
cles of food, too, which contain oil, it is apt 
to prove highly injurious if eaten in a state 
of decomposition. Indeed, death has been 
the result of a meal of pickled salmon which 
had become somewhat decomposed. 

SAL-PRUNELLE— Is saltpetre which has 
been fused by heat and cast in a mould, ge- 
nerally of a globular form. The prepara- 
tion is used by some persons in incipient 
sore-throat with advantage ; the ball of the 
salt being allowed to dissolve gradually in 
the mouth. 

SALT. — The term salt is applicable to 
saline matters generally, (see Salines;) in 
this article, however, it is regarded in its 
conventional acceptation of "common salt," 
as used in daily life. Common salt is a 
compound of soda and muriatic acid, or in 
another view, of chlorine and sodium and 
water. It is therefore either a muriate of 
soda, or a chloride of sodium with water. 
Indeed, common salt is one great source 
whence the soda of commerce, now so cheap 
and so extensively used, is obtained. — See 
Chlorine — Soda, §c. 

Common salt is most generally procured 
either from the salt mines, such as those of 



SAL 



464 



SAN 



Cheshire, from saline springs, such as exist 
in America, or in Germany, or from sea- 
water ; in the two latter cases by evapora- 
tion. However obtained in the first in- 
stance, salt generally requires to be puri- 
fied from other saline ingredients, with 
which it is usually mingled, and which par- 
ticularly interfere with its keeping proper- 
ties, causing it to become moist. Of late 
years the finer descriptions of salt have 
become so cheap that the coarser kinds are 
scarcely seen. 

As regards the use of salt as a condiment, 
or as an addition to food by man, there can 
be no doubt as to its beneficial effects ; in- 
deed, the desire for salt seems almost to be 
instinctive, as a necessary for health. In 
countries at a distance from the sea, and where 
from the absence of saline springs salt is 
difficult to procure — as in the interior of 
Africa — it is most highly prized as a neces- 
sary of life. Many travellers have described 
a temporary deprivation of salt as one of 
their greatest hardships ; and, to descend to 
the lower creation, the way in which the 
salt springs or ; * licks" in America are fre- 
quented by the wild animals, is evidence of 
instinctive desire ; and indeed the eager de- 
vouring of salt by, and consequent improve- 
ment of condition among domestic animals, 
sufficiently testify, if not the absolute ne- 
cessity for, at least the great benefit arising 
from the admixture of salt with food. Salt 
unquestionably assists and renders more 
perfect the process of digestion : moreover, 
it forms one of the constituents of the blood 
and of the body generally. If salt be de- 
nied, the digestion is weakened ; the general 
tone and nourishment of the body are im- 
paired, and it is observed that worms are 
more likely to be generated in the intestines. 
Salt, therefore, ought to be an addition to 
the food of all, and attention should be paid 
to children in this respect ; they should be 
made to eat a certain proportion of salt with 
their food — their greater liability to be in- 
fested by worms than adults being an addi- 
tional reason. 

It is, however, a very different thing to 
eat salt with food, and to live upon meat or 
fish which has been salted. In the latter 
case it is well ascertained that certain che- 
mical effects are exerted upon the meat and 
its nutrient constituents by the salt, which 
modify considerably the nutriment afforded 
to the body. — See Preserved Provisions. In- 
deed, the effects of a continued diet of salted 
meat are most injurious. — See Scurvy. The 
exclusive and continued use of salted provi- 
sions is here alluded to, not their moderate 
occasional employment. Salt may almost 



be regarded as medicinal in some cases of 
convalescence, in which the craving for it 
becomes intense. It should be allowed. It 
appears to act as a tonic. From one to two 
ounces of salt, dissolved in half a pint of 
water, forms a good and not unfrequent 
domestic emetic. It may, however, purge 
instead of causing vomiting. It is used in 
the form of clyster to destroy worms. The 
occasional use of salt in the treatment of 
typhus fever, and of cholera, &c. does not 
require notice here. Externally, salt is 
used in solution, generally as in sea or cold 
salt-water bathing, in which cases it seems 
to exert a tonic effect. Warm saline bathing 
is efficacious in rheumatism. For local 
bathing after injuries, such .as sprains, &c, 
the salt-water douche is well adapted to 
give strength. For the above purposes, a 
pound of salt dissolved in three gallons of 
water is a good average strength. The 
"brandy and salt" application, so much in 
vogue some years ago, is of the same use 
as any other stimulant application. Salt 
is widely distributed throughout nature, 
forming a constituent of the animal and 
vegetable kingdoms. 

liefer to Preserved Provisions — Sea, §c. 

SALT-MEAT. — See Salt — Preserved 
Provisions, &c. 

SALTPETRE.— See Potash, Nitrate— 
Sal-Prunelle. 

SALT OF TARTAR.— A purified sub- 
carbonate of potash. — See Potash. 

SAMPHIRE.— This plant, which grows 
on rocks close to the sea, is used as a pickle, 
and is about as wholesome as pickles gene- 
rally. — See Pickle. 

SANATORIUM— Is an institution for the 
promotion and preservation of health, in 
contradistinction to an hospital, which is 
devoted to the cure of disease. The sana- 
torium is at present but little known, or 
brought into use, although probably it will 
become more so. The hospital for conva- 
lescents must be regarded as a sanatorium 
of the most useful description ; and at the 
present time a sanatorium for consumptive 
patients is about being established at Tor- 
quay, in connection with the Brompton 
hospital for consumption. The author, 
however, is not aware that these are on the 
plan suggested in this article, the nearest 
resemblance to which is the covered square 
of one of the London hospitals. The bene- 
ficial effects of winter residence in a warm 
climate, in some cases of disease, have been 
too well proved in numberless individual 
instances to admit of doubt that such a 
change is not, in the cases adapted for it, 
in the highest degree serviceable. At the 



SAN 



m 



SAN 



same time, there cannot be a doubt that 
change of climate, as it is usually resorted 
to, has been much abused, and that in 
numerous instances uncalled-for sacrifices, 
not only of a pecuniary nature, but of the 
strongest feelings and affections of the 
human heart, are made to give a beloved 
invalid the change of climate considered 
necessary for the restoration of health, or 
for the preservation of life. Not only doubt, 
but certain conviction, exists in many minds, 
that numerous cases which formerly would 
have been sent abroad should now, and will 
now, be kept amid home comforts and home 
affections, to live or to die. But it must be 
matter of thankfulness, that, when the hope 
— too often the delusive one — of that last 
resource of "climate" is, to say the least, 
weakened, another and a better one is likely 
to open up, one which involves neither sever- 
ance from home nor friends, and one which 
may be made the resource of the indigent 
as well as of the rich. The resource is the 
glass-covered sanatorium — the acres of plea- 
sure and of exercise-ground — under a climate 
which may be rendered more certain and 
genial than any open to the winds of heaven, 
which may be accessible to the delicate, and 
to the invalids, during a winter season in 
England. The various arrangements under 
which a glass-covered sanatorium may be 
made available are very palpable. With 
such a building as the new crystal palace at 
Sydenham, it might be possible to connect 
the villas of the wealthy, in which invalids, 
though resident in the houses, and mingling 
in the society of their own families and 
friends, might yet enjoy the free but genial 
atmosphere and extensive grounds of the 
magnificent erection. But, even without 
the magnificence, wide extension, and con- 
sequent expense of such a fabric, it would 
be very possible to enclose glass-covered 
spaces of one, two, or more acres in extent, 
into which the windows of some of the 
apartments of adjoining houses might open, 
apartments to be occupied by the invalids, 
while the rest of the house, for a family 
generally, has the ordinary aspects and ar- 
rangements. Or, under another construc- 
tion, detached houses, or sets of houses, 
might be connected by covered glass or other 
passages with the general glass-protected 
garden, or promenade, or climate, as it may 
be named. The varied arrangements of 
which glass structures, for the benefit of 
consumptive and other invalids in this coun- 
try, are capable, need not be entered into 
here. The possibility of such structures is 
certain, not less so, peimaps, the fact of 
their wide adoption in years to come ; but, 

80 



amid the various plans for glas3 structures 
in the vicinity of our large towns, for the 
purposes of pleasure or instruction, the 
author has regretted to see little or no 
notice taken of their important availabili- 
ties as regards health. Their capability of 
supplying a great want and of serving as 
an antidote to our comparatively rigorous 
climate should be remembered on occa- 
sions which so often present the apparent 
necessity for the young and the delicate 
seeking a home, and too often finding a 
grave, in a foreign climate, exposed as they 
then are to the depressing, and therefore 
necessarily injurious influence which sever- 
ance from home scenes, home comforts, so- 
ciety and home affections, cannot fail to 
produce in a greater or lesser degree. 

It would be possible to dilate greatly upon 
the advantages offered by the glass sanato- 
rium ; but, perhaps, enough has been said 
for the purpose. 

SANITARY, or Sanatory — Regulations 
and observances are daily acquiring more 
importance, both in a public and in a private 
point of view. The " Commissions" and 
"Reports" commanded and issued by the 
government [in England,] and the numerous 
publications which are appearing upon the 
subject, attest the growing interest ; but 
much, very much, yet remains to be done ; 
the movement is as yet in its infancy ; and 
if its growth and development do not pro- 
gress more vigorously than they have yet 
done, not this generation only, but the next, 
will be in their graves before sanitary im- 
provement has gained any approach to ma- 
turity. The fact is, although the interest 
on the subject is increasing, it is as yet 
confined to but a few. There are a few 
honoured names among the aristocracy as- 
sociated with the principles of sanitary 
reformation, and many of the medical pro- . 
fession, and a few of the more intelligent 
middle classes, have given it their hearty 
aid ; but the great mass of our citizens heed 
it not, and are indeed profoundly ignorant 
of the subject. 

The principles of sanitation ought to be 
made part of all modern education ; there 
are no situations of life in which they would 
not be useful, in some they would be invalu- 
able. A more extensive acquaintance with 
them, on the part of the clergy especially, 
would greatly add to their means of useful- 
ness in their visits amid the poorer classes. 
A step in this direction has lately been taken 
in the delivery, before the theological stu- 
dents of King's College, of an admirable 
course of lectures upon "hygiene," by Dr. 
Guy— an addition to the ordinary routine 



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of education ■which cannot be too highly 
estimated. In fact, before long, no educated 
man, in any position of life, especially if he 
has, either by courtesy or by appointment, 
influence or command amid his fellows, can 
with propriety be ignorant on these subjects. 
Attention to the principles and practice of 
sanitary observances and regulations, in- 
cluded under the single word "hygiene," 
is so constantly enforced in the present 
work, that further notice here would be 
superfluous. The articles more especially 
devoted to sanitary matters, to which refer- 
ence should be made, are — 

Acclimation — Air — Bed and Bedroom — 
Chimney — Climate — Clothing — Cold — Con- 
tagion — Damp — Diseases — Drainage — Edu- 
cation — Exercise — Food— Graveyards— Heat 
— Houses — Life — Light — Putrefaction — Re- 
creation — Skin — Sleep — Temperance — Town 
— Training — Ventilation — Walls — Water, 
&c. 

SARDONIC SMILE, or Grin— Is a pe- 
culiar characteristic expression of counte- 
nance, 'which occurs in some diseases. The 
corners of the mouth are retracted and the 
teeth exposed. 

SARSAPARILLA— Is the root of a tribe 
of creeping plants, natives of Central Ame- 
rica and of Northern South America. The 
drug is brought to this country in the form 
of the roots, tied up in bundles, which are 
distinguished by various characteristics, 
according to the place from whence they are 
imported. These roots are cut up into chips 
for retail selling. Medical men are greatly 
divided in opinion, not only as regards the 
medicinal properties of sarsaparilla, but as 
to whether it possesses any medicinal pro- 
perties of value at all : while some contend 
that if the root itself has medicinal power, 
this is destroyed by the usual modes of pre- 
paration. However the truth may be, sar- 
saparilla is not a medicine likely to be used 
domestically, that is, without medical pre- 
scription ; and when it is employed, it will 
be most efficaciously so, as sold in some of 
the usual prepared forms of extract, infu- 
sion, decoction, &c. The decoction is or- 
dered to be made by digesting five ounces 
of sarsaparilla chips in four pints of water, 
kept just below boiling, for two hours ; the 
chips are then to be taken out, bruised, re- 
placed, the whole boiled down to two pints, 
and then squeezed and strained. The dose 
of this preparation is from two to four 
ounces. 

SAUSAGES — Generally speaking, are in- 
digestible as an article of diet, but they 
chiefly demand notice here from the liabi- 
lity, especially of some of the German forms 



of the preparation, to undergo a peculiar 
kind of decay, by which they are rendered 
highly poisonous ; indeed, the thing goes by 
the name of the "sausage poison." Many 
hundred deaths have occurred from this 
cause in Germany. The sausages in ques- 
tion are generally made of liver, blood, with 
fat, &c, salted, and spiced, and smoked, 
and, if properly prepared, keep well, and are 
wholesome for months. If badly prepared, 
they undergo the poisonous putrefaction, 
which is probably analogous to that which 
takes place in some descriptions of cheese, 
in bacon, salmon, and other oily articles of 
diet. The symptoms of poisoning from sau- 
sages are not very quickly developed ; they 
are similar to those described under the 
article Putrefaction. 

Refer to Putrefaction. 

SCABIES — The itch.— See Itch. ' 

SCALD.— See Burn. 

SCALD-HEAD.— See Scalp. 

SCALP. — The skin of the head is tolera- 
bly thick and firm, and is connected to the 
parts immediately subjacent by a rather 
loose cellular tissue. These circumstances 
often give a peculiar character to the effects 
of violence and to wounds of the head, for 
the skin being firm, and the cellular tissue 
being easily torn, large portions of the scalp 
are occasionally separated in flaps, either 
entirely or partially. When, as the result 
of violent accident, a portion of scalp is 
separated, the best thing that can be done 
by a bystander is to replace the parts as 
nearly in their proper position as possible, 
provided grit or dirt have not been forced 
into the wound. This will require a little 
care, for the skin is apt, from its own elas- 
ticity, to curl up. If the wound has got 
dirt in it, and if it is possible to procure 
surgical aid in the course of a few hours, 
the best plan will be to rest content with a 
superficial cleansing of the wound and adja- 
cent parts, and then simply to lay the de- 
tached portion somewhat in its proper posi- 
tion, and to place over all a cloth wet with 
tepid water, till the arrival of the surgeon, 
who will cleanse the wound in the most ef- 
fectual manner — a matter of some import- 
ance. If, however, surgical assistance is far 
distant, some one should endeavour, care- 
fully, to free the wound of foreign matter, 
by means of washing with a soft sponge, 
and also by picking out small portions of 
gravel, or the like, if these are present, by 
means of forceps or tweezers. After the 
wound has been cleansed, the detached scalp 
must be fitted as closely as possible in its 
proper position ; and if the hair around the 
wound has not been already clipped close 



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off, this should now "be done : in addition, it 
will be requisite in most cases to have the 
scalp perfectly clean for some distance 
around. To retain the detached portion of 
scalp in its place, if it be large, two or more 
stitches, according to the size of the wound, 
may possibly be required, (see Wounds,) in 
addition to plaster. If the wound be small, 
strips of plaster laid evenly, so as to hold 
the edges together, will probably be suffi- 
cient ; but in any case, in order that these 
may retain their hold, the hair must be 
shaved clean off. After the plasters are 
applied, a piece of lint, double, and wet 
with simple soft water, is to be laid over the 
wound, and over this, to retain all in place, 
a bandage of some kind. A handkerchief, 
applied as represented in fig. xi., article 
Bandage, will generally answer every pur- 
pose, or a cap maybe made to fit close upon 
the head ; indeed, the cap or the handker- 
chief are better than any regular bandage, 
and are generally more accessible. After 
the wound has been thus dressed, the per- 
son who has suffered from it should, whe- 
ther feeling ill or not, go to bed, keep per- 
fectly quiet on low diet, especially avoiding 
stimulants for some days, and, if of full habit 
of body, take a dose of common purgative me- 
dicine. A few hours after the dressing, the 
wound will probably feel hot and dry, but 
these symptoms must be kept down by the 
use of cold water, used so as. to soak through 
the dressings without ^removing them. In 
the course of two or three days, according 
to circumstances, the wound may again be 
dressed. — See Dressing. Simple incised 
wounds of the scalp are to be treated in a 
manner similar to the above, but of course 
they are less troublesome when the scalp is 
not detached. Some persons condemn the 
use of stitches and plasters entirely in the 
treatment of wounds of the scalp, and prefer 
the use of pads, adapted, by bandage and 
otherwise, to retain a flap in its place ; it is 
doubtful whether this method could be ap- 
plied by a non-professional person, at least 
with sufficient accuracy. Bleeding from 
wounds in the scalp is often profuse, espe- 
cially if an arterial branch has been divided ; 
it may, however, generally be stopped by 
the use of cold, or by pressure. Even when 
a very large portion of scalp has been de- 
tached, it is often marvellous how quickly 
and completely it becomes reunited to the 
other parts ; at other times, however, por- 
tions of the skin die, leaving a granulating 
wound to heal like other wounds of the 
same kind. One chief danger to be appre- 
hended after wounds of the scalp — inde- 
pendent of the violence to the brain which 



is often a concomitant of such accidents — 
is the occurrence of erysipelas, which may 
set in, spread over the head, cause extensive 
formation of matter under the skin, and 
perhaps destroy the patient. Such a case 
must, of course, be treated as erysipelas 
from any other cause ; but if a medical man 
has not before seen the patient, he ought to 
do so now without delay; it may require all 
his skill to save life. 

The scalp is often the seat of "encysted" 
tumours, which are at times conspicuous on 
the heads of aged people ; they are perfectly 
harmless and painless if they do not inter- 
fere with the wearing of the usual head 
covering. If desired by the possessor, their 
removal is simple. Soft fluctuating tumours 
beneath the scalp of infants are sometimes 
met with immediately after birth : they ge- 
nerally disappear shortly, but it is better 
they should be examined by a medical man. 

The scalp is the seat of different forms 
of eruption, or of skin disease, especially in 
children. It would be quite superfluous 
and useless, as far as the non-professional 
are concerned, to attempt to enter into the 
differences between these, although some of 
them differ greatly, or to give the various 
modifications of treatment: general obser- 
vations are all that can be offered with any 
advantage. The first great object in erup- 
tions of the scalp is to get them under 
treatment as early as possible ; the next, to 
observe the strictest cleanliness. The variety 
and the obstinacy of the disease in question 
is a reason for placing them under proper 
medical treatment as early as possible. 
When this cannot be done quickly, the first 
step should be to examine the head tho- 
roughly, that no affected spot be undisco- 
vered ; the next to clip the hair moderately 
short, and around the affected parts per- 
fectly close. If the eruption is extensive, it 
is better to cut the hair close off altogether 
at once. The hair having been removed by 
clipping, in preference to shaving, washing 
with good brown soap, with warm soft water, 
night and morning, is a process which will 
cure many a scalp eruption, especially 
among those classes in whom deficient clean- 
liness is often the cause of the evil. When 
this does not suffice, an ointment made with 
ten grains of the red oxide of mercury to 
the ounce of lard, smeared slightly over the 
affected part, is often of much service. As 
long, however, as there are any scabs or 
incrustations on the head, there is no use 
applying either this ointment or any other 
application ; these, therefore, should be re- 
moved in the first place by poulticing. In 
some kinds of scalp eruptions, such as scald- 



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head, alkaline washes are often of service. 
Dr. Bennett, of Edinburgh, recommends in 
some forms of that disease a lotion, com- 
posed of two drachms of subcarbonate of 
soda to the pint and a half of water, to be 
applied to the affected parts by means of 
lint soaked in it, and covered with oiled silk. 
Very many applications for eruptions on the 
scalp are and have been used ; but if a dis- 
ease of the kind does not yield to the simple 
measures above detailed, a medical man 
should see the case. Moreover, in some 
forms of scalp eruption, it is scarcely desir- 
able that the eruption should be done away 
with, at least quickly, or without the con- 
stitution being acted upon by medicine ; for 
it may happen that, after the disappearance 
or cure of a scalp eruption, a child will be- 
come the subject of convulsions, or of other 
affections of the brain. 

In all cases of tendency to eruption on 
the scalp, the diet should be attended to, 
salted meats forbidden, and, in those of full 
habit, the .allowance of animal food cur- 
tailed, and milk and farinaceous diet sub- 
stituted, more or less according to circum- 
stances ; on the other hand, in the weak and 
delicate, it may be requisite to improve the 
diet both in nourishment and stimulation. 

In strong children, three grains of gray 
powder, given at bedtime, and followed in 
the morning by a dose of senna or other 
aperient, will often be useful. In more deli- 
cate children, half a grain of gray powder 
with two or three grains of carbonate of 
iron, given twice a day for a week or ten 
days at a time, is a useful remedy. In all 
such cases, however, proper medical attend- 
ance is the best and safest plan. 

When there is eruption on the scalp, the 
glands of the neck are liable to become en- 
larged and painful. 

liefer to Erysipelas — Skull — Wounds. 

SCAMMONY.— -This drug, which belongs 
to the class of purgatives called cathartics, 
is obtained from a species of convolvulus, a 
native of the countries of the Levant. It 
is one of our most valuable medicines, but, 
from its high price, one of the most adulte- 
rated drugs in use. Indeed, the scammony 
generally met with does not contain above 
fifty per cent, of the pure drug, and the 
doses are generally regulated according to 
this ; consequently, if pure, or, as it is 
called, "virgin," scammony was generally 
attainable, the doses would not be above 
half what they now are. Scammony is 
generally met with in the form of a grayish 
mass, or gray powder ; the adulterations 
are chiefly chalk, flour, &c. Scammony acts 
as an efficient purgative without griping, 



and is not liable, if properly given, to pro- 
duce violent effects ; its certainty of action 
is however increased by combination with 
other purgatives ; on this account it forms 
a valuable addition to the compound colo- 
cynth pill. For children, when free purging 
is required, scammony is remarkably well 
adapted, combined with small doses of calo- 
mel or gray powder; moreover, its small 
bulk of dose, and the comparative absence 
of nauseousness, fit it for such administra- 
tion. For a child of four years of age, four 
grains of ordinary scammony alone, or one 
grain and a half of calomel, or three grains 
of gray powder, with three grains of scam- 
mony, will prove a certain and active pur- 
gative. Scammony alone may be given 
rubbed up with milk in the form of emul- 
sion. 

SCARF-SKIN, or Epidermis, or Cuticle. 
— See Skin. 

SCARIFICATIONS— Are deep scratches, 
or superficial cuts, made generally upon the 
skin, or upon a mucous membrane. The 
chief use of scarifications is to give exit to 
blood or serum, from parts in which there 
is an improper accumulation of either of 
these fluids. The scarification of the gums 
in children is not, as is often supposed, to 
assist the passage of the tooth, but to re- 
lieve the tension and inflammation of the 
gum by allowing the escape of blood from 
the overloaded vessels and tissue. Scarifi- 
cations of other parts act in a similar way. 

Refer to Children. 

SCARLATINA and SCARLET FEVER— 
Are both designations for one and the same 
disease, although an idea prevails popu- 
larly that the former is the name of a 
milder and less dangerous affection than the 
latter. 

Scarlet fever belongs to the class of erup- 
tive fevers, and is characterized by symp- 
toms so well marked that it can scarcely be 
mistaken for any other disease, even by un- 
professional persons. Generally, the first 
symptom complained of, in the incipient 
stage of scarlet fever, is sore-throat, either 
accompanied, or quickly succeeded by the 
usual symptoms of a feverish attack, shiver- 
ing, headache, loss of appetite, perhaps 
vomiting, followed by heat of skin, quick 
pulse and thirst. The eruption appears 
early, on the second day after the first 
symptoms of indisposition. It first shows 
itself in the form of minute red points on 
the chest and arms, especially about the 
elbows, the points becoming more nume- 
rous, till they form one diffused surface of 
a tolerably bright scarlet eruption, which 
extends to the neck, face, and abdomen, 



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and body generally. On the second day, 
when the eruption is appearing, the symp- 
toms of general fever, and especially the 
heat of skin, continue unabated, the throat 
is more inflamed, and the tongue assumes 
the appearance characteristic of this disease. 
It is probably covered with a white creamy- 
looking fur, through which the " papillae" 
on its forepart, about the tip especially, 
project like red points. This appearance 
may continue, but in many cases the fur 
comes off, as it were, in patches at a time, 
and ultimately leaves the tongue preter- 
naturally clean and red, covered with the 
elongated papillae, in some cases almost 
like a pile upon it'. The eruption in scarlet 
fever generally looks more patchy upon the 
extremities than it does upon the trunk. 
In a moderately favourable case of scarlet 
fever, the eruption begins to fade between 
the third and fourth day from its appear- 
ance, and with it tne feverish symptoms, and 
other general symptoms of the disease, such 
as sore-throat, &c. The patient of course 
is left weakened, but with moderate care, 
convalescence is for the most part speedy. 
The chief care is required until the des- 
quamation of the cuticle, or peeling, is com- 
pleted. During this period also the power 
of communicating the disease by contagion 
appears to be retained. 

Although favourable cases of scarlet 
fever pass through the course nearly as 
described above, there are much severer 
forms of the disease. The feverish symp- 
toms from the first may have a high inflam- 
matory form ; or the reverse may give evi- 
dence of an extreme condition of bodily 
depression, with tendency to malignant dis- 
ease, and to a putrescent or typhoid condi- 
tion. In such cases the eruption is tardy, 
and, when it does appear, patchy, and dusky 
in colour, the swelling of the throat is great, 
and if they can be seen, the tonsils are 
evidently ulcerated, the breath offensive, 
the tongue swollen, and swallowing diffi- 
cult, if not impossible. Offensive discharges 
take place from the nose, and at the same 
time there is evident extreme depression of 
the constitutional powers, with delirium. 
Between the comparatively mild form first 
described, so mild indeed at times as scarcely 
to constitute a perceptible disease, and the 
malignant, scarlatina is met with in every 
degree of severity. As a general rule, the 
severity or mildness of the attacks of scarlet 
fever depend greatly upon the type of the 
prevailing epidemic, which at one time may 
be so favourable that almost every case 
does well, while at another the greatest 
fatality attends it, and sorrowing parents 
2P 



see their children carried off one after an- 
other with fearful rapidity. 

The great variation in the severity of the 
attacks of scarlet fever must render the 
variation in the treatment equally great. 
When the form of the prevailing epidemic 
is extremely mild, little if any treatment is 
required, and many cases get none at all, 
not even confinement to the house, and cer- 
tainly not to bed. This is not well, even for 
the sake of others; and should the weather 
be ungenial, or should cold be taken, a mild 
affection may be at once converted into a 
dangerous disease. A moderately smart 
attack of scarlet fever requires, certainly, 
confinement to bed, in as well ventilated a 
room as possible, kept at an average tem- 
perature of 60° Fahr. ; the diet should be 
kept low, and consist of milk, farinaceous 
articles, &c, and the thirst may be freely 
indulged with diluent drinks. The patient 
must not be covered with bedclothes, 
which will keep up feverish heat. If the 
heat of skin is great, and indeed in most 
cases of this disease, sponging the surface 
of the body with tepid water, with or with- 
out the addition of a little vinegar, is at 
once most beneficial and grateful to the pa- 
tient. A gentle aperient should be repeated 
once or twice in the course of the disease, a 
tablespoonful of castor-oil, a dose of mag- 
nesia and rhubarb, or from a half to a whole 
seidlitz powder, may be required; or in 
fuller habits, or where fever runs high, a 
more active purgative still, of calomel and 
scammony, or in an adult, calomel or blue 
pill, and colocynth. 

The common effervescing soda-powders 
are often liked, and may be permitted in 
moderation to all; but more freely (and 
indeed the salines generally) to persons of 
full habit. From five to ten grains (accord- 
ing to age) of chlorate of potash, given 
every six or eight hours, in a little sugar 
and water, is one of the most appropriate 
cooling salines in this disease. 

If the feverish symptoms run high, of 
course the lowering and cooling remedies 
must be more actively enforced. In most 
cases much relief is afforded to the throat 
by the frequent use of warm gargles, made 
either with simple gruel, or with gruel with 
one or two tablespoonfuls of vinegar to each 
half-pint. Externally, hot bran poultices, 
frequently renewed, are also of much ser- 
vice to the throat. When the throat is very 
much swollen, leeches may be requisite, but 
so much caution is called for in the abstrac- 
tion of blood in scarlet fever, that this should 
only be done under medical sanction. Great 
enlargement of the glands around the jaw 



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and in the neck must always be regarded 
seriously. When a case of scarlet fever 
presents symptoms of malignancy, every 
method of supporting the strength by wine, 
broths, &c. must be used, and the prepara- 
tions of chlorine employed both internally, 
and as washes and gargles, to the nose, 
mouth, tonsils, &c. The chlorate of potash 
in from five to ten grain doses, must be given 
every three or four hours ; or muriatic acid 
in five drop doses in sweetened water. 
Two drachms of the solution of chloride 
of soda, in the half-pint of water, will make 
a convenient wash, to be used with a 
syringe, if the child or person is unable to 
gargle. 

Although the above directions are given 
for circumstances which might render them 
useful, it is not with the idea that any one 
in their senses would have recourse to them 
if medical aid could in any way be procured. 
The fearful rapidity of a fatal case of malig- 
nant scarlet fever calls for the most ener- 
getic exertion of the highest skill, which is 
too often of no avail. After the eruption 
has faded, the person may sit up, and gra- 
dually return to fuller diet, such as pudding, 
broth, fish, &c, the bowels being kept free, 
but not purged, and close attention given 
to the state of the urine as to quantity and 
appearance. At this stage, too, much com- 
fort and benefit will accrue from the use of 
two or three warm baths. These relieve 
greatly the discomfort arising from the harsh 
and dry state of the peeling skin, and, what 
is more important, encourage and keep 
active its ordinary perspiratory functions, 
which are apt to be impaired or impeded, 
and thus to give rise to one of the most se- 
rious incidents connected with the disease 
in question, that is, to a dropsical condition 
connected with a disordered state of the 
kidneys. The occurrence of dropsy after 
scarlet fever is always a serious matter, 
and the possibility of it a cogent argument 
for guarding against all those influences 
which, by interfering with the perspiratory 
functions of the (for the time) morbidly 
susceptible skin, tend to induce it. It is 
observed that the attacks of dropsy after 
scarlet fever are by no means in accordance 
with the severity of the attack itself, and 
this is supposed to be because those who 
have had only a mild attack are more care- 
less as to after exposure than those who 
have suffered a severe one. However this 
may be, it is certain that many, who have 
passed safely through the disease itself, fall 
victims to the subsequent dropsy, purely as 
the result of carelessness on their own part 
or on that of others. The attacks of dropsy 



are most likely to occur from the end of the 
first fortnight to the end of the fourth week 
after the decline of the eruption. Its symp- 
toms are generally those of languor and 
oppression, with headache, and it may be 
vomiting, the swelling coming on simulta- 
neously. Usually, the face (especially the 
eyelids) is first affected, and the dropsical 
swelling may go no further, but generally 
the feet and legs, the hands, arms, chest, 
&c. become filled. Concomitant with these 
symptoms, the urine is scanty, high coloured, 
or "smoky" in tinge. It presents, more- 
over, peculiar chemical changes. 

Little has hitherto been said about medi- 
cal attendance in a case of scarlet fever. 
Although mild cases may be, and every day 
are, carried safely through with simple nurs- 
ing, the attack, if it be at all a smart one, 
ought to be attended to by a medical man ; if 
it is severe, his presence is indispensable, 
equally so, whatever th£ case may have 
been, if the least symptoms of the after 
dropsy show themselves. Should this last 
contingency occur, warm baths ought to be 
used to restore, if possible, the functions of 
the skin, hot bran poultices applied to the 
body, and if there is pain about the kidneys, 
blood taken by leeches or cupping. The 
bowels should be well cleared, or rather 
purged, by the calomel and rhubarb, or 
calomel and colocynth pill, or better still, 
by calomel and compound powder of jalap. 
At the same time a draught consisting of a 
drachm of nitrous ether, half an ounce of 
spirit of mindererus, and ten or fifteen drops 
of ipecacuanha wine, in a wineglassful of 
water, may be given every four or five hours. 
These measures ought to be sufficient till 
medical assistance is procured ; if, as some- 
times occurs, convulsions or delirium come 
on, they are to be treated as directed in the 
articles on those disorders. Besides dropsy, 
scarlet fever is liable to be followed by other 
affections, particularly in those of weak or 
scrofulous constitution. If the affection of 
the throat has extended to the ears by the 
Eustachian tubes, the structure of the organs 
of hearing may be materially damaged, and 
deafness, total or partial, be the result. 
Frequently, runnings from the external ears, 
from the nose or eyes, continue for long 
after the subsidence of scarlet fever, and 
if the attack has been a severe one, a per- 
manent state of impaired health may be the 
consequence. Of course, if a patient, after 
an attack of scarlet fever, remains weak, 
tonic medicines, quinine or iron, with wine 
and good nourishment, will be required — 
also warm clothing. 

The question of contagion in scarlet fever 



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is an important one. Few diseases perhaps 
are more eminently contagious, and few 
retain the power of propagation longer ; 
indeed, it is difficult to say when this totally 
ceases, at least for some weeks. Probably, 
when the peeling stage is complete, the risk 
of contagion is gone, or nearly so. The 
fomites (see Fomites) from scarlet fever are 
very persistent, and unless the rooms which 
have been occupied by patients, and indeed 
every thing which has been about them, are 
very freely cleansed, aired, or fumigated, 
there is always some risk for a considerable 
time. The power of belladonna, in acting 
as a prophylactic, that is, in protecting in- 
dividuals against the contagion of scarlet 
fever, has been much discussed. It has 
been used extensively in Germany, and also 
in this country, and with apparent success ; 
indeed, the author believes he has found it 
efficient for the purpose ; at all events, the 
evidence is sufficient to make it worth a 
trial during the prevalence of a very severe 
or malignant form of scarlet fever. — See 
Belladonna. Scarlet fever is generally a 
disease of childhood, and is usually passed 
through once in a lifetime ; but adults who 
have escaped it in early life, are liable to 
be affected. Second attacks are rare. Al- 
though, however, those around persons suf- 
fering from searlet fever may not have the 
disease, they are very liable to suffer from 
sore-throat, often in a severe form. It is a 
serious thing for women to be exposed to 
the contagion of scarlet fever soon after 
child-birth ; every means, therefore, should 
be used to guard against such a contin- 
gency. 

Scarlet fever has sometimes been con- 
founded with measles ; a comparison of the 
described symptoms of the two diseases will 
point out the complete difference. 

SCAPULA — The Shoulder Blade. — See 
Shoulder. 

SCHOOL. — It too often happens that in 
consequence either of ignorance or of care- 
lessness, the health of young people suffers 
irretrievable injury during the years of in- 
struction. In day-schools the chief source 
of injury is from deficient ventilation. The 
consequences of this, and the remedies, are 
sufficiently entered into under such articles 
as Air and Atmosphere — Bedroom — Ventila- 
tion, §c, and require no further comment 
here. Suffice it to remark, that the effect 
of breathing an atmosphere deteriorated by 
the carbonic acid exhaled from the lungs of 
a number of children into a small or badly 
ventilated room, must be to produce drow- 
siness and languor, and consequently to 
neutralize in some degree the exertions of 



the teacher. [In the United States, the pu- 
pils sometimes suffer from being retained in 
the school for too long a period consecutively. 
The old hours of nine to twelve, and two to 
five o'clock, are, in the opinion of many me- 
dical men, preferable to the long session from 
nine to two o'clock, as this exhausts many 
children.] 

In boarding-schools, the health of the 
children is of course subject to those general 
conditions and laws of health which are 
commented on in the various sanitary ar- 
ticles ; and parents would do well to assure 
themselves that due attention is paid to 
these, ere they commit the daily life of their 
children to influences over which they have 
no control. It is to be hoped that there 
are few seminaries for the young, in this 
country, in which actual deficiency of food 
occurs ; but it is possible, that in the selec- 
tion and preparation of the food, there may 
be defects, which to strong- constitutioned 
children are of comparatively little moment, 
but which are of the greatest importance to 
the delicate. The point should not be over- 
looked. It is impossible in the limited space 
of this work to enter into particulars, but 
the reader is referred to the various articles 
on Food — Digestion — and the principles of 
Nutriment. Equally important with quan- 
tity and quality of food is the permission 
of sufficient time for meals, not only for the 
mere eating, but for rest after them, before 
school-work is resumed. The author is in- 
duced to notice this point especially, from 
having recently had his attention drawn to 
the regulations of a large educational insti- 
tution, in which the time allowed for meals 
is so short that the meal itself must be a 
scramble, independent of the injury which 
may result from the resumption of head- 
work immediately after taking food. — See 
Digestion and Indigestion. It does seem to 
be the case with some, that in seeking to 
cultivate the mind they destroy the body, 
forget how dependent the activity of the in- 
strument they seek to form is upon the 
well-being of its material clothing. There 
are many other points connected with school- 
hygienics which are important, but, as be- 
fore said, they fall under the heads of sani- 
tary information generally, as already given 
in other parts of this work, and which space 
forbids to be reiterated. 

Refer to Air, §c. — Bedroom — Education 
— Ventilation, §c. §c. 

SCIATICA — Is neuralgia or nervous rheu- 
matism, affecting the great or "sciatic" 
nerve of the lower extremity. This nerve, 
the largest in the body, passes down the 
back of the thigh to the ham, a little above 



SCI 



472 



SCR 



which it divides into two main branches. 
The nerve sometimes becomes the seat of 
severe neuralgic pain, felt down its entire 
course, or perhaps in the hip only, or some- 
times in the foot and ankle only ; the pain 
comes on in paroxysms, and is generally 
increased by exercise ; in some cases press- 
ure upon the course of the nerve causes 
pain. 

Sciatica is often attended with so much 
suffering, that it affects the general health 
to a considerable degree ; moreover, it is 
frequently most difficult to get rid of. For 
these reasons, the case should be under 
medical superintendence. Leeches and cup- 
ping, in the first instance, down the course 
of the nerve, especially in plethoric sub- 
jects, followed by blisters, are useful; or 
heat and moisture may be used with advan- 
tage, in the form of the bran poultice, fol- 
lowed twice or three times a day by an 
embrocation composed of one part of tur- 
pentine and two of soap and opium lini- 
ment. 

A couple of drachms of this should be 
rubbed in for ten minutes at a time. The 
bowels being cleared by a purgative, if there 
is no tendency to fever, drachm doses of 
carbonate of iron, given three times in the 
twenty-four hours, often cures quickly ; or 
turpentine, in doses of fifteen drops, given 
in milk, three times a day, may be tried ; or 
quinine, in two-grain doses, every eight 
hours. There is considerable uncertainty 
in the effect of remedies in sciatica, even in 
skilful hands. In obstinate cases the author 
has found much benefit from the use of the 
warm saline baths, such as those of Moira, 
or of Ashby-de-la-Zouch. Acupuncture is 
often of service in this disease, and is, per- 
haps, not so much had recourse to as it 
might. In all cases of sciatica, perfect rest 
of the limb is essential. Again, it is re- 
peated, the obstinacy of the disease, the 
uncertainty of remedies, and the possibility 
of its being symptomatic of irritation in 
the kidney, make it the safer and wiser plan 
to have the case treated by a medical man 
at once. 

Refer to Neuralgia. 

SCIRRHUS — A form of cancer character- 
ized by its peculiar hardness in the inci- 
pient stage of the disease. — See Cancer. 

SCLEROTIC— The outer thick coat of 
the globe of the eye.— See Eye. 

SCREAMING— Of infants, if continued, 
and if increased on particular movements 
of the body, should not be neglected. In- 
termittent screaming may be indicative of 
painful affection of the chest or abdomen, 
which incites the child to scream; while. 



on^ the other hand, the aggravation of the 
pain thus induced compels it again to de- 
sist, thus giving the intermittent character. 
Screaming of children during, or on awak- 
ing from sleep, may arise from the irrita- 
tion of teething, or of worms, &c, or from 
indigestible matters in the bowels ; for these 
causes the suitable remedies are to be used, 
as directed in the proper places. Scream- 
ing in sleep may be simply a bad habit, un- 
traceable to any cause, or may be attributa- 
ble to dreams, or excitement of mind pro- 
duced by fright during the day, excited 
accidentally, or by design, by foolish nurses. 
Lastly, screaming may arise from incipient 
disease of the brain. If the affection be 
persistent, its cause should be investigated 
by a medical man. It is said that in some 
cases of screaming a small dose of bella- 
donna given to a child at bedtime is useful 
as a preventive. The author has no expe- 
rience of the remedy. 

SCROFULA — Is the name rather of a 
constitutional tendency, or "diathesis," 
than of a disease, although cases of a scro- 
fulous disease alone do occur where the 
tendency is strong. That many persons 
may be tainted with scrofula, and neverthe- 
less be free from those external signs which 
are usually considered to indicate the ten- 
dency, is unquestionable ; but, "generally, 
if the scrofulous diathesis is at all strongly 
marked, its evidences are sufficiently appa- 
rent, and often strikingly so. The follow- 
ing description of the signs of scrofula, by 
Dr. Phillips, one of the highest authorities 
on the subject, is peculiarly truthful : — " In 
the form of the body there is usually ob- 
servable a want of muscular development ; 
but even this is often absent. There is 
often an appearance of plumpness and 
roundness, which is. the result not of mus- 
cular development, but simply of an infil- 
trated condition of the cellular tissue, and 
which rapidly disappears under fatiguing 
exercise, privation, or disease. Commonly, 
there is a general paleness and coldness of 
the surface of the body, which is owing to 
a feeble circulating apparatus ; but in a 
large number of cases, that paleness does 
not extend to the face. The colour of the 
hair is very variable, but for the most part 
it inclines to a dark tint. Of nearly nine 
thousand scrofulous children examined, a 
little over thirty-two per cent, had light 
hair and eyes. The abdomen is commonly 
tumid — discharges from the nose, the eye, 
and the ear are common — the tongue has 
commonly a dirty whitish coating ; the 
tonsils are usually enlarged, and they are 
often so tumid as to impress a disagreeable 



SCR 



473 



SCR 



and frequently husky character upon the 
voice, and to cause snoring when the patient 
is asleep. The stomach and bowels are 
frequently disordered, and digestion is ill 
performed. Sometimes the evacuations are 
clay-coloured, very offensive, and of varying 
consistency, at others having a redundancy 
of bile. The skin, though often dry and 
hard, is often the seat of a considerable 
greasy exhalation ; sometimes it is found to 
be fetid and sour. The scalp and other 
parts of the cutaneous integument are often 
the seat of eruptive affections. The absence 
of vascular and muscular energy often 
causes the child to sit and lie about much, 
and indisposes him to enter into the ener- 
getic games of his playfellows. As to the 
intellectual development claimed for scro- 
fulous persons, that is usually wanting. 
That many scrofulous children present that 
character is quite true ; but the result of 
very careful observation," says Dr. Phillips, 
"has convinced me that the overwhelming 
majority are without those superior intel- 
lectual qualities which have been pointed 
out as their ordinary characters." More- 
over, if the intellectual powers are forced, 
as too often happens, " and the nervous and 
intellectual systems have the vital actions 
concentrated on them too intensely, the 
sufferer loses flesh, the general health lan- 
guishes, and the intellectual faculties may 
give way, destroyed by an opposite but not 
less sure method than^that which breaks 
down the poor man's child." 

As noticed above, the very common idea 
that scrofula is usually associated with light 
hair and complexion is far from being cor- 
rect, the larger proportion of scrofulous 
subjects have dark hair and eyes, with a 
dingy complexion ; and some are ruddy, 
and to the common observer look robust ; 
others with delicate skin, inclined to freckle, 
have red hair. 

Of the causes of scrofula there can be 
no doubt that hereditary predisposition is 
the cause above all others. The fact is 
beyond dispute, and there are few families 
in this kingdom who have not, indirectly at 
least, practical connection with the fact. It 
is to be observed, however, that the predis- 
position is strengthened, if a parent adds 
to the taint an acquired state of bad health, 
or if in a father the bodily powers are im- 
paired by age. Probably the reverse holds 
good, that whatever conduces to health and 
vigour, even in parents tainted with scro- 
fula, tends to improve the constitution of 
offspring as regards the predisposition. 
Further, it is undoubted, that whatever 
hereditary tendencies children may possess 
2p2 



they are greatly retarded or strengthened 
by the external conditions to which such 
children are exposed. If the climate in 
which they reside is dry and bracing, if 
they are so placed that healthy habitations, 
good clothing, and nourishing food are 
provided for them, and especially if their 
parents and guardians are awake to the 
importance of these things, of being on the 
watch for any tendency to failing health or 
to disease, the chances of health and life 
are far greater than they are for children of 
even originally better constitution, who are 
exposed to a damp cold climate, and to the 
unhealthy influences attendant upon the 
circumstance of poverty. These, in fact, of 
themselves, especially cold, damp, and pri- 
vation of food, particularly if accompanied 
with depression of mind, may even engen- 
der scrofula in a constitution comparatively 
untainted by it. It ought always to be an 
object in those predisposed to scrofulous 
disease, to maintain the highest possible 
condition of health. 

In children, the glands, (those of the neck, 
chest, and belly,) are the most usual seat of 
scrofulous disease, though few if any other 
of the tissues are free from the liability. 
In adults, the lungs most generally suffer. 
Whatever disease affects a scrofulous per- 
son, whether it be, like enlargement of the 
glands, distinctly traceable to the scrofula 
itself, or some other ailment, it is apt to be 
modified in its course and appearances by 
the existing tendency. Purely scrofulous 
inflammation is slow in it progress, and un- 
attended in any marked degree by the usual 
phenomena of inflammation. When sup- 
puration ensues, the matter is not " healthy 
pus," but more like whey or serum. If 
ulceration results, it is indolent, and the 
discharge is also of the thin whey-like 
character. The formation of tubercles or 
of tubercular matter is another character- 
istic of scrofula. These bodies, so common 
in the lungs, may also occur throughout the 
body : consisting of cheesy-looking sub- 
stance, they excite inflammation and form- 
ation of matter in the adjacent parts of 
the tissue in which they are deposited. 
When this occurs in the lungs, the tubercles 
become as it were softened down in the sur- 
rounding matter, and the fluid or semifluid 
mass is discharged by cough. 

Under the head of causes, sufficient has 
been said to indicate the general course to 
be followed when a tendency to scrofula ex- 
ists ; when the disease actually breaks out, 
the same measures must be continued, and 
new ones of a more direct medicinal charac- 
ter adopted. These, to be thoroughly carried 



SCR 



474 



sou. 



out, require the superintendence of a medical 
man. Iodine in its various preparations, 
especially that of the iodide of iron, also 
iron itself, -with tonics generally, and above 
all the use of codliver-oil, are the principal 
remedies ; and change of air, when obtain- 
able, to the sea, or to a dry bracing air, is 
always advisable. Season, as might be ex- 
pected, exerts considerable influence over 
the scrofulous constitution ; the early spring 
months being the most unfavourable. In 
some countries there is considerable import- 
ance attached to the contagiousness of scro- 
fula. It cannot be considered contagious in 
the ordinary acceptation of the word, but it 
must be always advisable, especially for 
those predisposed to the disease, to avoid 
close contact with the affected. The scro- 
fulous is often spoken of as the "strumous 
diathesis." 

SCURF.— See Dandruff. 

SCURVY. — This disease, so well known 
and so fatal in times past to voyagers and 
others, has, within the last few years, been 
again brought prominently into notice, in j 
consequence of its prevalence in England , 
during the year 1817, when, in consequence j 
of the failure of the potato crop, numbers 
of the population were compelled to do alto- 1 
gather without a vegetable substitute. It 
is requisite here to explain, that what is' 
meant by scurvy in this article, is a very dif- 
ferent disease from that meant in the popu- 
lar acceptation of the term, which is applied 
to undefined cutaneous disorders, especially 
of a scaly character. The error has proba- 
bly arisen from the dry scurfy appearance 
of the skin, which often precedes an attack 
of the real scurvy. True scurvy is a severe 
disease, unquestionably owing to deteriora- 
tion of the blood, as a result of inappropri- 
ate nourishment, especially of nourishment 
unvaried by the admixture of fresh vegeta- 
bles, milk, &c. Scurvy commences with 
languor and signs of general debility, and 
great depression of spirits, the gums be- 
come swollen and spongy, red or purple 
looking, project over the teeth, and bleed 
easily ; this tendency to the exudation of 
blood extending to the various mucous sur- 
faces within the body, in bad cases, and 
showing itself in the discoloured patches of 
effused blood beneath the skin. The lower 
extremities become first stiff, then swollen 
and hard, the skin being as it were glued 
down to the parts' beneath, and covered 
more or less with brownish or purple patches. 
If the case goes on unchecked, blood is 
passed from the various outlets of the body, 
and the patient sinks. Fortunately, for 
this formidable malady we possess the well- 



known and almost certain cure of lemon- 
juice ; but although this is the most strik- 
ingly speedy and most certain curative 
agent, it is by no means the only one : as 
the deprivation of fresh vegetables or of 
milk seems to be one chief cause of the dis- 
ease, so a return to the use of these articles 
appears to be an antidote ; and, in this way, 
potatoes and vegetables generally, without 
medicine at all, are often sufficient to cure. 
Indeed, in the epidemic of scurvy which 
prevailed in 1846, in the General Prison at 
Perth, the cases which occurred were cured, 
and the further progress of the disease ar- 
rested, by the addition of milk, and in some 
cases meat, to the usual dietary ; malt liquor 
is likewise found useful in diminishing the 
tendency to, and in arresting the progress 
of scurvy. 

Of course, in a bad case of scurvy, when 
lemon-juice is procurable it should be used ; 
half a pint may be given in the day, alone 
or diluted. Until lately, the opinion has 
prevailed that the curative powers of lemon- 
juice in scurvy depended upon its acid, and 
that the good effects of other vegetables 
arose from their containing that or other 
similar acids : the researches of Dr. Garrod, 
however, have thrown doubt upon this, and 
apparently go to prove that the beneficial 
influence is rather due to the potash which 
exists in combination with the acid. This 
view is supported by the fact, that citric 
acid — the acid of the lemon — when used 
alone, does not cure scurvy. Should the 
potash view of the question prove correct, 
it will afford an important, cheap, and ge- 
nerally available remedy for this severe and 
often fatal affection. [Dr. Hammond, Sur- 
geon, United States Army, has reported 12 
cases o'f scurvy cured by the salts of potash, 
thus confirming the views of Dr. Garrod. The 
"cream of tartar," bitartrate of potash, an- 
swers very well, and so also does the carbon- 
ate.] Although, however, it is certain that the 
disease in question depends for its develop- 
ment upon the deficiency of certain articles, 
or constituents of food, it is no less certain 
that its attack is greatly favoured by the 
deficiency of sanitary regulations generally, 
and that those who are subjected to confine- 
ment, as in a prison, or on board ship, espe- 
cially if ventilation and other necessary 
arrangements are neglected, will much more 
quickly become the subjects of scurvy, than 
those who are not exposed to the same de- 
pressing influences, even if the food be the 
same. Salt provisions alone will not pro- 
duce scurvy, unless other conditions favour 
the disease. Males are more liable to it 
than females. 



SC Y 



475 



SEA 



SCYBALiE — Are hard lumps — generally 
black-looking — of feculent matter. 

SEA. — The effects of the sea upon health 
have to be considered under the two aspects 
of exposure to "sea-air," and of "sea- 
bathing." That exposure to the air of the 
sea, especially in the case of persons unac- 
customed to it, exerts a stimulant and tonic 
effect cannot be doubted. The freshness 
and, in summer, comparative coolness of the 
air in the vicinity of the sea contributes to 
this ; and its impregnation with saline par- 
ticles, the chlorides especially, probably 
adds to its tonic properties. Moreover, the 
average temperature of sea-coast places is 
more equable than of those inland, being 
generally warmer in winter. Although, 
however, the general character of sea-air, 
and its effects upon health, in different 
places are similar, it varies greatly, accord- 
ing to locality, as to particular influences : 
thus, at Torquay the relaxing air is the 
opposite of the stimulating atmosphere of 
Brighton, which again is very different from 
Hastings. These differences, it is true, de- 
pend more upon land influences, such as 
formation of coast, the vicinity of hills, &c, 
than upon the sea itself, but still they 
modify the effect of the latter so greatly as 
to make them a serious consideration when 
residence, either temporary or permanent, is 
chosen with reference to health* Under 
any- circumstances, it is considered as a ge- 
neral rule that invalids, derive more benefit 
from sea-air, at a little distance — quarter 
of a mile — from the water, than they do 
close to it. 

Refer to Climate. 

SEA-BATHING— When properly employ- 
ed, is a stimulant, in the first instance to 
the skin, and further to the body generally. 
The stimulant action upon the skin, indeed, 
even proceeds so far as to cause eruptions, 
somewhat resembling scarlatina. In some 
cases the smarting from these eruptions is 
so severe, after each immersion, that the 
practice has to be discontinued, at least for 
a time. 

The abstraction of calcric from the body, 
in consequence of bathing in sea-water, 
certainly appears to be less than it is from 
bathing in fresh. The effects, however, 
from bathing in the sea must vary, as the 
proportion of the saline constituents varies 
considerably in different localities. " The 
average quantity of saline matter is three 
per cent., which consists of chloride of soda, 
or common salt — sulphate of magnesia, or 
Epsom salt — sulphate of soda, or Glauber 
salt ; also muriate of magnesia and of lime, 
with salts of iodine and bromine." The 



above constituents are uniform as to pre- 
sence, but are so unequal as to quantity 
that, "in the Baltic, a pint of water con- 
tains scarcely two scruples of salt ; on the 
coasts of Great Britain it contains more 
than half an ounce ; in the Mediterranean 
much more, and in some parts under the 
Line, the quantity amounts to more than 
two ounces." " From the beginning of July 
the temperature of the sea is constantly on 
the increase, and during the month of Ati- 
gust it is at the highest, remaining the 
same with very little alteration till Septem- 
ber, when the temperature again becomes 
less. The minimum temperature of the sea, 
for each day, is in the morning before ten 
o'clock, its maximum from twelve to five. 
Other circumstances being the same, the 
temperature of sea-water is observed to be 
higher in proportion to the proximity of 
continents and islands."* Moreover, the 
temperature of the sea on a line of coast is 
modified by the construction of the shore ; 
if this be rocky, rapidly deepening, the tem- 
perature of the sea during summer will be 
lower than it is on a flatter shore, where the 
advancing tide travels over an extent of sand 
warmed by the sun, and vice versa in winter. 

Persons who are unaccustomed to sea- 
bathing, may sometimes find it of service 
to take two or three tepid sea-baths before 
going to the open sea. There is, however, 
no necessity, as some suppose, for a course 
of medicine beforehand, unless the indivi- 
dual is decidedly out of health, and then 
sea-bathing should not be engaged in before 
consultation with a medical man, who may 
give medicine for the existing ailment ; but 
certainly, persons in good health have no 
occasion for preparatory medicine. Indivi- 
duals who are very plethoric, who are the 
subjects of any organic disease, or who have 
any tendenc}' to fulness about the head, also 
aged persons, should not bathe without me- 
dical sanction. 

If a person is in a state of body to benefit 
by bathing, and if the good effects are not 
counteracted by too long immersion in the 
water, the bath should be followed by reac- 
tion, which conveys a sensation of increased 
strength and spirits, a glow of warmth on 
the skin, and increased appetite. If, on the 
other hand, the reaction is tardy, if the skin 
continues cold and blue-looking, if the fin- 
gers and toes become what is called "dead," 
if there is bodily and mental depression, 
with languor and sleepiness, it is certain 
the bathing does not agree, from some cause 
or other. — Refer to Bath. When cold sea- 

* Lee's Batlis of England. 



SEA' 



476 



SEB 



bathing does not agree, or is too depress- 
ing, the tepid sea-bath is often of much 
service, and does not relax like fresh-water 
tepid bathing. 

Sea-water, as might be expected from its 
saline constituents, acts as a purgative. The 
usual dose is half a pint, repeated once or 
twice according to effect. It may be gone 
on with with less risk of depressing conse- 
quences than ai-ises from the use of saline 
aperients generally ; indeed, it exerts a tonic 
influence. In worms, both when taken by 
the mouth and used as an enema, sea-water 
is often useful. "Sea-water has been fre- 
quently taken in habitual costiveness, par- 
ticularly by those of full habit who lead a 
sedentary life. In this instance its stimu- 
lant properties are as useful as its purgative 
qualities. When it is to be given to chil- 
dren, they are easily persuaded to take the 
dose if its nauseous taste be covered with a 
little port wine. It is a curious fact, that 
by the continued employment of sea-water 
as a purgative, although for a short time it 
produces emaciation, yet its secondary effect 
is to promote obesity." 

"It is not easy to account for the fact, 
that no artificial mixture of the component 
parts of sea-water produce a compound of 
powers equal to the natural." "Although 
sea-water cannot be regarded as a purgative 
of much power, yet in some constitutions it 
operates when no other cathartic will take 
effect." "When it fails to purge, which it 
does in some habits, it produces fever of a 
low kind, accompanied with purple spots on 
the skin."* 

SEA-SICKNESS.— See Sickness. 

SEASONS.— The influence exerted by the 
changes of the seasons upon man's health 
and life has been considerably elucidated 
by the researches of different observers, and 
by the statistical returns of this and other 
countries. But it is a subject so much mixed 
up with coincident influences and circum- 
stances, that accurate results are with diffi- 
culty attainable, as, for instance, while 
according to the returns of mortality in 
England, the winter months present the 
greatest average of death, — according to the 
researches of Casper and Quetelet, summer 
is the most fatal season in Stockholm, in 
Montpelier, and in Berlin, and probably 
throughout Central Germany. These dif- 
ferences perhaps depend on local causes. 
Along with this uncertainty, however, there 
are certain general rules of climate connect- 
ed with the seasons, which are well ascer- 
tained ; such, for instance, as the greater 

* Thomson's Materia Medica. 



prevalence of inflammatory attacks, and of 
disorders of the respiratory organs during 
winter and spring ; the frequent occurrence 
of apoplexy during frost, and the epidemic 
of biliary disorder toward the close of sum- 
mer and autumn, after the high temperature 
has permitted the accumulation of carbona- 
ceous compounds in the system. The in- 
fluence of season is of course much less 
felt by the young, the robust, the well-fed, 
clothed, and housed, than by those who are 
exposed to the reverse circumstances. "At 
no period of life is the influence of the sea- 
sons on mortality more perceptible than in 
old age ; and at no age less than between 
twenty and twenty-five, when the physical 
man, fully developed, enjoys the plentitude 
of power."* Of course, much is to be done 
by care, in guarding against the influences 
of climate consequent upon season, both in 
old and young. 

Refer to Clothing — Cold — Heat, §c. 

SEASONING.— See Acclimation. 

SEBACEOUS— Glands or Follicles— 
Are glands situated in the skin, which se- 
crete an unctuous matter ; they are most 
common on the face and about the nose. In 
many persons, especially in those who live 
in towns where there is much smoke, the 
orifices of these glands become black, con- 
stituting what are called "black-heads." 
When these are squeezed, the "sebaceous" 
matter is expelled in a worm-like form, and 
with the black-head at the extremity, from 
its resemblance to a worm, has actually been 
taken for such. The sebaceous matter itself 
is not indeed a worm, but it has within the 
last few years been discovered by Dr. Simon, 
of Berlin, that it is the seat or " habitat" in 
many persons — according to Mr. Erasmus 
Wilson, in all — of a minute parasitic ani- 
mal. According to Mr. Wilson, the animal 
varies from the T ^ T to the ^L of an inch in 
length. There are usually two,' but often 
more, in the small mass of sebaceous matter 
squeezed out of a follicle. Even in the most 
healthy-looking skins they are said to exist, 
not causing irritation unless by accumula- 
tion in undue numbers. 

When irritation takes place in a sebaceous 
follicle, it causes the inflammation and form- 
ation of matter which constitute a common 
pimple. The formation of black-heads is 
best prevented by bathing with warm water, 
and then rubbing the surface well with a 
towel ; frequently, however, the tendency is 
connected with disorder of the digestive 
organs, which requires rectification. 

Refer to Skin. 

* Quetelet, On Man. 



SEC 



477 



SEN 



SECALE CORNUTUM.— See Ergot. 

SECONDARY.— See Primary. 

SECRETION.— This term, as usually ap- 
plied either to vegetables or animals, signi- 
fies the separation of a specific substance 
from the ordinary fluids of the organized 
body. In the stricter acceptation, it is more 
applicable to such processes in animals as 
the secretion of the saliva, gastric juice, 
&c. 

SECUNDINES.— The after-birth and mem- 
branes cast off after the birth of the child. 
—See After-birth— Child- bed. 

SEDATIVES— Are medicines which de- 
press the activity and sensibility of the nerv- 
ous system, without causing previous ex- 
citement ; in this they differ from narcotics. 
There has been considerable diversity of 
opinion respecting the action of sedatives, 
and as to what agents truly belong to the 
class. Prussic acid is usually cited as a 
characteristic example. 

Refer to Narcotics. 

SEDENTARY.— The observations made 
under such articles as Exercise — Motor 
Change, Sfc. $c, render comment upon the 
effects of sedentary habits superfluous. 

SEIDLITZ. — The waters of this well- 
known Bohemian spa owe their aperient 
activity to the presence of Epsom salts, or 
sulphate of magnesia, one hundred grains 
of which are said to be contained in every 
pint of water. It also contains lime in 
small proportion. These qualities are very 
different from those which distinguish the 
commonly used Seidlitz powders. 

SEIDLITZ POWDERS. — These consist 
essentially of two drachms of Rochelle salt, 
mingled with forty grains of carbonate of 
soda in the one paper, and thirty-five grains 
of tartaric acid in the other, usually the 
white paper. Seidlitz powders possess the 
advantages and disadvantages of saline 
aperients generally, except that they are 
pleasanter than most. 

Refer to Effervescing — Purgatives — Salines, 

**■ 

SELTZER-WATER — Is chiefly distin- 
guished by the large amount of carbonic 
acid it contains, in combination with alka- 
line carbonates, such as those of soda, mag- 
nesia, and lime ; it also contains common 
salt. It is useful in some forms of dyspep- 
sia, gravel, &c. &c. It cannot, however, 
be used habitually, as it is by some who 
are in good health, with any apparent ad- 
vantage. 

SEMOLA and SEMOLINA— Both belong 
to the class of farinaceous preparations. 
The former, as made by Mr. Bullock, con- 
sists principally of the gluten of wheat, free 



from the starchy constituent of the grain. 
Its nutritive power, therefore, that is, its 
capability of yielding the plastic elements 
of nutrition, (see Grains,) must be consider- 
ably greater than that of the simple grain. 
Indeed, it must in some degree approach 
animal food in nourishing power. Semola 
may be mixed with soap, or prepared like 
sago, &e. Semolina, also called manna 
croup, a preparation of a Russian grain, is 
less used now than formerly, but forms a 
light nourishment, prepared and used like 
sago. 

SENDING for the DOCTOR.— Under the 
head of Advice, Medical, a few observations 
applicable to the present "subject have al- 
ready been offered : a few more may be ser- 
viceable. In large towns, where distances 
are short and medicines procurable in every 
street, it is generally of less consequence 
for a medical man to be strictly informed 
of the nature of any case of emergency to 
which he is summoned, than it is in the 
country. In the latter, if the case is at all 
an urgent one, or if it is an accident, the 
message should always be either clearly 
given to an intelligent messenger, or sent by 
note, which is the safer plan, giving such 
an idea of the nature of the case as may 
serve to guide the practitioner in taking 
with him remedies or instruments, the im- 
mediate employment of which may save 
much inconvenience to all parties — much 
suffering to the patient, perhaps life. A 
medical man cannot, of course, at all times, 
even from the plainest message, form a cor- 
rect idea of the case he is to meet, but he 
may in many. When a case is one of acci- 
dent or emergency, of course any hour, 
night or day, is the same ; and if medical 
attendance is required, it should be so at 
once ; in other cases, however, much con- 
venience to all parties may be secured by 
messages properly timed. Some persons 
have a habit of putting off till evening send- 
ing for a medical man. This, when it can be 
avoided, is neither just to themselves nor 
to their medical attendant; they get a man, 
jaded perhaps with a day's work, and with 
his energies less alert than in the morning, 
and they also perhaps subject him to un- 
necessary fatigue, which a timely morning 
message might have saved. Of course, cases 
of illness which have appeared slight in the 
morning, may, by becoming much more ag- 
gravated in the lapse of a few hours, and 
especially toward night, call for that at- 
tendance which before seemed unnecessary; 
these are not what are meant, but, in ordi- 
nary cases, it ought to be a rule to let a 
medical man have the message as early as 



SEN 



478 



SEN 



possible in the forenoon. It not only enables 
him to arrange his own business better — 
and, when he is busy, the question of ar- 
rangement is no slight consideration — but 
it renders it probable that his patient will 
be earlier visited. Again, when a message is 
sent, care should be taken that there is no exag- 
geration. 

A portion of the above advice may pro- 
bably surprise some persons, but every me- 
dical man who has been in general practice, 
must have experienced its want, not so much 
among the wealthier classes as among the 
poor; above all, the subject last alluded to, 
that of sending exaggerated messages, re- 
quires notice. The message that a person 
is "dying," or "killed," even in cases of 
comparatively slight, though sudden illness, 
or of an accident, is an extremely common 
one in the country. And although when a 
practitioner has been deceived by such calls 
time after time, he gets more wary, and 
takes them for what they are worth, it may 
occur that the repeated " cry of wolf" will, 
in some instance, cause him unintentionally 
to overlook a case, by turning a careless ear 
to the call which has so often before proved 
untrue. Certain it is, that such is the real 
explanation of some of those cases of ap- 
parent neglect of the poor by medical men, 
which now and then come before the public. 
The general readiness of the members of 
the medical profession to attend to the poor, 
either by engagement or gratuitously, when 
such attendance is really requisite, might 
save them from some of the censure, public 
or private, with which they are occasionally 
visited for such omissions, by those who 
know little of the trials and vexations to 
which they are subjected. 

It is not meant to say, that whenever an 
exaggerated message is brought, it is a wil- 
ful misrepresentation. In many cases, some 
relative or bystander, without waiting to as- 
certain the real state of matters, starts off 
in a fright to the surgeon ; in other in- 
stances, however, among the ignorant, the 
system is one of deliberate forethought, 
under the idea that the medical man will 
make greater haste in attending to his pa- 
tient. It has been shown how, in the long 
run, this defeats its own end, and does mis- 
chief as well. Lastly, some persons send for 
the doctor by irregular channels, through 
third or fourth parties, or by leaving mes- 
sages at houses, &c. ;' this is always uncer- 
tain, and often, by the message being forgot, 
inflicts disappointment. If a medical man 
is really required, send for him direct, soon 
in the day if possible, and, if there is any 
distance to be traversed, by note, giving a 



clear account of the case to which he is 
summoned. 

SENNA. — This most useful purgative is 
the leaf or rather leaves of different species 
of cassia. It is a very old medicine, having 
been used by the Arabians. Senna grows 
abundantly in Northern Africa, from whence 
large supplies are obtained ; it as also culti- 
vated in India, and a considerable amount 
exported thence. The most familiar desig- 
nations of senna are Alexandrian, Tripoli, 
and East Indian senna ; other varieties are 
known in commerce, but not commonly in 
this country. 

Alexandrian senna has the highest gene- 
ral reputation. It is brought chiefly from 
Nubia and Upper Egypt. As imported, its 
long lance-shaped leaves are mingled with 
pods, flowers, leaf-stalks, &c, of the plants, 
with the broad leaves of another description 
of senna, and with the leaves of a plant which 
is not a senna at all. The latter adultera- 
tion, which is always introduced into this 
description of senna to some extent, and 
sometimes largely, goes by the name of 
argel. This leaf may be known from the 
true senna by its being thicker and more 
fleshy-looking, by the absence of the pro- 
minent veins of the true leaf, and by the 
regularity of the leaf, which, it will be seen, 
differs from that of the senna, one side of 
which is more prolonged down the midrib 
than the other. The "picked senna" of 
the shops is chiefly the Alexandrian senna, 
from which the impurities, broken leaves, 
&c. have been removed. 

Tripoli senna closely resembles the above, 
but, probably from more careless gathering 
and packing, the leaves are more broken, 
and the admixture of impurities greater. 
It is cheaper than the picked senna ; but if 
the impurities are not very abundant, the 
mere fact of the leaves being broken up, if 
they appear to be properly dried, does not 
militate against the perfect efficiency of the 
drug ; indeed, it is as good as the other. 

Some varieties of East India senna, such 
as the Bombay, are of but low value, owing 
to being badly prepared ; there is one kind, 
however, the " Tinnivelly senna," which is 
described by Dr. Royle as "well grown 
and carefully picked ; the leaflets of a fine, 
rather lively green colour ; thin, but large, 
being from one to two inches in length, and 
lance-shaped." This kind is now highly 
esteemed, and is rapidly displacing the 
other sorts in many places. " It is mild in 
operation, certain as a purgative, and ope- 
rates without griping." 

Senna, as a purgative, is safe, certain, 
and convenient, and deservedly holds a 



SEN 



479 



SEX 



high place among domestic remedies. It 
is a pure aperient, does not depress or de- 
bilitate, and is admissible in most forms 
of disease, and at all times of life. 
Senna is often accused of griping, but this 
effect generally results from faulty prepara- 
tion, or from the admixture of the Argel leaf 
above alluded to. Senna is generally given 
infused ; if time permits, the infusion may 
be made "with cold vrater, which, in the 
course of a night, will fully extract the 
purgative principles of the leaf. When 
quicker preparation is necessary, the infu- 
sion may be made with hot water, like 
common tea, but should never be boiled; the 
higher the temperature employed in pre- 
paring the senna infusion, the more likely 
is it to gripe. Formerly, an idea prevailed 
that the griping properties of senna de- 
pended on the presence of the leaf-stalks. 
It is erroneous. Additions, such as ginger, 
caraway, &c, are frequently made to senna 
to prevent griping, and saccharine matters 
are often added for the same purpose. The 
inconvenience is better rectified by atten- 
tion in preparing; and no addition covers 
the slight nauseous taste of the drug so 
effectually as a small portion of common 
black tea infused along with it, with or 
without the addition of a little milk and 
sugar. Besides infusion, senna is given in 
the form of confection, and of syrup ; but 
none of these preparations are so actively 
certain as the infusion; and may disorder 
the stomach. 

The common combination of Epsom salts 
with senna infusion, or, as it is called, 
black draught, forms a very active purga- 
tive, but is only suitable for the strong. 
The average dose of senna is a quarter of 
an ounce, infused in rather less than a 
breakfastcupful of water ; this will make 
a teacupful of infusion, and be a suitable 
dose for a child ten years of age. Confec- 
tion of senna, the old "lenitive electuary," 
agrees well with some persons, as an habi- 
tual aperient, particularly if they are liable 
to piles. The dose is two drachms or tea- 
spoonfuls. [The fluid extract of senna is 
far preferable to the old form of infusion. 
It may be taken in doses varying from ten 
drops to a teaspoonful, and in this dose will 
be equal to a teacupful of the infusion.] 

SENSATION and SENSIBILITY.— See 
Nerves and Nervous System. 

Refer to Pain. 

SERUM. — The serum is the watery por- 
tion of the blood, which remains after the 
clot is separated in the process of coagula- 
tion or clotting. The "water" thrown out 
in a blister is the most familiar example 



of serum. While the blood circulates in 
the living body, it consists of the globule 
(see Blood) floating in the "liquor san- 
guinis," or fluid of the blood, which is 
serum holding the "fibrin" in solution. 
When blood is withdrawn from the body, 
and allowed to repose, this fibrin sepa- 
rates, and in the act, entangling the glo- 
bule, forms the red clot, the serum remain- 
ing as yellowish-looking fluid. In this state 
the serum still holds in solution " albu- 
men" and earthy salts; if it be exposed 
to heat, the albumen is separated by co- 
agulation. — See Albumen. The remaining 
watery fluid still contains the salts of pot- 
ash, soda, lime, and iron, which exist in all 
healthy blood. 

SETON. — A seton is usually formed by 
means of a portion of a skein of silk, passed 
under the true skin, so that it excites sup- 
puration ; it is in fact an issue. The sur- 
geon forms a seton by pinching up a fold 
of the skin in which he intends establishing 
it; he then passes the silk through the base 
of the fold by means of a "seton needle," 
made for the purpose, or by cutting the 
skin with a knife, and using a probe to pass 
the silk. Caoutchouc, and other tapes, are 
used for setons as well as silk. In a few 
days after a seton has been introduced, 
there is usually a free discharge of thick 
matter. A seton, to be at all tolerable, re- 
quires the strictest cleanliness, and ought 
to be dressed twice a day, with fresh linen, 
spread with a simple cerate, the silk being 
moved from side to side at each dressing, 
so as to keep up the irritation ; if this does 
not seem to be sufficient, it will be neces- 
sary to smear the silk from time to time 
with some Spanish fly, or savine ointment. 
When the silk becomes hard and stiff it 
must be changed, by attaching the fresh 
silk to the old, and drawing it into the 
wound. 

SEWER.— See Drainage. 

SEX. — With regard to the question of 
sex, in connection with childbirth, there can 
be little doubt that a pregnancy in which 
the child is male is like to be more pro- 
longed than one in which it is a female. 

As regards the relative number of the 
sexes born, the averages for Europe give 
106 boys for every 100 girls. Further, 
according to researches made both in this 
country and in Germany, "on the influence 
of the age of parents on the male and fe- 
male births, it is found that in general 
when the mother is older than the father, 
fewer boys than girls are born ; the same 
is the case where the parents are of equal 
ages ; but the more the father's age ex- 



SH A 



480 



SHI 



ceeds that of the mother's, so is the ratio 
of boys greater."* 

The nearer the sexes approach puberty, 
the greater is the consideration required 
for the different tendencies of constitution, 
and after that period the peculiar differ- 
ences, of the female at least, require con- 
stant consideration. As a general rule, 
females require medicine in smaller doses 
than men. 

SHAMPOOING— Is a system of mecha- 
nical manipulation of various parts of the 
body, for the cure of disease. In rheumatic 
affections, sprains, &c, it is said to be 
useful. The practice is much followed in 
the East. 

SHARE-BONE.— The anterior portions 
of the "ossa innominata." — See Pelvis. 

SHELL-FISH— Generally, are indigest- 
ible, and some, such as the common mussel, 
are at times even poisonous. The poison- 
ous effects of mussels have been attributed 
to the presence of copper, and in some 
instances this metal has been detected in 
the fish which have caused symptoms of 
poisoning; in other cases, however, che- 
mistry could afford no clue to the cause of 
the catastrophe. "It is probable that there 
is an animal poison present." The symp- 
toms produced by mussel poisoning are 
described by Dr. Taylor, as uneasiness, 
and sense of weight at the pit of the sto- 
mach, numbness of the extremities, heat 
and constriction in the mouth and throat, 
thirst, cramps; or with swelling of the 
eyelids, heat and itching of the skin, with 
nettle-rash eruption ; also vomiting and 
diarrhoea, with colic. Emetics, followed 
by sal-volatile, or stimulants, would be 
appropriate treatment. 

Refer to Crab — Oysters, $c. 

SHERRY — One of the dry strong wines, 
contains, as imported into this country, 
rather more than 19 per cent, of alcohol. 
It is free from the astringency of port wine, 
and generally agrees better with persons of 
weak digestive powers. To be good, it ought 
to be free from acid, or nearly so. 

SHINGLES— Is a disease of the skin, 
known to medical men as herpes. It con- 
sists of groups of vesicles situated upon 
inflamed patches of skin. The "breaking 
out" upon the lips, nose, &c, which occurs 
after a cold, is an eruption similar in kind 
to that of shingles-. Shingles is usually 
situated near the waist, surrounding one- 
half of the trunk of the body, like a zone 
or belt : it may, however, extend in other 
directions over the trunk, and, but rarely 



* Quetelet, On Man. 



on the limbs, it is always situated on one 
side, and that, generally, the right. The 
eruption of shingles is generally preceded 
by symptoms of general indisposition, and 
especially by severe darting pain in the 
parts where it is about to appear. At first 
red patches show themselves at the extre- 
mities of the site of the future eruption, 
and gradually become more numerous till 
they form a line — upon these patches shin- 
ing points form, which gradually enlarge 
into vesicles, a little under the size of small 
peas, these vessels containing a clear fluid, 
which gradually becomes opaque. At length, 
in the course of eight or ten days, the vesi- 
cles burst, discharge, and dry off in the 
form of scabs, or it may be, in very weak 
subjects, leaves sores or ulcerations. The 
belief was formerly entertained among phy- 
sicians, and still retains its hold of the 
popular mind, that if the belt of the erup- 
tion of shingles was continued round the 
body, so as to meet, the disease provedfatal. 
This is perfectly erroneous. In itself, shin- 
gles is a disease devoid of danger, but requires 
investigation, on account of its frequently 
being sympathetic of constitutional disorder 
and disease, On this account, although the 
eruption itself may subside under the use 
of simple remedies, a case of shingles should 
be examined by a medical man. 

When the disease occurs in the young and 
plethoric, the diet must be reduced to one 
of milk and farinaceous substances, and all 
sources of heat or excitement avoided. Five 
grains of blue pill at night, followed by 
senna, black draught, or Seidlitz powder in 
the morning, may be repeated once or twice ; 
and, in the course of the disease, if there is 
much fever, five grains each of the carbon- 
ate and nitrate of potash may be taken 
twice or three times a day, dissolved in half 
a tumblerful of water; or the proportion 
of carbonate of potash may be doubled, and 
a teaspoonful of lemon-juice used to form 
an effervescing draught. The painful itch- 
ing of shingles often causes much distress. 
It may sometimes be allayed by simply 
keeping the eruption covered with a cloth 
soaked in tepid water, or by using the com- 
mon lead lotion in the same way. Pencil- 
ling the shingly eruption with a strong 
solution of lunar caustic, as recommended 
in erysipelas, is found to relieve the severe 
pain. 

When shingles occurs in the aged and 
debilitated, instead of the diet being re- 
duced, it requires, perhaps, to be improved ; 
at all events, the system must be sustained 
with nourishing broths, and probably with 
wine, along with quinine and medicinal 



SHI 



481 



SHO 



tonics, the bowels being regulated, but not 
purged. In such cases, however, a medical 
man must be in attendance. Care should 
always be taken that the vesicles of shingles 
are not forcibly burst, as by lying upon 
them ; if they are, troublesome ulceration 
may follow. Herpes is not contagious. As 
above mentioned, it is generally owing to 
constitutional disorder, which a medical 
man only can discover and rectify. Its 
occurrence has been at times apparently 
traceable to violent mental emotion, such as 
anger. In some cases the tendency appears 
to be hereditary. 

SHIP. — At all times, but especially at 
present, when so many hundreds and thou- 
sands are emigrating from England, it is 
to be regretted that stricter supervision is 
not maintained over vessels, in which, for 
the time being, those who have taken their 
passage in them, are utterly powerless, or 
nearly so, as regards abuses, and are obliged 
to submit to whatever arrangement, or, too 
often, want of arrangement, there exists on 
board. Space forbids the subject to be 
entered into here as it deserves ; it has 
been ably treated in a recent number of 
" Household Words." The reader is further 
referred to the article " Emigration," in the 
present work, as containing a few hints on 
the subject. It is reiterated, those who 
contemplate embarking on board ship for a 
long voyage should assure themselves well, 
not only that the vessel is right in a nautical 
sense of the word, but that she is arranged 
and fitted in such a manner that they need 
not fear that health will be injured or sacri- 
ficed during the transit. "While these sheets 
are going through the press, attention is 
drawn in some of the public prints to the 
injurious results from a description of 
"patent fuel," which is carried on board 
some vessels. The matter should not be 
forgotten. 

In addition to the ordinary provisions, the 
following is a list of the supply of "medical 
comforts" which emigrant vessels are bound 
to be provided with for every hundred adult 
passengers. 

56 lbs. of oatmeal. 

20 lbs. of West India arrow-root. 

40 lbs. of Scotch barley, 
100 lbs. of sago. 

20 lbs. of tapioca. 

30 lbs. of preserved boiled beef, in 1-lb. 
tins. 

20 lbs. of preserved boiled mutton, in 1-lb. 
tins. 
400 pints of lemon-juice, in wickered stone 

bottles, of five gallons each. 
300 lbs. of sugar. 

2 O. 31 



24 bottles of port wine. 
12 bottles of sherry wine. 

6 bottles of gin. 
66 gallons of approved stout, including at 
least six dozen in bottles, the rest in 
9-gallon casks. 

5 gallons of brandy. 
15 gallons of vinegar. 
12 dozen pints of preserved milk. 

2 cwt. of marine soap. 

The above medical comforts to be issued 
at the discretion of the surgeon, whether^ 
for the sick, or to preserve health. 

Women, who may be nursing, may have 
a pint of brown stout each day, if ordered 
by the surgeon, and the surgeon is to make 
liberal use of the preserved milk, for keep- 
ing up the health of the younger children. 

SHIVERING— As a symptom of illness, 
is the sensation as of cold, which all must 
have experienced at the commencement of 
even a slight cold or ailment. When it 
amounts to actual shaking of the limbs and 
chattering of the teeth, it is called rigor. 
The cause of the sensation of shivering is 
probably from the nervous system. 

Shivering, or rigor, is a symptom which 
frequently accompanies the formation of 
pus or matter within the body, in the course 
of inflammatory disease. 

SHOCK — In medical language, is the de- 
pressing impression imparted to the nerv- 
ous system, and through it to the constitu- 
tion generally, as a consequence of severe 
pain or injury. The extent of the shock, its 
duration, and even its fatality, often depends 
more upon the part or organ through which 
it is received, than upon the actual extent 
of the living body injured, or the pain suf- 
fered. Thus, a comparatively slight blow 
over the region of the heart, upon the pit of 
the stomach, or on the neck, in all which 
situations nerves are collected in numerous 
interlacements, is apt to be followed by im- 
mediate, and it may be, fatal shock. The 
depression of the system which follows a 
blow on the head is of a similar nature. 
Again, injuries which involve large portions 
of the body in destruction, which cause 
severe pain, or much effusion of blood, are 
all followed by shock. This is, or rather 
was, one of the principal hazards of severe 
surgical operations ; was, for the introduc- 
tion of chloroform, and of other aneesthetic 
agents, has in a measure done away with 
this hazard, and in doing so must already 
have saved numbers of lives — numbers 
which would far outweigh the few instances 
of death which have been attributable to 
the use of these most merciful alleviators 
of human suffering. 



SHO 



482 



SHO 



When an individual suffers a shock from 
any of the causes above enumerated, he 
may die at once, as sometimes occurs from 
a blow on the pit of the stomach ; life, as it 
were, is simply extinguished. But if the 
shock is not of this immediately fatal kind, 
the person becomes pale, perhaps falls to the 
ground, and, it may be, vomits — conscious- 
ness is partly or entirely suspended, and 
the action of the heart suppressed, till it is 
all but imperceptible. This state of shock 
may be recovered from in a few minutes, or 
it may continue for many hours, and termi- 
nate either in recovery or death, its duration 
depending on contingent causes, often on 
the fact whether there has been much effu- 
sion of blood or not, along with the injury. 
In some cases of shock, in which severe pain 
has been suffered in the first instance, it 
appears as if the intense suffering had an- 
nulled the sensations of the nervous sj^stem, 
the sufferer undergoing even the most severe 
operations apparently without feeling. This 
is always a most fatal symptom. The im- 
mediate treatment of a person who has suf- 
fered a shock is similar to that recom- 
mended in cases of fainting, and of concus- 
sion of the brain, with the same precaution 
as to the use of stimulants. When the state 
of shock continues, stimulants by the mouth, 
although required to be gone on with, must 
not be too strongly pressed ; it is impossible 
to lay down any rule beyond that of cau- 
tious administration. Ammonia in different 
forms, the ethers, and the most readily pro- 
curable alcoholic stimuli must be employed ; 
but along with these should be joined the 
stimulation of heated fluids, of stimulant 
clysters, and of heat applied externally ; the 
latter, especially, is most useful on account 
of the continued coldness of the surface, 
and especially of the extremities, which ac- 
companies such cases. Above all, any inju- 
dicious interference or movement during the 
first state of shock must be avoided, as 
likely to extinguish whatever remains of 
struggling vitality may be left. The absurd, 
almost murderous practice which formerly 
prevailed, of surgeons, whenever called to 
a case of accident, bleeding the patient, has 
already been alluded to. — See Blood. What- 
ever is requisite to be done for the treat- 
ment of the injuries of a person in a state 
of shock, should, if possible, be delayed till 
at least some effort has been made by the 
use of stimulants to vouse from the state 
of depression. In alluding to the shock sus- 
tained by the wounded on the field of bat- 
tle, Mr. Hennen, in his Military Surgery, 
remarks, "Many lives might be saved, and 
the patients placed in a more favourable 



condition for undergoing primary opera- 
tions, by the early administration of a small 
quantity of wine." 

Refer to Pain. 

SHORT-SIGHT.— See Vision. 

SHOULDER.— The shoulder, in addition 
to the muscles and other soft parts, by which 
it is surrounded, is made up specially of the 
three bones, the shoulder-blade, or "sca- 
pula," (fig. cxvi. 1,) the "clavicle," or collar 
bone, (2,) and the "humerus," or arm bone, 
(see Humerus,) the round head of which (6) 
fits to the cup (5) of the shoulder-blade (see 
Tig. cxvi. 




Skeleton) to form the shoulder-joint. — See 
also Ligament. The upper ribs (4) may also 
be considered as entering into the forma- 
tion of the shoulder region generally. The 
whole formation and adaptations of this 
most important part of the body are singu- 
larly beautiful, made so as to give the most 
extensive motion, and yet that fixedness and 
steadiness of action, by which those most 
perfect agents — the human arm and hand 
— of that most wonderful instrument — the 
human mind — are so specially adapted to 
fulfil the ends of the Creator of each. By 
means of the collar bone (2) bearing at the 
one extremity on the breast bone (3) and at 
the other upon a projection of the shoulder- 
blade, the shoulders are kept extended or 
"squared." It is this squaring of the 
shoulders which causes the chest to appear 
broader at the superior than at the inferior 
portion, whereas, in itself, the cavity of the 
chest is conical, the narrowest part above. — 
See Chest. The comparatively loose attach- 
ment of the great body of the shoulder- 
blade to the trunk admits of much freedom 
of motion, while the fullest extent of move- 
ment is secured to the arm itself by the 
nature of the shallow ball-and-socket joint, 
formed by the head of the arm bone, (6) and 
the shallow cup of the blade bone, (5.) The 
shallowness of the cup, however, which is 
requisite to admit of this free movement, 



SI A 



483 



SIL 



renders the head of the arm bone, in some 
degree, liable to displacement or disloca- 
tion more frequently than other bones of 
the body. 

Refer to Dislocation — Fracture — Clavicle — 
Ligament — Skeleton — Axilla, §c. 

SIAL AGOGUES— Are medicines which in- 
crease the flow of the saliva, when they are 
chewed, such as horse-radish, ginger, &c. 
They are rarely prescribed. 

SICKNESS.— See Vomiting. 

SICKNESS, SEA.— The primary cause of 
the distressing affection, sea-sickness, has 
been a good deal disputed, but its depend- 
ence upon peculiar affection of the brain, 
by the motion of the vessel, seems now very 
generally admitted. It has been imagined 
that the effect upon the brain was conveyed 
through the medium of the eye, and caused 
by the apparent movement of the objects of 
sight ; as, however, blind people suffer from 
sea-sickness, the affection must be excitable 
by other means than the above. Possibly, 
as has been suggested, it partly results from 
disturbance of certain portions of the brain, 
which have for their function the preserva- 
tion of the equilibrium of the body. That, 
however, sight is in some degree accessory 
to the excitement of nausea is evident from 
the fact that some persons experience the 
sensation simply from objects appearing to 
move before them, as they do from a ship 
moved by the waves, or, indeed, in some 
cases by the mere appearance of a waving 
pattern upon a wall-paper. The affection 
is more readily caused by long heaving 
waves, than by a short rough sea. The 
best preventives of sea-sickness seem to be 
the horizontal posture, as near the centre 
of the vessel, and therefore the centre of 
motion, as possible — that is, where the mo- 
tion is least. Exposure to the open air 
renders the liability less. Stimulants, com- 
bined with sedatives, certainly appear to 
have considerable effect in preventing or 
alleviating the affection. A pill, composed 
of four grains of cayenne pepper, with two 
or three of extract of henbane, taken at 
intervals, may be found useful. Creasote 
is also an excellent antidote. — See Creasote. 
Some persons find themselves less liable to 
sea-sickness if they take food freely — with 
others the reverse is the case; the effect 
probably depends upon the state of the di- 
gestive powers of the stomach, temporary 
or permanent. If these are vigorous, the 
excitement of digesting food acts probably 
as a counter-agent to the cause of the 
nausea. Sea-sickness, of itself, is rarely 
injurious, but it should be a subject of con- 
sideration with persons who are liable (or 



likely to be) to head-affection, who are the 
subjects of rupture, prolapsus, &c, how far 
they should incur the risk of these being 
aggravated by the mechanical action of 
vomiting. Some who do not suffer from 
sickness while on the water, experience 
nausea and other uncomfortable sensations 
after landing — an effect, doubtless, due to a 
partial disturbance of the digestive organs, 
and probably to biliary disorder. One or 
two doses of compound colocynth, or com- 
pound rhubarb pill, will generally remove 
the inconvenience. 

SIDE — Pain in the Side. — This very 
common affection arises from a great variety 
of causes. If situated high up, in the re- 
gion of the chest, it may be occasioned by 
inflammatory affection of the lungs, but in 
this case will be accompanied with more or 
less fever, and other symptoms indicative 
of the disorder. — See Lungs. It may, how- 
ever, be caused in the same situation by a 
kind of rheumatism or neuralgia of the 
muscles connected with the ribs. In this 
form there is not, generally, fever, and the 
usual signs of affection of the lungs are 
absent; the pain, moreover, is much more 
liable to aggravation by pressure externally, 
and by slight movement, than that of inflam- 
mation of the lungs. The affection requires, 
chiefly, the local treatment of rheumatism ; 
bran-poultice, and anodyne and turpentine 
liniment. The above pains may, of course, 
occur on either side of the chest. Pain on 
the right side, lower down, may be owing 
to affection of the liver, (see Liver ;) on the 
left side to affection of the spleen. — See Ab- 
domen — Spleen. Pain on the left side, how- 
ever, often occurs as a sympathetic affection, 
sometimes of the heart or lungs, in either 
sex. It is most common in females, and is 
then very often sympathetic of disorder, 
functional or otherwise, of the womb. Any 
person becoming the subject of continued 
pain in the side, should have the cause in- 
vestigated by a medical man. 

SIGHT.— See Vision. 

SILK. — Some persons who, from irrita- 
bility of the skin, cannot wear woollen ma- 
terial next it, find a woven silk texture a 
good substitute. 

SILVER. — The only preparation of this 
metal much used in the practice of me- 
dicine is the nitrate of silver, or lunar 
caustic, and this principally as an external 
application ; it is, however, given internally 
by medical men. For convenient use as a 
caustic, nitrate of silver is cast in the form 
of small cylindrical sticks, which are carried 
generally in silver, or silver-gilt holders ; 
the best having a "quill" of the metal 



SIN 



484 



8KB 



called palladium, to hold the caustic, it 
"being found that in time the nitrate of sil- 
ver acts chemically upon the metallic silver 
of the holder. Cheaper holders of glass, 
gutta-percha, &c, are made. When nitrate 
of silver, in the least degree moistened, 
touches the body, it acts as a corrosive, and 
on the skin leaves a deep brownish or black 
stain, which is only removed as the outer 
skin is worn off and renewed in course of 
time ; or, if it is applied early, by hydrio- 
date of potash. If, however, the caustic 
be rubbed on the skin it will probably cause 
blistering. The modes of using nitrate of 
silver being pointed out in the different 
articles, such as Erysipelas, Whitlow, &c. 
&c, it is unnecessary to repeat them here. 
Oxyde of silver has lately been brought 
prominently before the medical public by 
Sir James Eyre ; as a remedy in some forms 
of stomach affection and of menorrhagia 
the author has found it useful. It is not a 
remedy for domestic administration. 

SINAPISM.— A mus- 
tard-plaster or poultice. 
— See Mustard — Counter- 
irritation. 

SINGING— Is open to 
the same objections, to 
the delicate-chested, as 
reading aloud, to the re- 
marks on which the 
reader is referred. 

SINKING.— The sensation of "sinking" 
at the pit of the stomach, is a nervous one, 
generally connected with disordered diges- 
tion, and often with overloaded bowels. 
Persons are too apt to have recourse to 
stimuli for its removal, which would often 
"be better effected by the use of an aperient, 
and by regulation of the digestive organs. — 
See Indigestion. 

SINUS — In anatomy, is a depression, or 
cavity, or covered tract. The large veins 
within the skull, which are partly formed 
by depressions in the bone, are named 
sinuses. In surgery, a sinus is a canal, the 
result of disease, leading from a diseased 
part. 

SKELETON, HUMAN.— The human ske- 
leton is that wonderful frame-work of bone, 
which gives support to, and to which are 
attached the various soft parts of, the body. 
It cannot truly be said that a skeleton is a 
beautiful object, in the usual sense of the 
term beauty. But the term beautiful is 
well applicable to the adaptation of the va- 
rious parts to one another, and to the man- 
ner in which they subserve the object of 
their existence. When, moreover, the con- 
nection of the different portions of the 



skeleton by means of the ligaments, and 
the action, and mode of action simple and 
combined, of the various muscles of the 
machine at large, are considered ; when we 
regard the protection given by the bones to 
important parts contained within the ca- 
vities, and to the blood-vessels in the limbs ; 
the strength, and yet comparative lightness 
of the whole fabric ; and lastly, the powers 
of reparation after injury, the word beau- 
tiful, in another sense, is that which really 

Fig. cxvii. 




expresses the admirable perfection of the 
structure. 

The entire skeleton consists of two hun- 
dred and forty-six different bones. As the 
descriptions of the most important of these 
are given in the separate articles, it is un- 
necessary to do more here than to poinf 



SKI 



485. 



SKI 



them out by name on the figure, (cxvii.) on 
the preceding page. 

1. The skull, or face bones, including the 

lower jaw. 

2. The spine, composed of the vertebree, 

which supports the head, and rests 
on the pelvis. 

3. The collar bones, or clavicles. — See 

Shoulder. 

4. The ribs. 

5. The breast bone, or sternum. 

6. The shoulder blade, or scapula. 

7. The arm bone, or humerus. 

8. The forearm bones, or radius and ulna. 

9. The wrist bones — eight in number, also 

called the carpal bones. 

10. The hand, and finger bones, also called 

the meta-carpal bones. 

11. The pelvis, or pelvic bones. 

12. The thigh bone, or femur. 

13. The knee cap, or patella. 

14. The leg bones. The larger, the tibia. 

15. The smaller, the fibula. 

16. The tarsal bones, seven in number. 

17. The foot and toe bones, also called the 

meta-tarsal bones. 
- The bones above mentioned do not nearly 
make up the number of two hundred and 
forty-six. To do this, must be added the 
small bones of the ear, the teeth, a de- 
tached bone, the " hyoid," situated near the 
base of the tongue, and sundry of what are 
called sesamoid bones, which are found 
regularly in the tendons of certain muscles, 
such as those of the thumb. 

SKIN. — No less wonderful than the bony 
frame-work of the human body, which we 
have just considered, is the covering of that 
body, the skin, which, while it protects, 
and retains in place the various parts, 
serves, also, most important purposes in the 
animal economy. 

The skin consists of two distinct forma- 
tions, the "epidermis" or cuticle, or scarf 
or outer skin, (figs, cxviii. 1, cxix. 1,) 
and the "derma." "Cutis," or true skin, 
(fig. cxviii. 2.) The skin is continuous with 
the mucous membranes at the openings of 
the various cavities, such as the mouth, 
nose, &c, its epidermis corresponding to the 
epithelium of the membranes. 

The epidermis is a thin, semi-transparent 
membrane, which is extended over the sur- 
face of the true skin of the body. Appa- 
rently, it is without structure, and indeed 
was long considered to be simply an exuda- 
tion which became hardened by exposure to 
the air. It is now known to consist of re- 
gular series or layers of cells, (fig. cxix. 1.) 
The outermost layers of these cells, which 
are exposed to general contact, and to the 
2 Q2 



Fig. cxviii. 




Fig. cxix. 



Fi.?. cxx. 



influence of the atmosphere, are compara- 
tively hard, and are flattened as repre- 
sented, becoming less flat, and softer, in- 
ward, (fig. cxix. 1,) as the surface of the 
true shin is approached, at which point the 
cells are quite soft and granular. This soft 
layer of the epidermis used formerly to be 
regarded as a distinct portion of the skin 
structure, under the name of "rete muco- 
sum." The intermixture, in this layer, of 
"pigment cells," that is, cells containing 
colouring-matter, gives the varied hues to 
the skin of different races, as most strongly 
exemplified in the negro ; and the appear- 
ance of freckles originates from the same 
cause. On the surface of the epidermis, 
the flattened cells lie over one another, as 
represented, (fig. cxx. 2,) — the outermost 
becoming continually detached and worn 
off. When these detached scales are re- 
tained, as by the hair, or by the clothing, 
they constitute what is called scurf or dan- 
druff. The epidermis is, as all are aware, 
insensible. It varies considerably in thick- 
ness on different parts of the body, even 
at birth, being much thicker on those, such 
as the heel, back, &c, which naturally re- 
quire greater protection. It, however, be- 
comes immensely thickened on any portion 
of the body which is subject to continual 
pressure or friction. Of this, the hand of 
every workman is an example. The ap- 
pearance of the skin, as are all aware, varies 
according to age, from the soft skin of the 
infant, or of the bloom of youth, to the flac- 
cidity and wrinkles of age. Constitution,, 



SKI 



486 



SKI 



also, exerts much influence over the appear- 
ance of the skin. — See Complexion. 

The "cutis vera," or " derma," or true 
skin, which lies underneath the cuticle, (fig. 
cxviii. 2,) is much thicker than the latter. 
It consists chiefly of areolar tissue, that is, of 
interlacing fibres, which inclose the Tblood ves- 
sels (3), nerves, &c. which make up the sub- 
stance of the covering. The true skin, being 
abundantly supplied both with blood-vessels 
and nerves, is extremely sensitive, so much 
so indeed as to require the protection of the 
cuticle as a necessity. All are aware of the 
painful sensibility of the true skin, when 
the outer skin has been abraded.' At its 
surface, where it is in contact with the 
cuticles, the true skin is elevated into little 
eminences, or "papillge ;" these are most 
manifestly developed, on the pulpy extremi- 
ties of the fingers, and on other places where 
sensation is acute, each papilla being re- 
ceived into a corresponding hollow in the 
soft granular layer of the epidermis. 

The deeper layer of the true skin is com- 
posed of interlacing fibres, already men- 
tioned, and with these are mingled elastic 
fibres, and a peculiar form of muscular fibre, 
the latter being evidenced in action by the 
occurrence of what is popularly called goose- 
skin. The deeper layer of the skin inter- 
nally rests upon the cellular tissue, fat, &c. 
beneath. 

Were the skin required simply for an 
elastic, sensitive, and complete covering to 
the body, the structures already mentioned 
might have been sufficient ; but it has other 
functions equally important to perform, for 
which provision is made over its wide ex- 
tent of surface. The most important per- 
haps of these functions is the discharge 
of the perspiration which is going on con- 
tinually. The perspiration is not, as might 
be thought, a simple exudation of fluid 
through the skin, but is a regular secretion 
and excretion from the blood, by means of 
innumerable small glands (figs, cxviii. 4, 4, 
and cxix. 2) which are situated in the deep 
layers of the true skin. These " sudipa- 
rous" or sweat-glands are composed, as 
represented, of a rounded extremity formed 
by the convolutions of the tube, which opens 
to the surface by means of a spiral duct 
about a quarter of an inch long. This duct, 
in many situations, makes its exit on the 
surface of the cuticle, obliquely, (fig. cxix. 
2,) in such a manner-that it has, as it were, 
a valvular covering : it does not pierce the 
cuticle, but this latter membrane is con- 
tinued down into it as a lining. In addi- 
tion to these perspiration glands, the skin 
is furnished with another set of excreting 



agents, ^ which closely resemble the above, 
but which are named the "sebaceous," or 
oil-glands, (fig. cxviii. 5, 5.)— See Sebaceous. 
The office of these glands is to separate 
certain matters from the blood, and to ex- 
crete them in the form of an oily matter 
from the skin, which oil or grease, although 
it is doubless an excretion, serves also to 
lubricate the skin, and to preserve it from 
cracking from dryness; on this account, 
probably, the sebaceous glands are more 
abundant in the skins of natives of warm 
climates, to shield them from the drying 
effect of the heat. The sebaceous glands 
have been already alluded to under the 
article sebaceous ; they are often lobular 
in structure, frequently communicate with 
one another by a common duct, and in such 
situations as the scalp, one or two of them 
open into each hair follicle, (fig. cxviii. 6.) 
As already mentioned, the skin, in addition 
to the above, contains blood-vessels and 
nerves abundantly ; it also contains absorb- 
ent vessels. The number of sebaceous and 
sweat glands, particularly of the latter, is 
almost innumerable, and some curious cal- 
culations have been made respecting them, 
by Mr. Erasmus Wilson, the well-known 
writer upon the skin, who says, "I counted 
the perspiratory pores on the palm of the 
hand, and found 3528 in a square inch. 
Now, each of these pores being the aperture 
of a little tube about a quarter of an inch 
long, it follows, that in a square inch of 
skin on the palm of the hand there exists a 
length of tube equal to 882 inches, or 73J 
feet." " To obtain an estimate of the length 
of the tube of the perspiratory system of 
the whole surface of the body, 2800 may 
be taken as a fair average of the number of 
pores in a square inch, and 700, conse- 
quently, of the number of inches in length. 
Now, the number of square inches of sur- 
face in a man of ordinary height and bulk 
is 2500 ; the number of pores therefore, 
7,000,000, and the number of inches of per- 
spiratory tube 1,750,000, that is 145,833 
feet, or 48,600 yards, or nearly twenty-eight 
miles." 

From the above exposition of the perspi- 
ratory system, the reader will be prepared 
to learn that the skin is often the most 
abundant excretor of fluid in the body, 
exceeding in this, except under particular 
circumstances, even the kidney, and also 
the lungs. According to the most generally 
trusted experiments, it is found that the 
average amount of watery fluid exhaled 
from the lungs and skin of the human 
body in twenty-four hours, at an ordinary 
temperature, is about fifty-four ounces, of 



SKI 



487 



SKI 



which amount, thirty-three ounces are at- 
tributable to the skin, the remaining twenty- 
one to the lungs. This excretion of fluid 
is capable, however, of being largely in- 
creased, and it is an ascertained fact that 
a stout man undergoing strong muscular 
exertion, under high temperature, has, in 
an hour, lost as much as five pounds weight. 
The perspiration thus depends greatly upon 
the external temperature of the atmosphere ; 
it is, however, considerably influenced by 
conditions of bodily health. Under ordi- 
nary circumstances, perspiration takes place 
insensibly, that is, in the form of vapour, 
which, passing off into the air as it is thrown 
out, gives no palpable indication of its pre- 
sence ; if, however, it is confined, as by an 
inverted glass, on the skin, a deposition of 
moisture at once occurs upon the glass. 
When the perspiration is so rapidly thrown 
out that it cannot be at once evaporated 
from the surface, it takes the form of sen- 
sible perspiration, or sweat, in greater or 
less abundance. It is evident, that when 
the external air is greatly laden with moist- 
ure, the perspiration will be much less 
quickly evaporated, and consequently much 
sooner evidenced than under the reverse 
circumstances. Moreover, as the kidneys 
alternate in some measure with the skin, 
in the excretion of fluid, influences which 
increase the one must diminish the other, 
as in hot countries the cutaneous moist- 
ure is much increased "and the flow of urine 
lessened. 

There is no doubt that the evaporation of 
the perspiration is one great means of keep- 
ing the temperature of the body down to 
its proper level under exposure to heat ; 
indeed, this is the secret by which persons 
have been able to endure, without injury, 
the heat of an oven of sufficient intensity 
to cook meat. It is not, however, a mere 
exudation of simple water which takes place 
in perspiration: the mixed fluid which is 
thrown out from both the sweat and the 
oil glands, contains a considerable amount 
of free acid — lactic acid — and of salts, car- 
bonates of soda, lime, and ammonia, mu- 
riatic acid, &c. To these must be added 
carbonic acid and nitrogen, which have also 
been proved to be excretions from the skin. 
According to Andral, the sweat is always 
acid, the sebaceous secretion alkaline, the 
predominance of one or other giving the 
characteristic chemical reaction. 

Simple reasoning might be enough to 
convince that the extensive perspiratory" 
apparatus spread over so large an extent 
of skin, and in such active operation, must 
subserve some very important offices in the 



animal economy. Moreover, the injurious 
effects of which all are aware, as the conse- 
quences of having this secretion suddenly 
interfered with, prove, that these offices are 
intimately connected with the health of the 
system generally ; and, lastly, direct experi- 
ments have added to the proof. The experi- 
ments alluded to are those of M. Fourcault, 
who demonstrated that if the transpiration 
of the skin of living animals was prevented 
by means of a coating of varnish, they 
speedily either died in a state resembling 
suffocation, or became the subjects of inter- 
nal congestions of blood, especially of the 
liver. In addition to its excretory func- 
tions, the skin is endowed with the reverse, 
becoming at times a medium for absorption 
of fluids, gases, or other substances into the 
system. The fact of gases being absorbed 
by the skin, adds to the importance of the 
body being surrounded by pure air ; in fact, 
by some it is thought that noxious effluvia, 
malaria, &c. are more readily absorbed into 
the constitution through the skin than 
through the lungs. If the body be im- 
mersed for some time in a tepid bath, it 
gains weight by absorption of water, and if 
thirst has existed it is relieved. Certain 
medicines, again, such as mercury, Spanish 
flies, rhubarb, &c, affect the constitution 
through the skin. Probably, as suggested 
by Dr. Combe, even matter which has been 
once cast out by the skin may be reabsorbed 
by it, and cause disease. 

Enough, perhaps, has now been said to 
demonstrate to all of what immense import- 
ance the functions of the skin are to the 
animal system ; to show, that while this most 
perfect structure fulfils the palpable office 
of a protector and coverer of the entire sys- 
tem, it constitutes one of the great channels 
by which used-up and therefore noxious 
matters are cast out from the blood — a chan- 
nel, too, which cannot be interfered with 
without its internal coadjutors, the liver, 
the bowels, the kidneys, the lungs, one or 
all of them suffering. 

Again, if it is reflected that every moment 
of our lives this exudation through the skin 
is going on, that while the watery fluid es- 
capes, it leaves the solids, the salts, the 
acid, the grease behind, mingled with the 
scales and scurf of the epidermis, and, added 
to this, the dust, &c, which must adhere to 
the skin, it will give some little idea of what 
there is to remove from the skin to keep it 
commonly clean — still more to keep it in that 
state of healthy activity and freedom which 
is requisite for. health. 

The "appendages" of the skin are thf 
hair, nails, &c. 



SKI 



488 



SKI 



Refer to Ablution — Absorption — Hair — 

Ty /77V9 

SKIN, DISEASES OF.— The diseases and 
disorders to which an organ — as it may be 
called — like the skin is liable, must neces- 
sarily be numerous. It is exposed, not only 
to many influences from without, to atmo- 
spheric vicissitudes, to the effects of neglect 
and dirt, of contagion and accident, but it 
is also liable to influences from within, aris- 
ing from those internal organs with which 
it is so intimately connected, both sympa- 
thetically and in function, and it is excited 
by altered conditions of the blood, for which 
it performs such important offices. 

Very various classifications of skin dis- 
eases have been made by different authori- 
ties on the subject, with the view of facili- 
tating their distinction from one another, 
and their treatment. In the following slight 
sketch, the author has adopted the divisions 
best calculated to give a clear general idea 
of the subject; to attempt more would be 
quite at variance with the character of this 
work. 

The exanthemata, or eruptive fevers, in- 
clude measles, scarlet fever, small-pox, cow- 
pox, and chicken-pox, some of the most im- 
portant affections connected with the skin, 
which have already been noticed under their 
separate articles. Many other eruptive dis- 
eases are accompanied with febrile symp- 
toms, but not of such marked peculiarity 
and uniformity as those which characterize 
the above. Some authors, however, include 
in the class of eruptive fevers, erysipelas 
and erythema — nettle-rash and rose-rash. 

Nettle-rash cannot be better described 
than as an eruption which closely resembles 
nettle-stings, both in appearance and in the 
sensations it gives rise to. When acute, it 
is generally accompanied with more or less 
fever. The nettle-rash, in almost all cases, 
arises from disorder of the digestive organs, 
caused either by indigestible food, or in 
some persons by particular kinds of food. 
Kernels or seeds, such as almond, peach, 
&c, which contain prussic acid seem espe- 
cially apt to cause nettle-rash, and in some 
individuals even the pips of an apple have 
been known to produce the disorder. Fish, 
particularly shell-fish, or mushrooms, also 
bring it on; also certain medicines, such as 
turpentine ; teething, hurry and agitation 
of mind in adults, and other irritations, also 
give rise to nettle-rash. The generally 
known causes of this affection indicate the 
remedy — the removal from the alimentary 
canal of offending matters. If there is a 
tendency to sickness, and if the eruption 
appears soon after a meal, an emetic is 



the appropriate remedy ; but whether this 
is administered or not, an aperient should 
be given. As acid in the bowels often ac- 
companies the condition, a dose of magne- 
sia with rhubarb is very suitable, or some 
other antacid may be had recourse to, and, 
afterward, castor-oil. External remedies 
are comparatively of little service in the 
acute forms of nettle-rash. A lotion com- 
posed of carbonate of ammonia and sugar of 
lead, of each one drachm, in half a pint of 
distilled or rose-water, will give relief. Dr. 
Watson recommends flour dusted over the 
surface. If nettle-rash takes a chronic 
form, that is, continues, and keeps recur- 
ring, after the use of such mild aperients as 
recommended above, and after regulation of 
the diet, the case should be seen by a medi- 
cal man. 

Rose-rash occurs both in children and 
adults, in the form of rose-red patches of 
various sizes, somewhat resembling measles 
in many cases, but of a redder hue. The 
disease is generally accompanied with some 
slight constitutional disorder or fever, but 
the symptoms differ from those which ac- 
company measles. It is devoid of danger, 
and generally subsides after the adminis- 
tration of a simple aperient. If either rose- 
rash or nettle-rash are thought to be con- 
nected with teething, the gums should be 
scarified. 

A class of skin diseases is called "papu- 
lar." They consist essentially of the eleva- 
tion of minute "papulae," or points, upon 
the surface. To this class of diseases belongs 
the "red gum" of infants ; also, two other 
diseases, named lichen and prurigo, which 
are both extremely troublesome, from the 
intense itching with which they are accom- 
panied, and the obstinacy with which at 
times they resist treatment. The affection 
named prickly heat, described in a former 
article, is a species of lichen ; and a some- 
what similar affection occurs in England 
in hot summers. The general directions as 
to diet, &c. given in the above article, may 
be useful when the affection occurs. Tepid 
baths, with or without the addition of vine- 
gar, or sponging with water, to each pint of 
which a drachm of diluted sulphuric acid 
has been added, may be tried as a tempo- 
rary relief to the itching. 

The vesicular class of skin diseases (see 
Vesicle) includes chicken-pox and cow-pox, 
which also may be classed with eruptive 
fevers; also shingles and similar "herpetic" 
eruptions. — See Shingles. One of the vesi- 
cular eruptive diseases, "eczema," "crusta. 
lactea," has its frequent site upon the scalp 
and face. — See Scalp. The class of "pustu* 



SKI 



489 



SKU 



lar" eruptions (see Pustule) also comprises 
various scalp diseases. In many of. the 
affections of this class, however, the pustu- 
lar eruptions extend over various portions 
of the body. 

The class of "bullse" are characterized 
by the development of "blebs," or small 
blisters, which resemble those occasioned by 
a scald, or by the use of a common blister. 
This form of skin disease is generally asso- 
ciated with great debility of constitution. 

The " scaly" diseases of the skin are 
many of them extremely obstinate, and 
sometimes resist every form of treatment. 
Of these, "lepra" is characterized by ele- 
vated, scaly, circular patches, distributed in 
greater or less number over the skin. It is a 
disease totally distinct from the "leprosy" 
of the Jews and other ancient nations. Tu- 
bercular diseases of the skin are equally dif- 
ficult to get rid of. Stains, mother-marks, 
or " nsevi," freckles, &c. are all included 
in the category of skin affections ; they are 
noticed under other articles. 

No description could possibly enable an 
unprofessional person to distinguish one 
chronic skin disease from another, nor would 
it answer any good purpose if the knowledge 
could be imparted. These affections are, in 
a majority of instances, indicative of some 
peculiar disordered condition of the blood, 
or of the digestive processes, primary or 
secondary, which require the strictest inves- 
tigation of a medical man, and, probably, a 
long continued course of treatment — even 
under the best directed remedial measures, 
they often prove intractable. Very many 
chronic skin diseases are connected with 
debility, and, of course, when such is the 
case, tonic remedies are useful ; a smaller 
proportion are owing to a plethoric state of 
the constitution ; some appear hereditary, 
and others are connected with the venereal 
taint. Whatever the case be, however, those 
who suffer may be assured that their best 
^course will be at once to put themselves 
tinder proper medical advice, and, if they 
can, under the advice of a practitioner who 
has made the skin a department of special 
study. Above all things, let sufferers be- 
ware of quack ointments, lotions, and the 
like ; they may inflict upon themselves irre- 
parable injury. In the event of any delay 
occurring before advice is procured, if the 
system is full and inclined to fever, low diet 
is advisable, and one or two gentle mercu- 
rials, followed by a saline aperient, may be 
taken with advantage. If the system be 
debilitated, while all sources of heat and 
irritation are avoided, nourishing diet should 
be taken, and the bowels regulated. When 



milk diet agrees, it is very suitable in many 
chronic skin affections, and there are few in 
which tepid bathing does harm; it clears 
the skin of any irritating matter, while it 
soothes ; it is, at all events, generally agree- 
able to the feelings of the patient. Another 
reason for the enforcement of tepid bathing 
is the fact that, although as stated above, 
very many, perhaps the majority of skin 
diseases are connected with constitutional 
disorder, some are almost entirely due, and 
others much aggravated by inattention to 
cleanliness, among certain classes. — See Ab- 
lution — Ski?i. 

It has been stated that the majority of 
skin diseases are of constitutional origin, 
and such is the case ; some, however, are 
not so. Itch, probably, is simply due to the 
presence of the insect ; and the form of 
skin disease — eczema — from which grocers, 
bakers, and others suffer, from handling 
flour, sugar, &c, is undoubtedly local. The 
last-mentioned cases will generally get well 
if the hands are protected from the irritating 
substance, and soothed by tepid bathing. 
If the eruption is obstinate, the ointment of 
red oxyde of mercury, ten grains to the 
ounce of lard, is of service. 

SKULL. — The skull (fig. cxxi.) contains 
the brain, and forms the support of the 
Fig. cxxi. 




features, and organs of the special senses. 
It is composed of twenty- two separate bones ; 
of these, eight are devoted to the cranium 
or brain-case alone: the remaining fourteen 
are the bones of the face. These bones, 
with the exception of the lower jaw, are 
united by means of joinings, named "su- 
tures." In one form of suture the margins 



SKU 



490 



SKU 



of the different bones are, as it were, 
toothed, (fig. cxxi. 1, 2,) the toothed edge of 
one fitting into the indentations of another. 
At fig. cxxi. 1, is seen such a suture, which 
forms the junction between the "frontal," 
or forehead bone, and one of the two "pa- 
rietal" bones, which principally form the 
arched vertex or " crown" of the skull. At 
fig. cxxi. 3, where the parietal is joined to 
the "temporal," or temple-bone, the suture 
is different, being formed by the thin margin 
of the latter bone overlapping the similarly 
formed edge of the former ; where these 
bones overlap, their edges are roughened, so 
as to give greater adherence. In another 
form of suture, the adjoining edges of the 
bones are simply roughened. In fact, the 
form of the bones of the skull individually, 
their junction, and the shape of the whole 
case, is constructed with reference to 
strength and lightness at the same time ; 
indeed, so strong is the arch of the vertex, 
or crown of the head, (fig. cxxi. 4,) formed 
by the parietal and frontal bones, that in 
falls on the head, instead of this portion of 
the skull giving way, it is not uncommon to 
find that the fracture, if it occurs, is in the 
opposite portion of the skull, where it is 
supported by the spine. When che skull is 
sawn through transversely, about its mid- 
dle, it presents the oval form, represented, 
(fig. cxxii.,) and if the brain be removed, the 
Fig. cxxii. 




interior portion of the skull, or floor, on 
which the brain rests, is seen as in the cut, 
consisting of (1,) anterior, (2,) middle, and 
(3) posterior depressions or "fossae;" the 
anterior and middle being adapted to receive 
portions of the larger brain or cerebrum ; 
the posterior being the receptacle of the 
lesser brain or cerebellum, on the top of 
which the posterior portion of the large 
brain is situated. — See Brain. The large 
opening (4) in the base of the skull gives 



passage to the spinal cord or marrow. There 
are a number of smaller openings in the 
base of the skull for the transmission of 
nerves and for the passage of blood-vessels. 
Within the prominent portion of bone (5) 
is contained the internal auditory appa- 
ratus. — See Ear. The interior surfaces of 
the skull are variously grooved and marked, 
more particularly for the accommodation of 
the blood-vessels, especially the large veins 
connected with the head circulation. The 
bones of the skull do not each consist of one 
solid piece of bone, but of an inner and outer 
"table" or plate of dense bone, separated 
by a lighter and more cellular portion, which 
is called the "diploe." — See DipJoe. The 
depressions and hollows of the outer table 
do not entirely correspond with those of the 
inner. 

The frontal or forehead bone, (fig. cxxi. 
5,) a bone of the cranium or brain-case, is 
also a bone of the face, entering largely into 
the formation of the eye-sockets, (6, 6.) 
These conical cavities (see Eye) are made 
up by the combination of other bones, such 
as the cheek-bone, (fig. cxxi. 7,) the upper 
jaw-bone, (8,) &c. At fig. cxxi. 9, is seen 
the hollow for the nostrils, divided in the 
centre. — See Nose. The lower jaw-bone 
(fig. cxxi. 10,) (fig. cxxiii.) of the figure re- 
presented, is joined to the skull by means of 
the rounded heads, (fig. cxxiii. 1, 1,) which 

Fig. cxxiii. 




fit into corresponding hollows in the skull. 
This is a specimen of the hinge-joint. The 
shape of the lower jaw varies greatly during 
the different periods of life. It also differs 
considerably in different races of human 
beings, exhibiting, as well as the upper jaw, 
a tendency to become more projecting as 
the descent is made in the scale of civil- 
ization. The variations which are observed 
in the forms and in the relative proportions 
of the different regions of skulls belonging 
to various tribes of the human family, is a 
study of the greatest interest. The bones 



SLE 



491 



SLE 



of the skull and face are closely covered, 
like other bones, by a membrane or " peri- 
osteum," in this case called the "pericra- 
nium.'^ The scalp is connected with the 
skull by means of a loose, easily torn, cellu- 
lar tissue. — See Scalp. 

Refer to Brain — Fractures. 

SLEEP.— The explanation of the actual 
physiological condition which constitutes 
this periodical phenomenon of life, has often 
been attempted, but the essential nature of 
the condition remains unexplained. The 
external phenomena manifested during the 
state of sleep are familiar, and, in some 
measure, those that take place within the 
body during the state are known, but there 
the knowledge stops. 

Sleep may be defined as that state of 
natural unconsciousness, in which the vo- 
luntary powers are in a condition of insen- 
sibility, while the involuntary functions of 
nutrition, secretion, &c. are going on, in- 
creased, diminished, or unaltered, accord- 
ing to circumstances. The cause of the 
sensorial inactivity of the voluntary system, 
and of the apparent disconnection of the 
mind with outward things, and, as it appears 
to us on awaking from sleep, disconnection 
with thought generally, has been variously 
explained. A kind of congestion of blood 
in the head, caused by the compression of 
the veins in the neck by certain muscles, 
has been suggested. The most general idea, 
however, is, that sleep is the consequence 
of exhaustion of the usual nervous stimu- 
lant in the services of the waking hours, or 
of exhaustion of this, along with waste of 
the tissues generally. As put by Liebig, 
" Since in different individuals, according 
to the amount of force consumed in pro- 
ducing voluntary mechanical effects, unequal 
quantities of living tissue are wasted, there 
must occur in every individual, unless the 
phenomena of motion are to cease entirely, 
a condition in which all voluntary motions 
are completely checked, in which, there- 
fore, these occasion no waste. This condition 
is called sleep." Dr. Carpenter advances 
the same idea somewhat in a similar man- 
ner, saying, " The occasional suspension of 
sensorial activity is requisite for the repa- 
ration of the destructive effects of that acti- 
vity ; so that, however unfavourable may 
be the external circumstances, sleep will 
supervene as a necessary result of exhaus- 
tion, when this has been carried very far." 
That exhaustion is one, perhaps the one 
great condition of sleep, is unquestionable ; 
but that it is not the only condition is no 
less true, unless, indeed, the statement of 
Liebig be adopted unreservedly, that wine, 



narcotics, and other sleep-inducing agents, 
produce a state of artificial exhaustion, by 
putting a stop to the regular changes of 
matter, especially its union with oxygen, 
which is constantly going on within the 
body. Moreover, there is a state of over- 
exhaustion both of mind and body, which 
tends to keep off sleep, rather than to induce 
it. Further, there is a most undoubted con- 
nection between the periodical revolution of 
the twenty-four hours which constitute our 
day, and the periodical requirements and 
renovations of sleep. 

It is observed by Dr. Whewell, in his 
Bridgewater Treatise, that " man in all na- 
tions and ages has taken his principal rest 
once in twenty-four hours, and the regu- 
larity of this practice seems most suitable 
to his health, though the duration of the 
time allotted to repose is extremely different 
in different cases. So far as we can judge, 
this period is of a length beneficial to the 
human frame independently of the effect of 
external agents. In the voyages recently 
made into high northern latitudes, when 
the sun did not rise for three months, the 
crews of the ships were made to adhere . 
with the utmost punctuality to the habit of 
retiring to rest at nine, and rising at a 
quarter before six ; and they enjoyed, under 
circumstances apparently the most trying, 
a state of health quite remarkable. This 
shows, that according to the common con- 
stitution of such men, the cycle of twenty- 
four hours is very commodious, though 
not imposed upon them by external cir- 
stances. No one can maintain with any 
plausibility that the period may be length- 
ened or shortened without limit. We may 
be tolerably certain that a constantly re- 
curring period of forty-eight hours would 
be too long for one day of employment, and 
one period of sleep, with our present facul- 
ties ; and all whose bodies and minds are 
tolerably active will probably agree, that 
independently of habit, a pei'petual alter- 
nation of eight hours up and four in bed, 
would employ the human powers less ad- 
vantageously than alternations of sixteen 
and eight." 

"The succession of exertion and repose 
in the muscular system, of excited and dor- 
mant sensibility in the nervous, appears to 
be fundamentally connected with the nerv- 
ous and muscular powers, whatever the 
nature of these may be. 

"The necessity of these alternations is 
one of the measures of the intensity of those 
vital energies ; and it would seem that we 
cannot, without assuming the human power! 
to be altered, suppose the intervals of tran- 



SLE 



492 



SLE 



quillity which they require, to he much 
changed." 

The amount of sleep necessary for an 
individual depends greatly upon time of 
life, upon natural constitution, or upon ac- 
quired habits. The infant, it is well known, 
spends most of its early days in sleep. In 
adult life the hours of repose are reduced 
to the moderate average of from six to 
eight hours, while in advanced life, that is 
before the period of decrepitude, the amount 
of sleep is still further diminished. By 
Liebig this is reduced to a regular calcula- 
tion. After giving the calculation, as com- 
puted in mechanics, of the force available 
for mechanical purposes in an adult man in 
a certain period, he says, "By the restora- 
tion of the original weight of his body, the 
man collects again a sum of force which 
allows him, next day, to produce, without 
exhaustion, the same amount of mechanical 
effects. This supply of force is furnished 
in a seven hours' sleep," provided, of course, 
sufficient nutriment has been given during 
the waking hours, from which the repara- 
tive powers can draw their supply of new 
. material. Further, if the man exhaust, use 
more out of his system than can be restored 
or repaid during the seven hours, or what- 
ever other amount of sleep he may take, 
his strength must diminish. Practically, 
therefore, sleep is a periodical natural con- 
dition, in which the voluntary os* exhausting 
powers, both of body and mind, being at 
rest, the involuntary or reparative powers 
have, or ought to have, time for restoring 
the material of the living body, which has 
been used up during the hours of wakeful 
activity. Such being the case, it is evidently 
most important, not only that a supply of 
sleep adequate to the reparative require- 
ment of the system should be procured, but 
that the benefit derived from the sleep should 
not be impaired by contingencies likely to 
interfere with the processes which are ac- 
tively carried on during the state of uncon- 
sciousness. These processes — devoted to 
the repair of the structures — must evidently 
be more connected with the secondary assi- 
milation of nutriment, that is, with changes 
in the nutriment after it has entered the 
blood, than with the primary assimilation 
in the stomach. This, probably, is one rea- 
son why nourishment is usually more bene- 
ficially taken some hours before the ordinary 
night's rest; it permits the result of the 
digestion of the meal, not only to enter the 
circulation, but. to be ready for the processes 
of reparation which take place during re- 
pose. It would almost appear as if these 
reparative processes were carried on at the 



expense of others, which are more active 
during waking hours ; for, during sleep, the 
respiration is diminished in frequency, the 
pulse is slower, and the action of the brain, as 
observed in Blumenbach's case, diminished. 
At the same time the temperature sinks, 
and the nervous power is evidently dimi- 
nished, and with it the power of resistance to 
morbific influences, such as malaria. In- 
deed, as observed elsewhere in this work, 
this diminished condition of nervous power 
is not recovered for some time after waking, 
and by the weak not until food has been 
taken. — See Breakfast — Early Rising, §c. 
The perspiration, for obvious causes,, is 
generally increased during sleep. 

The amount of sleep required by different 
individuals varies greatly ; as already stated, 
the infant requires most, sleeping at least 
twenty hours out of the twenty-four. The 
hours of sleep which are requisite diminish 
up to adult maturity, when from six to eight 
hours is the average requirement during 
the most active periods of life. There are, 
indeed, instances of persons who could do 
well with a much smaller average of sleep 
— four, three, two hours, or even less ; but 
these are exceptional instances, and the in- 
dividuals have generally been persons of 
strong constitutional powers. The exten- 
sion of the hours of sleep beyond the term 
of eight, or at least nine hours, is generally 
the result of habitual indulgence. More- 
over, when sleep is thus taken excessively, 
more is required, or thought to be required, 
on account of the debility which arises from 
consequent excessive action of the skin. 
Women, as a general rule, require rather 
longer sleep than men ; and it is said that 
tall and bulky people do so, more than those 
who are the reverse. 

Many of the external conditions requisite 
for sound and healthy sleep having been 
noticed under "Bed" and "Bedroom," it 
is unnecessary to repeat them here. It may 
be added, that no portion of clothing which 
tends, either in the way of wristband or of 
neck fastening, to confine in the least de- 
gree, should be worn. Especial attention 
should be directed, especially in the case of 
children, to the injurious effects of sleeping 
with mouth or head covered over with the 
bedclothes. The practice is a common but 
most hurtful one. 

Some persons, Napoleon for instance, have 
appeared to possess the power of falling 
asleep almost momentarily — of as it were 
putting themselves to sleep ; and the faculty 
has been quoted to prove that sleep was an 
active state rather than a passive one. It 
would rather prove that the mind has so 



SLE 



493 



SLE 



far power over the body as to restrain the 
tendency to sleep until it can be conve- 
niently indulged in, and that as soon as the 
powers of body and mind are surrendered 
to its influence, it at once takes possession 
of them. The power of certain external 
agencies, (soothing sounds in particular,) in 
inducing sleep, are well known, and may be 
taken advantage of. 

In the above remarks, sleep has been con- 
sidered as a natural, healthy process, either 
the result of exhaustion, nervous or general, 
or the consequence of a periodical condi- 
tion of the body. It has been regarded as 
a process tending to health, to recruit the 
exhausted powers of body and mind. But 
sleep is often not a natural process ; it may 
be occasioned by excessive use of alcohol, 
or by narcotic drugs, by the action of heat, 
or by the depression of extreme cold; it 
may result from overfulness of blood, or 
from deterioration of the vital fluid — in the 
latter case, generally, it is probable, by the 
accumulation of carbonaceous materials, 
consequent upon imperfect aeration of 
blood in the lungs, or its imperfect purifica- 
tion in the liver. — See Biliary Disorder. 
Again, heavy, very heavy sleep, is a com- 
mon accompaniment of chlorotic or anaemic 
conditions of the system. — See Anosmia. In 
such cases, although the powers of the body 
are in some degree recruited by the sleep, 
it is not followed by the same feelings of 
health as the natural sleep of the properly, 
but not over-fed — well-exercised, but not 
exhausted — worker of either mind or body, 
provided the worker of the mind neglect not 
the physical exercise. 

Sleeplessness arises from various causes. 
It is often a distressing concomitant of old 
age, (see^re,) but mental causes, anxieties, 
excitements, distresses, most frequently give 
rise to it, and especially intellectual exer- 
tion of the mind late in the evening, and 
just before retiring to rest. Want of due 
physical exercise also occasions sleepless- 
ness ; it is the result of dietetic errors — 
either eating heavy meals too late in the 
evening, or retiring to rest without sufficient 
nourishment ; and especially is it caused by 
strong tea or coffee taken at a late hour — in 
some people, at any hour. — See Tea. If any 
of the above causes of habitual sleepless- 
ness are suspected to be the origin of the 
evil, the most effectual mode of correction 
is of course to remove the cause ; but ex- 
cept under the sanction of a medical man, 
who can discriminate how far sleeplessness 
is dependent on disease, or likely to impair 
the constitution, artificial, that is medicinal, 
modes of procuring sleep should never be 
2R 



resorted to. Early rising, moderate atten- 
tion to diet, and moderate exhaustion of 
both body and mind by exertion, ought to 
be the means tried to bring back the soft 
restorer. Sometimes, the mere alteration 
in the hour of a meal, a biscuit before re- 
tiring to bed, instead of going with an 
empty stomach, or some apparently trifling 
alterations in habits, is all that is requisite 
as a corrective. Continued sleeplessness is 
a symptom of delirium tremens ; it is too, 
the forerunner and concomitant of some 
forms of insanity. In both these phases it 
requires to be dealt with by a medical 
man. 

Disturbed sleep is almost a constant attend- 
ant upon disorder of the digestive organs, 
either as exhibited in mere restlessness, or 
unpleasant dreams, or in the more aggra- 
vated form of nightmare, which is generally 
considered to depend upon impeded respira- 
tion and circulation within the chest, caus- 
ing those disagreeable sensations connected 
with the condition, of which all must at 
times have been conscious. It is probable 
that the uncomfortable sensation in the 
chest, in the first place, gives rise to the 
" suggestive dream." — See Dreams. Night- 
mare, if of frequent occurrence, may depend 
en disease connected with the heart or cir- 
culation; but more usually it is the result 
of causes much more easily removable, such 
as indulgence in heavy suppers, or excess 
of food generally — in fact, of indigestion. 
Disturbed sleep in children is very common, 
taking either the form of moaning or rest- 
lessness, with grating of the teeth, or talk- 
ing ; of awaking suddenly, frightened and 
screaming ; or of getting out of bed, when 
it becomes somnambulism, or sleep-walking. 
The excitability of the nervous system in 
children renders them liable to be thus af- 
fected by even slight disorders of the bowels, 
and especially by worms, &c. ; in such cases, 
therefore, it is always right to make sure 
that nothing offends in this way, by clear- 
ing out the canal by means of a smart 
purge ; calomel and scammony is probably 
the best. If the affection does not seem to 
depend on disorder of the bowels, so much 
as upon general excitability, every thing in 
the way of mental excitement which can in- 
crease this, must be avoided ; cold bathing 
of the head every morning, and the cold 
douche to the back should be used, and the 
nervous system tired before bedtime by 
active but not exhausting exercise. 

Somnambulism, or sleeping-walking, in 
adults, belongs to the class of mental, or 
rather psychological phenomena, not yet 
generally understood; it evidently resent 



SLO 



494 



SM A 



Tbles, if it is not identical with, the mesme- 
ric condition of which some, and generally 
the same class of persons, are susceptible. 
Where a tendency to sleep-walking does 
exist, it is perhaps scarcely requisite to 
remark that every means of guarding the 
person so unfortunately affected, from ac- 
cident, should be had recourse to. 

Night is the natural season for rest ; but 
in warm climates, a day sleep, both in man 
and animals, seem beneficial. In temper- 
ate climates, after the age of childhood, it 
is not an advisable custom. After any un- 
usual fatigue, however, a short sleep before 
— not after — dinner, is often very service- 
able. 

Refer to Breakfast — Dreams — Early Ris- 
ing — Night, §c. 

SLOUGH. — A slough is a dead portion 
of tissue cast off from a living animal 
body. 

SMALL-POX.— This dreaded disease be- 
longs, like measles and scarlet fever, to the 
class of eruptive fevers. It is, too, like 
these diseases, characterized by its own 
special constitutional symptoms from the 
commencement, independent of the erup- 
tion which stamps its character. 

Small-pox commences with shivering and 
languor, followed by heat, thirst, and head- 
ache: so far, these symptoms mark the 
beginning of most other severe febrile affec- 
tions ; but added to them, in the disease in 
question, there is usually either pain or 
great oppression at the pit of the stomach, 
and not unfrequently vomiting ; there is 
severe pain in the back or loins, and in 
children not uncommonly, and more rarely in 
adults, convulsions. On the third day after 
the setting in of the above symptoms, 
usually toward evening, minute red spots, 
somewhat resembling flea-bites, show them- 
selves on the forehead, the neck, the wrists 
and arms, the chest and abdomen, and 
finally on the extremities; this, at least, is 
the course of the eruption, but it does not 
reach the lower extremities till at least the 
fourth day. If the eruption on the parts 
first mentioned is discovered over night, by 
morning it is much more distinct, and the 
spots are much more numerous than they 
first appeared to be ; they are, too, slightly 
and conically elevated — are, in fact, " pa- 
pular ; from this they continue enlarging ; 
on the third day after their appearance 
they evidently contain a little fluid on their 
summits, which gradually increases in 
quantity, giving either a globular form to 
the spot, or an umbilicated or wheel-like 
form, resembling that which is seen in cow- 
pox, the centre of the vesicle or pustule 



being depressed, tied down as it were, in 
the centre. Toward the fifth or sixth day 
of the eruption, this peculiarity of form 
disappears, the pustules become real pus- 
tules, and contain pus or matter. About the 
seventh or eighth day of the eruption they 
begin to "crust," that is to break, allowing 
their contents to escape, and then to harden 
into a crust or scale. At this period of the 
disease, that of "maturation," the eighth 
day of the eruption, the eleventh of the 
disease, what is called the secondary fever 
comes on ; the febrile symptoms, which had 
more or less abated after the eruption ap- 
peared, become again aggravated, and con- 
tinue so for a few days. At length, if the 
case has progressed favourably, toward the 
end of the third week from the first showing 
of 'the eruption, some of the scabs begin to 
separate and fall off, leaving either a pit or 
a stain of a deep red colour. 

Such are the most prominent character- 
istics of small-pox, as they show themselves 
upon the face to the eyes of an observer. 
The progress of the eruption on the body 
generally must be reckoned as twenty-four 
hours, and even more on the lower limbs, 
later than the face. Much of the severity 
and danger of the small-pox depends upon 
the amount of the eruption : whether it is 
what is called "discrete," that is, each 
separate spot distinct from another; "con- 
fluent," when the spots all run into one 
another, forming one mass of eruption ; or 
"semi-confluent," a medium between the two 
former. There is of course every degree 
of severity. It need scarcely be added, 
that the regular confluent small-pox is the 
most dangerous disease. As a general rule, 
the eruption of small-pox is thickest on the 
face, and its variety, confluent or not, is 
generally reckoned from its amount in the 
above situation. The skin surrounding 
each pustule is inflamed or swollen, this 
inflammation and swelling being of course 
more severe according to the severity of the 
eruption ; in consequence of it, the features 
are swollen and disfigured, and the eyelids 
closed. The eyes partake of the inflamma- 
tion of the skin, and are apt to be much 
affected, discharge of matter taking place 
from beneath the eyelids. The nostrils, 
mouth, and throat are usually more or less 
affected with small-pox pustules; indeed, 
one of the most serious dangers apt to arise 
in the course of small-pox, is the throat 
affection, and any signs of impeded breath- 
ing are always to be most anxiously watched 
and cared for. Unless the attack of small- 
pox is extremely modified, as by previous 
vaccination, the pustules on the face almost 



SM A 



495 



SM A 



all run through their regular course as 
above described. In many cases, however, 
they do not do so on the body, but on the 
eighth day, that is, -when those on the face 
are discharging their contents, those on the 
trunk and lower limbs begin to "go back," 
as it is called, or wither up, without the 
formation or discharge of matter. 

When an attack of small-pox comes on 
with great severity, and when the constitu- 
tional powers are, as it were, overwhelmed, 
a person may sink early in the disease, but 
more generally the chief danger is about 
the time of the secondary fever, either from 
the affection of the constitution, or from that 
of the throat and from impeded respiration. 
Small-pox may show itself in an extremely 
mild form, there not being more than a 
dozen spots — if so many — on the body alto- 
gether. This generally occurs when the dis- 
ease is modified by previous vaccination, or 
has been introduced into the system by 
inoculation. 

In the early stages, small-pox may be 
confounded with other eruptive diseases, 
especially with measles, which disease its 
eruption in the first stage somewhat resem- 
bles. This mistake, however, can scarcely 
occur if the distinct characters of the con- 
stitutional symptoms of the diseases are 
kept in view ; when the eruption has ad- 
vanced a little way there can be no con- 
fusion. 

It need scarcely be said, that an attack 
of small-pox, of even ordinary severity, is 
not for unprofessional management. If the 
disease be prevailing, and if an individual 
exhibits the symptoms above detailed, 
small-pox may fairly be suspected. 

The appetite, probably, is totally gone 
from the first ; but in such cases, food of 
the lightest kind only must be taken, and 
cooling drinks (nothing is better than the 
ordinary effervescing powders) may be al- 
lowed freely ; or Seidlitz powders, to keep 
the bowels lax, without purging ; or castor- 
oil, or other mild aperients, must be given 
if required. But, although the bowels 
should be kept easy throughout the disease, 
when the eruption is coming out all at- 
tempts at purging should be dropped, cool- 
ing saline medicines being continued. If 
the surface is very hot and dry, sponging 
with tepid water is useful and agreeable. 
When the secondary fever comes on, it may 
be requisite both to act more freely on the 
bowels by means of the aperients already 
mentioned, or by senna, or Epsom salts, 
well diluted, or some of the aperient pills, 
while at the same time the distressing rest- 
lessness requires opium, twenty drops of 



sedative solution, or five-and-twenty of 
laudanum at bedtime. In some cases, if 
signs of sinking come on, with weak pulse, 
tardy eruptions, and pustules not filling, 
all lowering measures are to be avoided, 
and good broths, wine, wine-whey, &c. ad- 
ministered, as the case may require. The 
principles of treatment are, in the onset of 
the disease to moderate febrile action, and 
through it, the eruption, by cooling ape- 
rients ; when the eruption is coming out, 
to interfere but little beyond keeping the 
bowels easy, regulating the diet according 
to the strength; and, again, in the stage 
of secondary feveB, to purge moderately. 

If much swelling and distress about the 
throat should result in the course of the 
disease, leeches ought to be applied, in 
number proportioned to the age and consti- 
tution of the patient. This treatment em- 
ployed in a case far distant from medical 
aid might save life. 

In any case small-pox is a fearful disease, 
and should be under medical care when 
possible ; circumstances, however, may 
occur in which the above directions will 
prove useful. The disfigurement which is 
apt to result in consequence of the marks 
left upon the face by small-pox is an addi- 
tional aggravation. Various methods for 
its prevention are resorted to. The light, 
being supposed to exert some influence on 
the progress of the pustule, is often exclud- 
ed from the room, and as the eyes are apt 
to be sensitive, the expedient is good in 
more ways than one. Opening each sepa- 
rate pustule with the point of a lancet, and 
touching the interior with a pointed stick 
of lunar caustic, has been found of use. In 
France, a mercurial — the Vigo-plaster, is 
used, being put like a mask over the face ; 
but it may cause heat and unpleasant sen- 
sations fn the head, and, therefore, a better 
application is the common mercurial oint- 
ment thickened with starch powder, smeared 
over the face on the second or third day of 
the eruption, and allowed to remain till 
the scabs separate. It is generally some 
months before the stains of even a mild 
attack of small-pox disappear. Small-pox 
is highly contagious, and may even be com- 
municated by the dead body. The attack 
generally comes on about ten or twelve 
days after exposure to contagion. As all, 
perhaps, are aware, until the discovery of 
vaccination by Jenner, the system of in- 
oculating small-pox, as introduced into 
England from Turkey, by Lady Wortley 
Montague, was generally followed, and 
certainly was a great boon. It substituted, 
in almost in every case, a mild form of th« 



SMB 



496 



SOD 



disease, for, to say the least, one of uncer- 
tain severity; and, moreover, the disease 
was imparted to a constitution which had, 
by preparation, been placed in a favourable 
condition for its reception, and for its de- 
velopment in a mild form. To counter- 
balance, however, these advantages, there 
was the serious consideration that, although 
a case of inoculated small-pox might in 
itself be a trifling affection, devoid of dan- 
ger, it was capable of originating the dis- 
ease in another person, in its most virulent 
form. This drawback, Jenner's discovery 
removed, and, vaccination has, therefore, 
rightly, taken the place of inoculation; 
and government has rightly put it out of 
the power of foolish people to do mischief, 
by imposing a heavy penalty upon the 
practice of inoculation for small-pox. 

The question of the relative values of cow- 
pox, or vaccination, and inoculated small- 
pox, having been alluded to in the article 
on the former, need not be repeated here. 

Refer to Cow-pox. 

SMELL.— See Nose. 

SMOTHERING.— See Suffocation. 

SNEEZING — Is a convulsive or spas- 
modic effort, the result of reflex action, ori- 
ginating in irritation of the lining membrane 
of the nostril, by which air is forcibly sent 
through the passage so as to expel any cause 
of irritation. Sneezing is one of the first 
symptoms of cold, of influenza, of measles, 
and of diseases which involve the air-pas- 
sages. Continued sneezing is a spasmodic 
affection, said to be relieved by emetics. 

SNUFF — Habitually taken, is injurious, 
and a common cause of dyspepsia. As a 
counter-irritant, in some forms of headache, 
snuff proves serviceable. — See Tobacco. 

SNUFFLES. — A name sometimes given to 
the catarrhal affections of infants. 

SOAP — Is a compound of fat or oil with 
alkali, which is usually soda. Tallow and 
other cheap fats are used for the commoner 
soaps, and yellow soap has about a fourth 
part of resin and palm-oil in its composi- 
tion. It is the resin which makes it irritat- 
ing to some skins. Windsor soap has the 
addition of olive-oil. For soft soaps, potash 
is used instead of soda, the medicinal soft 
soap being composed of potash and pure 
olive-oil. Soap of any kind is an antidote 
in poisoning by the mineral acids, and 
might be used in the absence of better 
remedies. 

Refer to Castile Soap — Plaster, §c. 

SODA. — This well-known and exten- 
sively used alkali is now manufactured 
almost entirely from common salt, which is 
a muriate of soda. — See Salt. Soda is best 



known in the form of its carbonates, or 
subcarbonate and bicarbonate — the former 
being largely used domestically, the latter 
medicinally and for some domestic pur- 
poses. The subcarbonate of soda, or as it 
is commonly known, " soda," being more 
irritant, and not so pleasant as the bicar- 
bonate, the latter is generally employed in 
medicine, its antacid properties being simi- 
lar to those of. potash, but rather weaker. 
It is usually sold in the form of white 
powder. 

Bicarbonate of soda is largely used for 
making the common " effervescing soda 
powder." — See Effervescing . Many dyspeptic 
persons take it habitually, as an antacid. 
The habitual use of soda internally, even in 
comparatively small quantity, cannot be too 
strongly condemned. It undoubtedly exerts 
a most debilitating effect upon the stomach, 
and also upon the system at large. Many 
persons injure themselves by its use. The 
usual dose, as an antacid, is from ten to 
twenty grains in solution. 

Soda-Wateb. — Properly so called, is water 
containing about twenty grains of bicarbon- 
ate of soda to the half-pint, and strongly 
impregnated with carbonic acid gas, but a 
good deal is made without the addition of 
soda at all. When used simply as a drink, 
this omission is unimportant, but not so 
when it is required as an antacid. As a 
drink in febrile diseases, soda-water is 
often beneficial, and much relished, but 
should not be given in too great quantities 
at once, otherwise the gas may cause inju- 
rious and uncomfortable distension. — See 
Effervescing. When a bottle of soda-water 
has been opened and recorked in a sick- 
room, it should be well corked, secured by 
tying, and inverted in a jug of cold water. 
In this way the gas is preserved ; but if the 
tying over is neglected, it very probably 
occurs that the gas, especially if the situa- 
tion is a warm one, forces out the cork, and 
the bottle out of the jug at the same time, 
spilling the fluid, and, what is worse, making 
a sudden noise that may startle, and thus 
seriously injure, an invalid. 

Milk and soda-water is thus made : — 
" Heat* nearly to boiling a teacupful of 
milk, and dissolve in it a teaspoonful of re- 
fined sugar, put it into a large tumbler, and 
pour over it two-thirds of a bottle of soda- 
water. This is an excellent mode of taking 
milk when the stomach is charged with acicl, 
and consequently is apt to feel oppressed 
by milk alone."* 

Chloride of Soda — Is the •' disinfecting 



* Thomson's Sick-Boom. 



SOL 



497 



SOR 



liquor of Labarraque." It is used medi- 
cinally by medical men for disinfecting pur- 
poses. There are better preparations. — 
See Chlorine. » 

Phosphate op Soda — Or tasteless salt, 
is a mild aperient, "which possesses the ad- 
vantage of having so little taste that it can 
be given in soup. The dose is half an ounce. 

Sulphate op Soda — Or Glauber salt, 
for a long time the commonest aperient in 
use, but has been displaced by Epsom salt, 
which much resembles it in action. The 
dose of Glauber salt is from half an ounce 
to an ounce, dissolved in water. The addi- 
tion of a few drops of dilute sulphuric acid 
diminishes the nauseous bitterness. 

Refer to Borax — Rochelle Salt — Salt, 
Common. 

SOLANUM. — See Dulcamara. 

SOLUTION — Is the disappearance of a 
solid body in a liquid menstruum or solvent. 
The colour of the liquid may be changed, 
but if perfect solution has taken place its 
transparency is unaltered. The solubility 
of bodies, such as salts of various kind, in 
liquids, varies greatly. Generally it is in- 
creased by heat, but not always. The mi- 
nute state of division in which a body ex- 
ists when in solution, renders this form 
especially favourable for the development 
of medicinal action. 

SOMNAMBULISM.— See Sleep. 

SORE-THROAT — Quinsy. — Sore-throat 
is not only a concomitant of other affec- 
tions, such as scarlet-fever, but is one of 
the most frequent effects of common cold. 
Some persons are peculiarly liable to it. 
One of the simplest forms of throat affec- 
tion from cold is relaxation of the uvula. 
— See Palate. Perhaps on waking in the 
morning, the sensation is experienced of 
there being something in the throat which 
requires to be coughed up, and along with 
this, tickling cough, from the uvula irri- 
tating the top of the windpipe. The condi- 
tion is easily discovered by means of a 
looking-glass, the uvula appearing longer 
than usual. Frequently the affection passes 
off in the course of a few hours. If it does 
not, the use of an astringent gargle (see 
Gargle) will remove it. 

Sore-throat may be simply inflammation 
of the mucous membrane of the throat ; 
there is an uncomfortable feeling of rough- 
ness or rawness about the fauces and tonsils, 
with some pain in swallowing, probably 
accompanied with constitutional symptoms 
of cold, shivering, &c. This form of sore- 
throat may pass away in the course of a day 
or two without going further, or it may 
spread by extension into the air-passages, 
2 r2 



causing cough and catarrhal symptoms. It 
is this form of the affection which is often 
quickly relieved by the use of the sal-pru- 
nelle balls, one or two being allowed gra- 
dually to dissolve in the mouth. It is 
generally best treated as a common cold 
(see Cold) with the addition of hot bran 
poultices up the angles of the jaws, and the 
use of hot gargles of simple warm water or 
gruel. This treatment is better than the 
mustard plaster and hartshorn and oil, re- 
sorted to by some. These, however, may be . 
advantageously used at a later stage. An- 
other and highly dangerous sore-throat, of 
an erysipelatous character, [called "Black- 
tongue"] sometimes prevails, and requires 
the most active measures of the medical men ; 
the most effectual treatment consisting in 
pencilling the whole of the inflamed throat, 
either with the solid lunar caustic or with 
the solution. — See Erysipelas. The great 
danger from this form of sore-throat is its 
extension to the larynx and air-passages, 
when it most frequently proves fatal. 

Another serious form of sore-throat in 
children, ending in croup, is described under 
the article on the latter disease. 

In quinsy, the inflammatory action is 
deeper than in the above-mentioned forms 
of the disease, and affects the substance 
of the tonsils and surrounding tissues, it 
usually ends in the formation of abscess. 
Quinsy is sometimes a most distressing 
disease, the swelling caused both by the in- 
flammation and by the matter preventing 
the swallowing even of fluids, which, when 
the attempt is made, instead of passing 
down, regurgitate into the nose. In bad 
cases the breathing is impeded, and when 
this occurs the case must always be regarded 
I seriously. The feeling attendant on quinsy 
is rather one of extreme distress than of 
acute pain, except when the attempt to 
swallow is made, at which time the pain is 
often greatly complained of as shooting up 
to the ears. In some cases the swelling 
extends down the neck, and completely under 
the jaws, affecting the tongue and the sali- 
vary glands. When this occurs, the flow of 
saliva is generally profuse, and in all cases 
there is formation of much stringy mucus 
about the tonsils. The voice is thick and 
husky, the tongue very much furred, and 
the breath offensive. Along with these 
local symptoms of quinsy, there is always 
more or less fever, and if the disease 
be long continued, considerable depres- 
sion from the deprivation of nourishment. 
The treatment of quinsy in the first in- 
stance is like that of common cold. If the 
symptoms are severe, and if the person has 
32 



SOR 



498 



SPA 



suffered from the disease previously, from 
four to six leeches may be placed under the 
jaws in the commencement of the attack, 
bran poultices, hot gargles, and steaming 
being used, with active purging at first. 
If the patient can swallow it, medicine in 
the effervescing form always gives relief, 
by clearing the mouth and throat. Nothing 
answers better than the common soda effer- 
vescing powder, with the addition of six or 
eight grains of nitre, in full habits ; or of 
a teaspoonful of nitrous ether in weak con- 
stitutions, in each dose. The above mea- 
sures may be continued until the matter, if 
it forms, discharges. When this occurs, the 
distress, which has perhaps been great, dis- 
appears at once, and convalescence, gene- 
rally rapid, commences. The discharged 
matter, which is usually offensive, may flow 
out in a perceptible gush, and be spat from 
the mouth, or it may be unnoticed, and 
ooze away, passing down the throat. The 
hot. poultices and gargles should be con- 
tinued to the throat for twelve or eighteen 
hours after the discharge of the matter; after 
that time an acid or astringent gargle will 
generally be most serviceable and grate- 
ful, and the poultices may be replaced by 
flannel, and perhaps by stimulant liniments. 
At this period, too, the patient, unless very 
much reduced, should be tolerably freely 
purged. At the same time good nourish- 
ment, broths, and, if requisite, wine being 
permitted. 

Blisters are sometimes used in quinsy ; 
at the very commencement they may be use- 
ful — but the author prefers the poultice. It 
is said that powdered guaiac, given in half- 
drachm doses every six hours, at the com- 
mencement of quinsy, will frequently cut 
short the disease. 

A person who has suffered from, or is 
subject to quinsy, should, after an attack 
has passed oft", use every means of strength- 
ening the throat ; by this the attacks may 
be greatly prevented. Any of the astrin- 
gent gargles may be used after quinsy, but 
none perhaps answers better, or is more 
accessible to the poor, than the decoction 
of oak-bark. This ought to be used night 
and morning for some weeks, and when its 
use is dropped, the person should acquire 
the habit of gargling the throat with cold 
water at the above times, as a regular prac- 
tice, and at the same -time should, habitually, 
lave freely with cold water, or salt water at 
first at least, all around the throat. In this 
way a tendency to quinsy may be greatly 
overcome. Further, all unnecessary muf- 
fling, either by fur or otherwise, about the 
neck, should be avoided, for there is no 



more fertile source of sore-throat. — See Fur. 
Doubtless many cases of simple sore-throat 
may be well managed domestically ; but the 
contingencies of erysipelatous or croupy 
sore-throat, or of quinsy, which may suffo- 
cate, must not be lost sight of. The attend- 
ance of a medical man gives the only chance 
for life in such cases. 

Refer to Croup — Throat, §c. 

SOUND. — A surgical instrument for ex- 
ploring cavities within the body. 

SOUND.— See Deafness. 

SOUND. — See Auscultation. 

SOUP. — See Broth — Beep, &c_. 

SPASM — Is painful contraction of the 
involuntary muscular fibres, in contradis- 
tinction to cramp. — See Cramp. There is 
cramp in the legs, sjpasm in the stomach or 
bowels, in the latter case constituting colic. 
Spasm of the stomach, owing to the presence 
of indigestible substances, is not unfrequent. 
It is characterized by sudden agonizing pain 
in the region of the stomach, which, like 
other spasmodic pain, is relieved by press- 
ure ; there may be attempts at vomiting, 
and perhaps eructation of wind. The seve- 
rity of the pain, in this form of spasm, makes 
speedy relief important, and for this the 
general remedies noticed under Colic should 
be resorted to ; in addition, if the presence 
of irritating matters in the stomach is sus- 
pected, an emetic should be given at once, 
and after it has acted, or in place of it, if it 
is not given, an antacid, magnesia, or soda, 
or potash, in combination with a stimulant, 
sal-volatile or brandy, and also opium. 
Five grains of rhubarb, five of alkali, a 
teaspoonful of sal-volatile, and from ten to 
fifteen or twenty drops of laudanum, will 
form a dose, which may be repeated every 
quarter or half hour, or at longer intervals, 
as requisite. These measures may be fol- 
lowed out, and give great relief before a 
medical man can be procured, which he 
ought to be, if the attack does not yield at 
once, for it is possible that other disorders 
may be mixed up with it. After the imme- 
diate attack has passed away, the digestive 
functions will require, attention. — See In- 
digestion. 

Spasm in the bowels has already been 
considered under article "Colic." Spasm 
of the heart is included under "Angina 
Pectoris." Spasm of the urinary passages 
may occur as the result of gravel or urinary 
irritation. In all cases of spasm, it should 
be remembered that heat is one of the best, 
and certainly is the safest remedy. 

Refer to Colic — Cramp — Urine, See. 

SPASMODIC DISEASES.— See Lock- Jaw 
— St. Vitus's Dance, &c. &c. 



SPA 



499 



SPI 



SPATULA— Is a blunt, flexible knife, used 
by the apothecary, and in the various me- 
dicinal manipulations. It is usually made 
of iron, but bone spatulas are also used for 
substances that act chemically on iron. 
The most convenient size of spatula for a 
domestic chest is one "with the blade about 
three and a half inches and the handle three 
inches in length. 

SPECIFIC— Is a term applied to a me- 
dicine which is known from experience to 
cure a particular disease or set of symp- j 
toms, the action by which it does so being | 
unexplained. Thus, quinine is specific in 
ague and other periodic diseases — specific, 
at least, within certain limits; that is, it 
is generally successful, though not always 
so. This applies to other so-called specifics. 

SPECTACLES.— See Vision, 

SPECULUM. — A surgical mirror, adapted 
to assist the examination of internal parts 
of the body. 

SPEECH. — Distinctness of speech, or ar- 
ticulation, is so intimately connected with 
the full command and free movement of 
the tongue, that indistinctness is often a 
valuable leading symptom in the investi- 
gation of disease, especially of a nervous 
character. The " thick" articulation of the ' 
drunkard is an instance of the affection ! 
of the tongue from nervous disorder ; the 
same thing occurs in paralysis and other 
diseases of the brain-; in some cases, the 
articulation of particular letters being in- 
terfered with, such as " d" being substi- 
tuted for "1." 

Stammering in the speech cannot be said 
to be a disease, being rather a functional 
disorder ; this is evident from the fact, that, 
under certain circumstances, an habitual 
stammerer does not stammer, and that 
cases have occurred in which most invete- j 
rate stammering has been completely cured 
— as histoi*y tells us in the case of Demos- ! 
thenes — by the exertion of the will. More- 
over, stammering is often caused either by | 
imitation in children or by nervousness in 
both children and adults. This nervousness 
is often the result of debility, and of weak \ 
constitution — a fact which should not be lost , 
sight of, for, if such be the case, every means 
of strengthening should be used. — See Chil- ' 
dren, Sfc. At the same time, while the ge- ! 
neral health is sustained, much may be done 
by checking children, and making them 
speak at all times slowly. Much pains with 
children, and much perseverance and self- 
command in adults, is required in the efforts 
to overcome the defect in question, but 
there is the encouragement that it has been | 



effected. When it can be done, a child 
should be placed under the care of a person 
experienced in the moral and intellectual 
training of children thus afflicted. Surgical 
operations on the tonsils and uvula have 
been proposed, even by high authorities, 
and practised largely for the cure of stam- 
mering, but they have never met with the 
cordial support of the profession. Articula- 
tion is sometimes indistinct from the tongue 
being "tied," that is, too much confined in 
its motions by its natural bridle, or "frae- 
num." — See Tongue. When this is discovered 
in early life it is very easily rectified. — See 
Children. 

SPERMACETI— Is a species of concrete 
oil found in the head of the sperm whale. 
Its appearance is sixfficiently well known. It 
was formerly used internally on account of 
its supposed healing properties, and, accord- 
ing to this idea, the "spermaceti-draught" 
was a favourite lying-in-room remedy. Sper- 
maceti is now used only as an addition to 
ointments. — See Ointment. 

SPHINCTER MUSCLES — Are muscles 
the office of which is to close the apertures 
round which their fibres run, usually in a 
circle. 

SPINACH.— This well-known vegetable is 
one of the most wholesome we possess, and 
less liable than most others to disagree. The 
leaves of cither the common beet-root or of 
the mangel wurzel, when cooked like spi- 
nach, form a substitute in some respects 
even superior to the former vegetable. 

SPICES.— See individual articles, Cinna- 
mon — Pepprr, &c. 

SPINE, or Spinal, or Vertebral Co- 
lums — : Is a chain of twenty-four bones, 
called the "vertebras," (see Skeleton,) so 
beautifully contrived and fitted to each 
other that, while they permit the most ex- 
tensive motion of the trunk of the body, 
they at the same time preserve it (in man 
at least) firm and erect, and guard the spinal 
cord or marrow (see Nerves) against all but 
the most violent injury. The spinal cord, 
thus guarded, is enclosed in the spinal canal, 
which is continued through the vertebral 
chain, from the head downward, to and 
into the "sacrum" bone of the pelvis. The 
twenty-four vertebras are divided by anato- 
mists into seven "cervical" or neck verte- 
brce, twelve "dorsal" or back vertebras, and 
five "lumbar" or loin vertebras; the verte- 
bras belonging to these divisions being dis- 
tinguished by marks peculiar to each, while 
at the same time all the bones have certain 
characters in common. All the vertebras, 
except the single one next the head, hav* 



SPI 



.00 



SPI 



"what is called their body, (figs, cxxiv. cxxv. 
and cxxvi. 1 ;) on the bodies rests the main 
weight of the parts above them : they are 




also extensively subservient to the motions 
of the spine. The bodies form the inner por- 
tion of the spinal column. — See Chest — Ske- 
leton. Attached to the body, one on each side, 
are "laminae," or projections, (figs, cxxiv. 
cxxv. 2,) which serve to enclose the canal (fig. 
cxxiv. 7) of the spinal cord; from the junc- 
tion of these laminae proceeds what is called 
the "spine" of the vertebrse, (figs, cxxiv. 
cxxv. 3, 3.) These "spinous processes" pro- 
jecting backward give the peculiar character 
of the spinal column, when examined in a 
living, and especially a thin person. In ad- 



dition to the parts above named, there are 
what are called the " transverse processes," 
(figs, cxxiv. cxxvi. 4, 4.) These processes are 
chiefly concerned in affording attachments 
to the muscles, and, in the dorsal vertebrae, 
in giving firmness and support to the ribs. 
— See Ribs. There are various other dis- 
tinctions common to the vertebrae which it is 
unnecessary to enter into here. The bodies 
of the vertebrae are separated from each 
other by what are called "inter-vertebral 
cartilages," (fig. cxxvi. 5.) These carti- 
lages are endowed with remarkable elas- 
ticity, yielding with every motion of the 
body, and breaking the effect of the shocks, 
which must have been communicated to the 
brain with every step, had the spinal column 
been all bone. Moreover, the variations in 
thickness of this component of the spinal 
column contribute greatly to mould its dif- 
ferent curves. 

In addition to being fitted to one another 
in a most beautiful manner, the vertebrae 
are firmly braced together by a series of 
ligaments of various kinds, which permit, 
but yet restrain motion. One of these liga- 
ments is shown (fig. cxxvi. 6) which runs 
down the bodies of the vertebrae externally; 
a similar ligament runs down the interior of 
the spinal canal, and there are others. — See 
Ribs, fig. cxi. 2. 

The two upper cervical or neck vertebrae, 
which are more especially concerned in sup- 
porting the head, are peculiar. The upper- 
most one, named the "atlas," from its of- 
fice, is little more than a ring of bone with 
two lateral joint surfaces on which the head 
moves in the performance of bowing motions. 
The second vertebre, called the axis, (fig. 
cxxv.,) has, in addition to (1,) the ordinary 
body of a vertebre, a tooth-like process or 
projection, (fig. cxxv. 7,) which, projecting 
upward, rests within the bony ring of the 
first vertebre, and is kept in position by a 
strong "transverse" ligament, which, run- 
ning across from one side of the ring of the 
first vertebre to the opposite, crosses the 
tooth-like process of the second vertebre, as 
at the dotted line — 8. By this arrangement, 
as a moment's reflection will show, the side 
to side motion of the head is secured, which, 
in combination with the bowing motion ex- 
ercised on the first or atlas vertebre, permits 
of that perfect capability of movement with 
which an all-wise Creator has endowed the 
noblest part of man. Should the above 
transverse ligament be broken by any 
chance, or by violence, as sometimes occurs 
in hanging, the tooth-like process, thus set 
at liberty, presses forward upon the spina] 
cord, and instantaneously extinguishes life 



SPI 



501 



SPI 



It is the danger of this occurrence which 
the author adverts to in the article on " Lift- 
ing Children." 

The seventh or lowest cervical vertebre is 
remarkable for being more prominent than 
the others, and is by this easily recognisable 
in the living body. The dorsal vertebrae 
support the ribs ; their spinous processes 
(fig. cxxiv. 8) overlap one another like the 
tiles of a house, (see Ribs, fig. cxi.,) while 
the spines of the neck and loin vertebrce 
project outward. The "lumbar" or loin 
vertebras (fig. cxxvi.) are the strongest in 
the body ; the lowest of them rests upon the 
sacrum bone, (see Pelvis,) and, indeed, this 
bone is evidently a series of vertebrce con- 
solidated to fulfil the functions of their po- 
sition. 

The spinal column constructed as above 
described is not straight, but has various 
natural curves. The principal of these is one 
outward, which increases the capacity of 
the chest, and one inward at the small of 
the back, which assists in maintaining the 
equilibrium of the body, and also in sup- 
porting the contents of the abdomen. — See 
Chest, fig. xxxiv. The canal which runs 
through the entire spine is continuous with 
the cavity of the skull by the opening in the 
base of the head, (see Skull,) and the mem- 
branes and nerve substance of the spinal 
cord are, through the above opening, con- 
tinuous with the brain and its membranes. 
■ — See Nervous System. The equilibrium of 
the spine, and therefore of the body gene- 
rally, and the motions of the trunk, are 
effected by means of the various muscles 
attached in a longitudinal direction, chiefly 
to the posterior portions of the vertebrce. 

Diseases and Injuries of the Spine. — 
The spine is liable to be the seat of a pecu- 
liar malformation at birth. This consists 
in the deficiency of the posterior portions of 
a certain number of the vertebrce, generally 
those of the loins, by which the membranes 
lining the interior of the spinal canal are 
left uncovered, except by the skin, both 
membranes and skin being distended into a 
livid-looking semi-transparent bag contain- 
ing fluid. This peculiar malformation gene- 
rally ends fatally, but not so invariably as 
to justify the child being left to its fate 
without an attempt to save it. This attempt 
can only be made by the surgeon, and will 
probably consist of cautious evacuations, at 
intervals, of the fluid contained in the bag, 
pressure being at the same time employed. 
Natural cure is said to have occurred in 
consequence of the fluid being allowed to 
escape through an ulcerated opening. Con- 
cussion of the spinal cord is not unfrequent, 



as a consequence of heavy falls on the feet, 
especially on the heels, or of direct blows 
on the back. The usual symptoms are de- 
pression of the system, with loss of sensa- 
tion and power of motion of the lower por- 
tions of the body, which either passes off in 
the course of a few days, or remains per- 
manently, perhaps passing into disease. 
Occasionally, very acute pain in the lower 
limbs comes on. In cases of concussion of 
the spinal cord, the power of evacuating the 
urine is sometimes lost, in which case the 
use of the catheter will have to be resorted 
to by the surgeon, whose speedy presence is 
requisite in every case of the accident in 
question. The best thing that can be done 
until aid is procured, is to place the patient 
as carefully as possible in the most easy 
position, and to keep him perfectly quiet. 
Any symptoms of inflammation following 
such an injury will require the usual treat- 
ment of leeches, fomentations, poultices, 
&c, the bowels being acted on by purga- 
tives given by the mouth or in clysters, &c. 
In patients confined to bed after injuries of 
the spine, bed-sores are particularly to be 
guarded against ; moreover, if sensation be 
much impaired, and the case be neglected, a 
sore may make considerable progress before 
it is discovered. Even if a case of injury 
of the spine does well, it is apt to be tedious, 
and the lost powers are very slowly re- 
gained. Friction repeated frequently, warm 
saline bathing, the douche, and gentle exer- 
cise of the limbs, are the most beneficial 
remedies. Displacement of vertebrce can 
rarely take place without extreme violence, 
and, even then, fracture generally accom- 
panies the accident, except in the case of 
the upper vertebrce of the neck, alluded to 
in the last article. Displacement is accom- 
panied to a greater or less extent by injury 
to the spinal cord, and consequently by 
paralysis of the parts below: if the injury 
is high up, instant, or at least speedy death 
being the result, In the event of an indivi- 
dual surviving, for a longer or shorter time, 
such an accident, all that others can do, till 
proper assistance is procured, will be to 
place the person in an easy posture, to admi- 
nister stimuli with due caution, and to en- 
deavour to preserve the proper heat of the 
paralyzed parts by friction and warm appli- 
cations, bearing in mind the cautions given 
under article "Paralysis." 

The spine is liable to various diseases, 
such as inflammation, apoplexy of the cord, 
softening, &c, the latter being not an unfre- 
quent concomitant of epilepsy. Pain in the 
part, and disorders of the functions of sen- 
sation and motion, and convulsive twitching, 



SPI 



502 



SPI 



are the most usual symptoms. It is not pos- 
sible, that beyond temporary soothing mea- 
sures, such as bran poultices, &c, unpro- 
fessional interference in such cases can be 
usefully employed. In cases of severe pain, 
however, opiates may be cautiously given 
till a medical man sees the case. In some 
forms of fever, and of lock-jaw, the spine is 
affected. Functional disorder, and what 
is called " irritation of the spine," are ex- 
tremely common, especially in females, and 
are often at the root of the obstinate palpi- 
tations, and many of the nervous and hys- 
terical derangements of the sex. In such 
cases, if the back be carefully examined, 
a tender spot may generally be discovered 
somewhere in the upper part of the spine, 
and often, when there is more than one 
tender spot, lower down. In these situa- 
tions, the spine may be simply tender on 
pressure, or pressure may cause pain to 
radiate as it were from the point, round the 
body, or, in severe cases, may bring on 
hysterical symptoms at once, and fainting. 
Such cases are frequently overlooked. They 
are generally connected with debility of con- 
stitution, and require the well directed treat- 
ment of a medical attendant. The use of the 
tepid or cold douche down the spine, followed 
by friction with a rough towel or flesh-brush, 
does much to relieve in such cases, often 
more than counter-irritation. The general 
health requires attention, and, generally, 
tonics, quinine and iron, are called for. 
Exercise must be regular, but not carried 
to fatigue, which is injurious. In severe 
cases, repeated small blisters are sometimes 
useful. 

Curvature of the spine is far from being 
uncommon. It is of three varieties — the 
angular curvature, lateral curvature, and 
curvature backward. The first of these, 
angular curvature, is caused by disease 
(caries) of the bodies of some of the verte- 
brae themselves, which, permitting the bone 
to yield under the weight of the body, causes 
angular distortion at the seat of the affec- 
tion. This disease, being sometimes at first 
accompanied with little pain, may be over- 
looked. It usually occurs in children, and 
in young people of delicate, and especially 
of scrofulous, constitution. Matter forms in 
connection with the diseased bone, and gra- 
vitating downward, shows itself as abscess 
lower down, perhaps in the loins or groin. 
The first symptoms of this disease may be 
the child wincing or crying out from sud- 
den pain in some movement of the spine. 
If allowed to go on unchecked, very great 
deformity ensues, and the constitution is at 
length worn out. The great essential of 



treatment in this form of curvature, is rest, 
in such a position as will take the pressure 
off the diseased bones ; this being best ef- 
fected by the use of the inclined plane, the 
patient lying either on the back or face ; 
but this, and the local and constitutional 
treatment, can only be properly conducted 
under medical superintendence. 

Lateral curvature is not, like the above, 
the result of disease, but is the mechanical 
effect of repeated and continual malposition 
of the body. It is the form of spinal curv- 
ature from which nurse-girls who are put 
at too early an age to carry heavy children 
frequently suffer. It is also the affection met 
with among the pupils of injudiciously con- 
ducted female schools. It of course is most 
liable to occur in weakly subjects but may 
take place in any young person who is com- 
pelled, habitually, to maintain the body, 
even without additional weight, in one po- 
sition for any length of time, (see Educa- 
tion,) and especially if compelled to support 
a weight on, or to make undue exertion 
with, any one side of the body. The first 
thing, generally, which attracts attention in 
this form of curvature, is the appearance of 
the shoulder, which assumes the prominence 
popularly known as "growing out;" that is, 
it evinces the displacement from its symme- 
trical position, which it, in common with 
the ribs, experiences from the curvature of 
the spine. If the incipient curvature be 
neglected, as a matter of necessity for the 
support of the head in an upright posture, 
a second curvature takes place in a direc- 
tion opposite to the first, giving the spine 
the curves laterally in the form indicated, 
(fig. exxvii.,) and distorting the body as re- 
presented. The causes of the above com- 
mon deformity which have been pointed out, 
naturally indicate that the first step to- 
ward cure must be the removal of the pro- 
ducing cause. If a weight has been carried, 
if exertion made, if injudicious school ma- 
nagement, such as too long-continued sit- 
ting or standing upright, has occasioned the 
deformity, it must be put a stop to at once. 
Such a course, with general tonic measures, 
rest of the body for a considerable portion 
of the day, equal exercise of the muscles 
connected with the upper extremities, and 
cold or tepid salt douche, with regular gene- 
ral exercise, will probably remove the tend- 
ency to curvature in incipient cases. If, 
however, deformity has made any progress, 
other and probably mechanical means will 
be required for its removal, which can 
only be properly employed under medical 
direction. 

The curvature of the spine from before 



SPI 



503 



S PR 



fig. cxxvii. 




back-ward occurs in weakly children, and 
constitutes the "stoop," or round-shoulder 
of the young. It is usually connected with 
general debility of constitution, which re- 
quires to be corrected by the ordinary 
means ; the local deformity being relieved 
by the horizontal posture, by the moderate 
use of " a back-board" when the patient is 
of sufficient age, and by the douche, fric- 
tion, &c. 

Refer to Education, $c. 

SPIRITS, LOW.— See Hypochondriasis 
— Indigestion. 

SPIRITS. — See Stimulants— Brandy- 
Gin, &c. 

SPITTING of BLOOD.— See Hemor- 
rhage — Lfngs, &c. 

SPLEEN, or MILT— Is a body of vari- 
able size, which is situated in the left hypo- 
chondriac region. — See Abdomen. It is 
somewhat of a spongy texture, and is capa- 
ble of containing blood so largely that its 
office in the economy (-which even now is 
not yet clearly made out) has been supposed 
to be that of a blood reservoir. Recent in- 
vestigations point to its close connection 
with the condition of the blood corpuscles. 
The spleen is liable to become greatly 
enlarged in cases of continued ague. — See 
Ague — [Ague- Cake. ] 

SPLINT.— See Fractures. 

SPONGE.— This well-known production 
of the animal kingdom is chiefly brought 
from Turkey. The great uses of sponge in 
medical, and especially surgical matters, 
need not be dwelt on here. Suffice it to 
remark, that sponge selected for such pur- 
poses should be free from the gritty parti- 



cles which are often present in considerable 
quantity in inferior sponges. Burnt sponge 
was formerly the best remedy in cases of 
"bronchocele." It is now known that its 
power of removing that disease depended 
on the presence of iodine. — See Iodine — ■ 
Bronchocele, §c. 

SPONGIO-PILINE.— See Poultice. 

SPORADIC DISEASES.— Diseases which 
show themselves in individual cases, in 
contradistinction to epidemic and contagious 

("jlCpOCpC 

SPRAIN, or STRAIN.— This painful in- 
jury is the result of forcible overstretching 
of the ligaments (see Ligaments) of a joint. 
In their natural state, the ligaments are but 
slightly sensitive, but when overstretched 
they are acutely so. There are few, perhaps, 
who have not, in a greater or less degree, 
experienced the sickening pain of a sprained 
wrist or ankle, the two joints which are most 
frequently the seat of the injury ; their lia- 
bility arising from their immobility, compared 
with such a joint as the shoulder, which is 
more liable to dislocation. A sprain is attend- 
ed with pain, which, perhaps, causes faint- 
ness or vomiting. "When this passes off, it is 
found that the joint cannot be employed as 
usual, evei'y attempt renewing the suffering. 
Shortly afterward swelling comes on, follow- 
ed by the heat and pain of inflammation. An 
injury of this kind, it need hardly be said, 
should not be slighted; for, should it be so, 
in some constitutions it may lay the founda- 
tion of irremediable disease. Few, perhaps, 
have either the power or the will to neglect 
a strain at first, but very many are inclined 
to rebel against the rest and confinement 
necessary for its perfect cure, which ought 
to be effected before the joint is brought into 
active use. When a sprain has occurred, 
complete rest is the first necessity, accom- 
panied by the soothing influences of fo- 
mentation and poultice, icell and thoroughly 
made use of, from the very first — the early 
employment of the remedies doing much to 
alleviate the suffering. When, in the course 
of a few hours, inflammatory signs appear, 
six, eight, or ten leeches may be applied 
around the joint with advantage, and if the 
patient is of at all full habit, a few doses of 
purgative medicine should be given. To 
allay the pain, six or eight grains of Dover's 
powder, with a couple of grains of calomel, 
may be given at night, and followed in the 
morning by a Seidlitz powder, or some 
other purgative. .After the joint has been 
soothed for some days by rest, with poui 
tices and fomentations, it will be advisable 
to change these applications for a bandage, 
which is to be kept wet with tepid water, 



SPR 



504 



SQU 



lightly applied to the injured part, -which, if 
agreeable to the feelings of the patient, may- 
be enveloped in some warm material. In 
such injuries, regulation of the temperature, 
the employment of heat or cold in the treat- 
ment, is always best ruled by the feelings 
of the patient. In some few cases, even 
from the beginning, cold lotions, such as the 
lead or the spirit lotion^ &c, are found most 
soothing, and then it is right to use them, 
at least as long as they prove agreeable ; 
but more frequently warmth, with moisture, 
is preferred and preferable. The bandage at 
first applied lightly, may gradually be used 
to exert more pressure, and to give more 
support, and the tepid applications may be 
exchanged for old ones. As soon as it can 
be borne, friction night and morning, with 
the soap liniment or soap and opium lini- 
ment, will be found agreeable and service- 
able. Lastly, instead of the morning rub- 
bing, the cold-water douche (the pump is 
a common and very good form) must be 
used to give strength and tone. For the 
latter purpose salt-water or sea-water is 
perhaps preferable to fresh. Whichever is 
employed, it ought to be continued till the 
joint aches slightly, the after reaction being 
promoted by rubbing well with a towel. 
It is repeated, too great caution cannot be 
used in bringing a joint, which has been 
sprained, into use, and especially if the sub- 
ject of the accident is at all of a scrofulous 
habit. Although the treatment of a sprain 
is perhaps neither difficult nor complicated, 
the discrimination of the accident in the 
first instance is sometimes by no means 
easy even to a surgeon ; for when much 
swelling has supervened, and when every 
slight movement is torture to a patient, 
there is much difficulty in coming to a de- 
cision respecting the exact nature of the 
injury, and in deciding whether or not 
the sprain is complicated with more or less 
fracture or displacement. On this account 
it is desirable that these accidents should be 
early examined by a medical man ; for it is 
too late, after weeks of poulticing, and 
bandaging, and rubbing, to find out that 
the so-called sprain is a fracture or dislo- 
cation. The swelling of a sprain is some- 
times colourless, but more generally it is 
coloured from the effusion of blood under 
the skin. As this is gradually absorbed in 
the process of cure, the variation from 
" black and blue" to greenish and to yellow, 
&c. takes place. 

SPRUCE-BEER— Is a* drink made from 
molasses or sugar fermented in water, and 
qualified by the extract from the spruce-fir ; 
the saccharine matter, in fact,- answering to 



the malt, and the spruce extract to the hop of 
common beer. Spruce-beer, when brisk in 
bottle, is not unpleasant, and is highly es- 
teemed among some of the Northern nations 
as a preventive of scurvy and other diseases. 
It probably owes any active properties to 
the presence of turpentine. 

SQUILL. — This drug is the produce of 
the Scilla or Squilla maritima ; the bulb, 
which weighs generally from one to three 
or four pounds, being the part used. It is 
chiefly brought from the shores of the Medi- 
terranean. 

Squill is met with in the shops in the 
form of yellowish, white, semi-transparent 
pieces, made by slicing the bulb, and then 
drying the slices. While perfectly dry, 
squill should be brittle, but from the readi- 
ness with which it attracts moisture, it is 
very often met with not quite dry, and rather 
tough. 

Squill is popularly known and used as 
an expectorant medicine, and when properly 
employed it is invaluable ; too often it is 
improperly given, and does mischief. It 
also acts as a diuretic, and may cause sick- 
ness or purging, in large doses. As an ex- 
pectorant, squill is irritant and stimulant ; 
it is therefore inadmissible when any thing 
like inflammatory action or active irritation 
is going on in the bronchi or air-passages ; 
in such cases it aggravates cough, instead 
of relieving. As an expectorant, squill is 
most serviceable in cases of chronic bron- 
chitis, especially in the aged ; but indeed in 
all cases when the phlegm or mucus is tough, 
viscid, and separates with difficulty from 
the air-passages, causing long and severe 
paroxysms of cough before it can be ex- 
pelled. Squill is most advantageously com- 
bined with opium ; the latter drug does not 
seem to impair its expectorant properties, 
while it modifies its tendency to irritate. 
From one to two drachms of paregoric, with 
twenty drops of tincture of squills, in a wine- 
glassful of water, forms a most excellent 
cough draught for night ; to which, if there 
is much debility, there may be added one 
drachm of sal-volatile. For diuretic pur- 
poses, squill is most generally given in pow- 
der, in from one to three grain doses, and 
usually in combination. It -is not adapted 
for domestic use with this view. 

Squill-vinegar is a frequently used pre- 
paration, made by macerating two and a 
half ounces of sliced squill-root in a pint of 
distilled vinegar for a week. After strain- 
ing and squeezing, an ounce and a half of 
proof spirit is added to insure keeping, and 
the whole is filtered. The syrup of squills 
is made by dissolving three and a half 



SQU 



505 



STA 



pounds of refined sugar in a pint of squill 
vinegar, by the aid of gentle heat. Its dose 
is from one to two drachms. Squill in 
powder is better purchased ready prepared; 
it requires to be very carefully secured in a 
well-stopped bottle, and to be kept in a dry 
place ; otherwise it quickly becomes useless 
from damp. The common squill pill is often 
used, but in many cases irritates and in- 
creases cough instead of relieving. The 
author has found the expectorant pill, for 
which a prescription is given under article 
"Pill," much more generally useful. In 
dropsy of the abdomen, a liniment composed 
of two parts of soap-liniment, and one part 
of tincture of squills, rubbed into the skin 
to the extent of two drachms, twice or thrice 
in the twenty-four hours, is said to be ser- 
viceable. 

Refer to Expectorants. 

SQUINT.— This unpleasant defect, when 
permanent, arises from contraction or per- 
manent shortening of one of the "straight" 
muscles of the eyeball. — See Eye. The 
squint may be congenital, or at least may 
appear very shortly after birth. In many in- 
stances, however, it dates from teething, 
especially if that phase of infant life has 
been accompanied with any tendency to con- 
vulsions ; it may also arise from irritation 
in the intestines, caused either by worms or 
by indigestible food. Indeed, in some chil- 
dren, the first and invariable symptom of 
their becoming disordered is the occurrence 
of squinting. In some cases squinting ap- 
pears simply to be the result of bad habits. 
Squinting comes on in some of the stages, 
especially the latter ones, of disease of the 
brain, such as acute water in the head. 

If squinting in a child is suspected to 
arise from irritation in the stomach or 
bowels, or from any cause, such as that of 
teething, the primary occasion of the dis- 
order is of course to be removed as far as 
possible. When no such origin is assignable, 
and when the defect, whether temporary or 
permanent, appears to be the result of habit, 
the best corrective, probably, is to cover 
over the unaffected eye for a certain period 
every day, so that the child in using the 
other shall be compelled by an exertion, if 
it possibly can be done, to direct it into the 
proper axis of vision, from which, in the 
case of a squint, it is thrown out. When 
squinting remains as a permanent defect, 
the only effectual remedy is the operation 
which some years ago was so much in vogue, 
and so indiscriminately performed. This 
operation consists simply in cutting through 
the muscle, the contracted condition of 
which occasions the squint. No sooner is 
2S 



it perfectly divided, than, in a successful 
case, the other muscles at once draw the 
eye to, and retain it in, the right direction 
— the divided muscle in the course of a short 
time contracting adhesion to the eyeball 
farther back than its original attachment, 
and so restoring and maintaining the ba- 
lance of action. The operation is in itself a 
trifling one, but is not successful in all 
cases ; in some it has happened that the 
muscle antagonistic to the one divided in 
the operation acts too strongly, drawings 
the eye as much in one direction as it had 
before inclined to the other ; other cases, 
although apparently cured for a time, are 
again apt to relapse to their former condi- 
tion. Still, even with these drawbacks,- the 
operation relieves many from an unsightly 
and annoying defect, and as it always re- 
quires the aid of a surgeon for its perform- 
ance, he must decide as to the probability 
of its affording prospect of permanent cure. 
Squinting is generally inward toward the 
nose, being caused by contraction of the in- 
ternal straight muscle ; it may, however, be 
either outward or upward, if the correspond- 
ing muscles are affected. 

Refer to Vision. 

STAB.— See Wounds. 

STAMMERING.— See Speech. 

STARCH.— See Fecula. 

STARVATION. — Deprivation of food, 
either total or partial. Under article 
" Food" it has been pointed out that nou- 
rishment is, or ought to have reference in its 
composition to two distinct ends — the nou- 
rishment of the bodily tissues, and the main- 
tenance of animal temperature ; moreover, 
in the above and other articles — " Debility," 
&c. — it has been shown, that to the latter — 
the support of the heat of the body — all 
other considerations must give way ; for that, 
fuel must be found, and if it be not fur- 
nished by periodical supplies of food, it will 
be taken from the component tissues of the 
body as long as these are capable of afford- 
ing it. Every inspiration of the starving 
man imparts to his blood the oxygen which 
is to be hurried to the consumption of his 
wasted and momentarily wasting tissues; 
every expiration gives out the carbonic acid 
and vapour, the smoke of the furnace within, 
which, like a steamer at sea run short of 
coal, is forced to consume its internal frame- 
work, in the effort to carry the hull to the 
haven of safety. The animal temperature 
must be maintained, or the person dies ; 
hour by hour, tissue after tissue is used up 
for this end, (see Animal Heat, §c.,) and 
hour by hour the slow wasting of starva- 
tion goes on, till either relief comes in the 



STA 



506 



STA 



shape of nourishment, or the last avail- 
able tissues have been exhausted, and the 
person dies, chiefly of cold. The fat, in the 
above process, goes first — its oxygen and 
hydrogen furnish the readiest fuel, the most 
easily burned material ; the muscles next 
yield and become soft and wasted, the 
nervous system falls before the pressure of 
necessity, and with it mental power ; deli- 
rium ensues, and the vital power of resist- 
ing the ordinary processes of decay is lost. 

A little consideration of the above will 
show that the process of starvation must 
be modified by various contingent circum- 
stances, more particularly the condition of 
the body as regards fat, &c. This internal 
supply of fuel, so to speak — were the simple 
chemical changes incurred in maintaining 
heat only to be considered — would make the 
fattest man the best resistant to, and longest 
liver under circumstances of starvation. 
This, however, will scarcely hold good, for 
there seems to be a power of endurance in 
the constitution (in the nervous system — 
of some) apparently a less susceptibility in 
the tissues to give way, that enables them 
to withstand a greater extent of privation 
than those who, according to the chemical 
theory alone, ought to last the longest. 
Again, external temperature influences 
greatly the effects of privation of food upon 
man. As shown under article " Cold" and 
elsewhere, a man exposed to low temperature 
requires food, not only more abundantly, but 
of a more nutrient character, to preserve 
him in health, than an individual surrounded 
by and breathing a warm atmosphere. It 
follows, therefore, that a man exposed to 
cold, breathing a cold air, and especially if 
ill-clad, will be much more quickly starved 
to death than under the reverse circum- 
stances. The above observations, especially 
if taken in connection with the articles re- 
ferred to, must make it clear that starvation 
is, in fact, the chemical union of the com- 
ponent particles of the tissues of the ani- 
mal body with the oxygen of the atmosphere 
carried through that body by the blood, and 
that the process is accelerated by whatever 
increases the amount of oxygen taken in by 
the lungs, whether it be cold, which gives 
a greater amount of oxygen in a given vo- 
lume of the atmosphere, or exercise, which 
increases the rapidity of the respiratory 
process, and at the same time the consump- 
tion of the muscular particles in the per- 
formance of motion. — See Motor Change. 

Happily, cases of starvation from actual 
inability to procure food are not frequent 
in this country ; but medical men often wit- 
ness an approach to a state of starvation in 



the progress of diseases, of fever especially, 
when patients lie for a great length of time 
without taking food. In such cases it occurs, 
that at last the patient is actually in dan- 
ger of perishing from starvation, or rather 
from cold ; the animal temperature begins 
to sink in consequence of the fuel tissues 
of the frame being all used up. Much, 
indeed, may be done to ward off this condi- 
tion by the employment of strong broths, 
and of gelatinous materials, which, by en- 
tering the blood, furnish materials for heat- 
ing, and so protect the tissues. But, after 
a certain point, these are insufficient, and 
nothing but alcohol will do ; nothing but 
spirit, with its ready combustible carbon 
and hydrogen, will give a chance of life to 
"him who is ready to perish" from the 
starvation of disease. 

Starvation has to be viewed as it takes 
place under total deprivation of food, and 
as it occurs under an inadequate supply. 
In the first of these, " there is pain at the 
stomach, relieved by pressure, the counte- 
nance is pale and cadaverous, the eyes wild 
and glistening, the breath hot, the mouth 
parched and dry, and the strength is pros- 
trated. After a time the body exhales a 
foetid odour, the mucous membranes at the 
outlets inflame, and life closes in delirium 
or convulsions."* 

In that gradual starvation produced by 
deficiency of food, the symptoms seem to be 
chiefly referable to depression of the nervous 
system, both the ordinary sensations and 
mental powers being in some respects 
blunted, although at the same time nervous 
irritability is present, and perhaps mental 
disorder. Dr. B. Holland, who has written 
on the subject, thus describes the condition 
resulting from continued deficiency of food : 
"The state is indicated by a sallow and 
dingy appearance of the skin, a soft and 
flabby feeling of the flesh, more or less ema- 
ciation, general debility, feebleness of the 
circulation, and swelling of the ankles. The 
stomach becomes disordered, the appetite 
defective, the digestion impaired. The indi- 
vidual feels languid and desponding, is soon 
fatigued, incapable of exertion, and has an 
irresistible disposition to fall asleep, from 
which he is apt to wake suddenly and in a 
fright. The body is easily chilled, breath- 
lessness and palpitation are experienced 
after slight exertion, attacks of giddiness, 
noise in the ears, and transient blindness 
are common, and there is a peculiar forlorn 
and dejected aspect of countenance which 
is very characteristic." The above symp- 



* Taylor's Jurisprudence. 



ST A 



507 



STI 



toms in a severe form occur in those who 
are so unfortunately placed as actually to 
want bread ; in a minor form they are met 
with in those who for some reason accus- 
tom themselves to take too little nourish- 
ment, either as regards quantity or quality. 

When total deprivation of food has ex- 
tended even to twenty-four hours — when 
partial deprivation has gone so far as to 
produce pain at the stomach, and marked 
debility — return to a proper supply of nou- 
rishing food must be very gradual. The 
stomach and its sources of nervous stimula- 
tion partake of the general depression, and 
are no more fit for much exertion than the 
rest of the body; consequently, food must 
be given in small quantity, and in such a 
form as will most easily enter the circula- 
tion, such as good broths along with a small 
proportion of alcoholic stimulant, very care- 
fully given, and warmed. When partial starv- 
ation or continued deficiency of food has 
been in operation for some time, it lays the 
individual open to the attack of epidemic 
and endemic disease, and, indeed, seems to 
be the exciting cause of disease, as observed 
in the " Irish fever," which followed the 
famine. 

STAYS.— See Education. 

STEAM. — See Heat — Inhalation — Poul- 
tice, &c. 

STEEL.— See Iron. 

STERNUM.— The breast-bone to which 
the collar-bones and ribs are attached ante- 
riorly. — See Chest — Ribs, §c. It consists of 
three separate pieces. 

STERTOR, or Stertorous Breathing — 
Is very similar to snoring. It occurs in apo- 
plexy, and on the approach of death from 
otliGi* discuses. 

STETHOSCOPE.— See Auscultation. 

STEWING— Which is the slow cooking of 
food by heat which does not reach the boil- 
ing point, renders meat peculiarly digest- 
ible ; and, moreover, as the juice of the 
meat, or gravy, is most usually eaten with 
the meat, the whole nutriment is preserved. 
Stewing may, of course, be rendered inju- 
rious to some invalids by the addition of 
much fatty matter, or by that of vegetables. 

STICKING PLASTER— Also called Ad- 
hesive or Diachylon Plaster. — See Dress- 
ing — Plaster, §c. 

STIFF-JOINT.— See Anchylosis. 

STILL-BORN.— See Child-bed — Chil- 
dren, &c. 

STIMULANTS, GENERAL. — See Ex- 
citement and Excitants. 

STIMULANTS, ALCOHOLIC— Temper- 
ance and Total Abstinence — Intemper- 
ance. 



Alcoholic stimulants are classed as fer- 
mented and distilled. The principal fer- 
mented liquors in use in this country are 
grape wines — domestic or home-made wines 
— liquors from the fermented juice of the 
apple or pear, cider and perry; and malt li- 
quors from various grains, principally barley. 
To these might be added many more made and 
used among different nations, according to 
the materials within their reach. Distilled 
liquors are not less numerous than the 
fermented, for man in every quarter of the 
globe has taxed his ingenuity, and generally 
with success, to find the means for their 
manufacture. The distilled liquors most 
commonly used in England are brandy, 
whisky, gin, and rum, or preparations from 
these : but, like the fermented liquors, many 
other alcoholic products of distillation are 
used in different countries, according as 
their natural products offer facilities for 
their formation. Distilled liquors contain a 
much larger proportion of alcohol than those 
which are simply fermented ; indeed, alco- 
hol and water make up their constitution, 
the peculiar flavour of each depending 
chiefly on the essential oils, or ethers, de- 
rived from the materials from which they 
are distilled. As the special characters of 
the various alcoholic liquors in use are en- 
tered into under their separate articles, the 
following observations are directed to the 
action of alcoholic stimulants, generally, 
upon man, and to their employment by him — 
their "use and abuse." Pure alcohol itself 
(see Alcohol) is ranked among the narcotico- 
acrid poisons. If a large quantity of strong 
spirit, or of alcohol, be quickly taken into 
the stomach, it may cause immediate death ; 
indeed, many deaths from this cause are on 
record, and are frequently noticed in the 
public prints, as the result of foolish at- 
tempts to drink a large amount of strong 
liquor in a given time. If, in such cases, 
death does not immediately ensue, total 
insensibility generally supervenes, lasting 
for a longer or shorter time, either termi- 
nating in recovery, or passing into apoplec- 
tic stupor. In these cases of poisoning, the 
alcohol undoubtedly acts in the first instance 
by giving a shock to the nervous system 
through the stomach, similar to that which 
is produced by a blow on the pit of the 
stomach, or by a draught of cold water 
taken by a person in a state of heat and 
exhaustion. And, secondly, it acts upon 
the system generally, and especially upon 
the brain, in consequence of its absorption 
into the circulation. W T hen this absorption 
occurs, it produces the phenomena observed 
in aggravated intoxication. To the article 



STI 



508 



STI 



" Intoxication" the reader is referred for 
further information. There can be no ques- 
tion that in the form above stated, of con- 
centrated or of pure alcohol, this agent acts 
as a poison ; but to deduce from this, as is 
frequently done, the assumption that under 
all forms, and in any dilutions or combina- 
tions, alcohol is a poison, is so illogical that 
it scarce deserves refutation. 

The effect of a moderate quantity of 
diluted spirit, or of wine or malt liquor, is 
very different from that of poisonous irri- 
tant doses of alcohol — as different as the 
scorching flame is from gentle heat. When 
a moderate quantity of diluted alcoholic 
fluid, such as wine or malt liquor, is swal- 
lowed by a person in health, there generally 
ensues a feeling of warmth in and around 
the stomach, which is gradually diffused 
over the whole body, and is accompanied 
with a slight increase of muscular and nerv- 
ous energy, the functions generally being 
more actively performed, and the mental 
power increased. Such may be called the 
salutary effects of a moderate quantity of 
the stimulant. If the bounds of moderation 
be passed, the stimulation is increased, the 
pulse quickened, the cheek flushed, and the 
mind excited in excess : if the quantity of 
stimulant is still further increased, " a 
degree of torpor is induced, both mental 
and bodily ; perception is blunted, there is 
a general languor, giddiness, and obscurity 
of vision, incoherence of ideas, and incapa- 
bility of exercising volition ; the person is 
" drunk," and either sinks into a state of 
somnolence — half sleep, half stupor — or, by 
becoming sick and vomiting, recovers his 
senses quickly, sometimes at once. The 
amount of stimulation caused by alcoholic 
fluids varies, of course, according to the 
strength of the dose, but also in some de- 
gree according to the habits of the indivi- 
dual ; for there is no question that those who 
habitually drink strong wines or spirits, 
derive little if any stimulation from the 
weaker alcoholic drinks ; moreover, some 
conditions of the system modify greatly the 
stimulant power of alcohol. In spasm, in 
fainting, in depressed states of the system, 
from fever or other such causes, persons 
often take, with scarcely perceptible effect, 
doses of wine or spirit which at other times 
would put them in a state of intense intoxi- 
cation. Although, however, habit enables 
individuals to consume alcoholic drinks in 
greater quantity, and of greater strength, 
it by no means follows that this is done 
with impunity ; if excess is habitually in- 
dulged in, the mucous membrane of the 
stomach becomes diseased, as the effect of 



a continued low state of inflammation, and 
even the other coats of the organ undergo 
changes of structure and indurations, which 
occasionally degenerate into cancer; at the 
same time the muscular and nervous sys- 
tems, and the secreting organs generally, 
especially the liver and kidneys, are apt to 
suffer seriously. 

There can be no doubt that most of the 
effects of alcoholic excitement, intoxication 
and stupefaction, depend upon absorption 
of the fluid into the blood, this having been 
found to take place very rapidly ; that is 
to say, the alcohol passes as alcohol into 
the blood, and circulates as alcohol in the 
vital fluid till it is got rid of by the usual 
processes of chemical change and of excre- 
tion. During this circulation, the most 
evident effects of alcohol are exerted in the 
nervous system ; nor can this be matter of 
surprise, considering that after death from 
drinking spirit — gin — largely, there has 
been found within the brain "a quantity 
of limpid fluid distinctly impregnated with 
gin, both to the sense of smell and taste, 
and even to the test of inflammability." 
Moreover, there appears to be some special 
relation existing between the nerve tissues 
and alcohol. 

With regard to the effect of alcohol upon 
the blood, it is unnecessary here to detail 
the various observations which have been 
made. One thing, however, appears to be 
well confirmed, which is, that the effect of 
intermixture of alcohol tends to keep up a 
venous condition (see Aeration — Blood) of 
the circulating fluid for a considerable time. 
According to Dr. Prout, after taking alcohol 
the excretion of carbonic acid from the 
lungs is at first diminished; languor, yawn- 
ing, and drowsiness being the consequence. 
There can be no doubt that the above effect 
of alcohol is in great measure owing to the 
elements of the spirit combining with oxy- 
gen in the body, and that its carbon and 
hydrogen are given off ultimately as car- 
bonic acid and water. " The oxygen which 
has accomplished this change must have 
been taken from the arterial blood ; for we 
know of no channel, save the. circulation of 
the blood, by which oxygen can penetrate 
into the interior of the body." " The oxy- 
gen thus abstracted from the arterial blood 
to combine with the elements of alcohol, 
would, under other circumstances, have 
combined with the atoms of the muscular 
and other tissues, giving rise to develop- 
ment of muscular force ; consequently, in 
this way, muscular power is rather dimi- 
nished; there is languor. This statement 
may seem at variance with a former one, 



STI 



509 



STI 



that alcoholic stimulants give rise to in- 
creased muscular energy. Both statements 
are true — it is circumstances only which 
alter the effects. This is proved by practi- 
cal experience, thus : — If an individual in 
good health, making active exertion in the 
open air, especially if it be cold, or if he 
be perspiring freely in warm air, consumes 
a moderate quantity of alcoholic fluid, he 
experiences the excitant effect ; that is to 
say, the special stimulation of the alcohol 
upon the nervous system is experienced ; 
but the activity of both the respiratory and 
circulating systems, and the consequent in- 
creased supply of oxygen throughout the 
body generally, counteract the chemical 
effect of the spirit elements on the blood — 
they do not permit the venous state above 
alluded to to be formed. On the other 
hand, if a person keeping quiet in the 
house, especially if the air be warm, and 
ventilation deficient, takes but a small pro- 
portion of alcoholic fluid, how quickly does 
he become languid, sleepy, and unfit for 
exertion, either mental or bodily ! In this 
case, even without alcohol, the circum- 
stances were such as to favour carbonic 
accumulation in the blood, and with it 
muscular inactivity and mental hebetude ; 
it is, therefore, much more likely that these 
symptoms will occur when the alcoholic in- 
fluence is added. A clear understanding 
of the foregoing remarks will explain much 
of the usual effects of alcoholic fluid, ob- 
served either in one's own person, or in 
that of others. It is only necessary to keep 
in mind, that the first effects are those of 
special excitement of the nervous system, 
giving increased activity through that sys- 
tem to every function of the living body ; 
but that this special excitement is apt to 
be interfered with by the chemical effect ex- 
erted by the elements of the spirit on the 
blood as above described, more or less, ac- 
cording as circumstances facilitate or not 
the introduction of oxygen into the vital 
fluid, and its transmission throughout the 
frame. Here attention may be drawn, as it 
has in other articles in this work, to the 
importance of this substitution of the alco- 
holic elements for those of the bodily tissues 
in exhausted states of the frame, as in fever, 
&c, (see Starvation.) the animal temperature 
being maintained by the artificial " alcoholic 
fuel," so to speak, when the ordinary tissues 
are exhausted. 

The less palpable effects exerted by alco- 
hol upon men who work out of doors, than 
upon those whose employment is of a more 
confining nature, probably influences in some 
degree the statistics of its consumption, and 
2s2 



for this reason Dr. Guy states, "that men 
who work out of doors are more addicted 
to drinking than men who are employed 

within doors." If the palpable general 
effects are not so great in the former as in 
the latter, it, however, by no means holds 
good that excess may not give rise to an 
equal amount of local injury to the digestive 
and other organs. 

The effect of alcoholic fluids upon the 
digestive organs and their functions has 
been the subject of much discussion and 
observation. In the case of St. Martin, 
(see Digestion,) Dr. Beaumont observed that 
even under the stimulation of ordinary food, 
but in greatly increased intensity if extra 
stimuli were taken, "the colour of the lining 
membrane of the stomach changed from a 
pale pink to a deep red." The actual effects 
of alcohol upon the digestive functions pro- 
bably vary according to the amount and 
strength of the fluid taken, and upon the 
habits of the individual. That immoderate 
doses of strong wine or spirit interfere with 
digestion is, perhaps, correct ; but that the 
moderate employment of alcoholic beve- 
rages with their meals is requisite to enable 
many persons to digest their food properly, 
is perfectly certain, and in accordance with 
the experience of medical men generally. — 
See Digestion. The requirement may not, 
perhaps, be that of a person in the full 
vigour of health, and placed in healthy cir- 
cumstances ; it is, however, one which we 
find closely linked with the every-day life 
and constitution of a large number of per- 
sons in this civilized, artificial community 
of Britain : such being the case, it is folly 
to ignore its existence. 

At the same time, although the admissi- 
bility, and in many cases the necessity, of a 
moderate allowance of alcoholic beverage, 
is contended for as necessary to perfect 
digestion under the circumstances named, 
it ought never to be forgot that the immo- 
derate use, the abuse of these stimuli exerts 
the most serious effects upon organs with 
which they come so immediately in contact, 
— the effects, moreover, being aggravated 
rather by the concentration of the spirit in 
the fluid usually drunk, than by its gross 
amount. Ardent spirit^, drunk regularly 
to excess, exemplify the baneful influence 
most strikingly ; the most usual consequences 
being, as already mentioned, a low degree 
of inflammation of the stomach, followed 
by thickening of its coats, and great impair- 
ment of its digestive power ; and along with 
these, frequently, hemorrhage from the 
bowels. The close connection of the liver 
with the stomach, both in situation, func- 



STI 



510 



STI 



tion, and vascular communication, renders 
it liable to be affected equally with the 
latter organ, and, in fact, the liver-affection 
of drunkards, the "gin-drinker's liver," (see 
Liver,) is matter of popular information. 
This affection, moreover, is liable to be in- 
creased by a warm climate, and a most 
remarkable diminution in the occurrence 
and fatality of liver complaints among the 
troops in India, has been proved, statistic- 
ally, to follow the abridgment of the allow- 
ance of spirits. Again, disease of the kid- 
neys is a frequent consequence of the abuse 
of alcoholic fluids, and with the kidneys 
the urinary organs are usually implicated. 
The lungs, the heart, the arterial system 
generally, are not exempt from the evil 
influence. Sir James Clark remarks, "that 
the abuse of spirituous liquors among the 
lower classes in this country is productive 
of tuberculous disease (consumption) to an 
extent far beyond what is usually imagined," 
and that not only is the tainted constitution 
acquired by the individual, but that it is 
transmitted with great certainty to the off- 
spring. Not only, however, is the physical 
effect transmitted, but the mental and moral 
taint are so likewise ; too often there is an 
inborn love of intemperance, which, if in- 
dulged, adds immensely increased power 
to the physical evil — the drunken child 
of a drunken parent is generally much 
the shortest lived of the two. Moreover, 
the child of a drunkard is very apt to' be 
deficient in intellect, and not improbably 
idiotic. 

If the abuse of alcoholic liquors is injuri- 
ous to the body, equally so is it to the ma- 
nifestations and tendencies of the mind. 
Passing over the milder forms of excitement, 
we find, under the influence of excess, that 
faculty which keeps the will subordinate to 
the judgment weakened, or for the time 
destroyed ; there is produced, in fact, a 
state of temporary insanity ; and so close is 
the resemblance that, as remarked by an 
esteemed writer,* there is simulated "the 
raving delirium, the maudlin sensibility and 
groundless apprehensions of the melancholic, 
the bloodthirstiness of the homicidal, the 
cunning desperation of the suicidal maniac ; 
the prostration of the moral feelings ; the 
inflation of the mind with delusions as to 
dignity, wealth, and knowledge ; and finally, 
in the last state of intoxication may be 
noticed the gradual disappearance of every 
manifestation of reason, until the vacant 
gaze and drivelling smile have for the mo- 
ment stamped upon the countenance the 



Dr. Robinson. 



fearful inanity of idiocy. Since, then, a 
single dose of an intoxicating substance 
possesses the power of temporarily disorder- 
ing the intellect, perverting the moral senti- 
ments, and even wholly suppressing the 
operations of the mind, it is not wonderful 
that the continued use of such agents should 
frequently induce permanent mental de- 
rangement. Continuance in that habit may 
occasion this effect either directly or indi- 
rectly. We possess no data by which to 
estimate its influence in predisposing to 
insanity ; we can, however, readily conceive 
that it must be very considerable. It is 
found that the minds of persons who have 
once laboured under an attack of mania, 
are ever afterward more liable to excite- 
ment, and less capable of preserving their 
equilibrium while exposed to disturbing 
influences, than those which have never 
deviated from a healthy state. We have seen 
that each fit of intoxication is, in fact, a 
temporary attack of insanity. We notice in 
every-day life how frequently the intellects 
of habitual drunkards become impaired ; 
and, knowing these things, we cannot avoid 
the conclusion, that an excessive use of 
intoxicating substances will in time so en- 
feeble the mind as to render it incapable of 
bearing ordinary sources of disturbance, 
and thus act as a powerful predisposing 
cause of insanity." 

Dr. Joseph Williams gives the following 
table as the proportion of cases of insanity 
caused by the "abuse of spirits," admitted 
into various asylums : — 

Proportion 
caused by in- 
temperance. 

134 

414 

20 

17 

76 

4 

.146 



Total 
admis- 
sions. 

Charenton 855 

Bicetre and Salpetriere.. 2012 

Bordeaux 156 

Turin, 1830-31 158 

Turin, 1831-36 390 

Gard 209 

United States 551 

Palermo 189 

Caen 60 

Dundee 14 

M. Parchappe 167 

M. Bottex 288 

5049 



16 
4 

46 
54 

940 



Dr. Robinson has drawn up a table, show- 
ing the proportion which intemperance bears 
to other causes of insanity, as exhibited in 
the returns from ninety-eight asylums in 
England and Wales. From the table we 
find that intemperance constitutes the im- 
mediate cause of one-seventh of the cases 
contained in the English asylums. Dr. 



STI 



511 



STI 



Robinson, however, considers the propor- 
tion estimated much below the real amount, 
which is marked by various contingent cir- 
cumstances. Accordingly another table is 
given, drawn up from the returns of twenty- 
five asylums. From the second table we 
learn that one-fourth of the cases of in- 
sanity admitted are referred to intemperance 
alone, and to it in conjunction with vice and 
sensuality, nearly one-third. It is further 
remarked, that many of those cases entered 
in the tables as unknown might be added to 
the list. 

Were it needful, much additional evidence 
on this point might be adduced. 

There is no doubt, when habits of intem- 
perance have reached a certain point, that 
the unfortunate victim becomes partly in- 
sane, at leastsomuchsoasto become affected 
with the species of monomania to which 
the term dipsomania has been applied. Sir 
Alexander Morrison describes it as a morbid 
craving for drink, which generally occurs 
at intervals, in which persons are seized 
with an irresistible propensity to drink to j 
excess, although conscious at the time of 
their misconduct, but are unable to control 
themselves. Change of scene, confinement, 
&c, effect a cure, but relapses are very 
likely to occur. 

In the endeavour, however, to correct, 
either the state of dipsomania or to reform a 
drinker, care must be taken that the brain 
be not affected, and mania or fatuity pro- 
duced by too sudden a withdrawal of the j 
accustomed stimulus. Andral relates the j 
case of a man who, being thrown into prison 
for theft, became, in the course of a fort- 
night, perfectly delirious, and was only re- 
stored to sanity by the physician allowing 
him a small proportion of brandy daily. 
The above might be regarded as a case of 
delirium tremens ; but the boundary line 
between the latter disease and insanity is so 
little defined, that it is difficult to say where 
the one ends, or where the other begins. 

It is under the temporary insane excite- 
ment produced by the abuse of alcoholic li- 
quor, whether purposely or accidentally, that 
a large proportion of the petty, and many of 
the most fearful, crimes are perpetrated by 
man. M. Quetelet, in his chapter on the 
"Development of the propensity to crime," 
assigns to the excessive use of intoxicating 
drinks the increase of crimes against pro- 
perty and person in certain provinces of 
France. But we need not go out of England 
to find evidences of the effect of the insane 
excitement of drink in stimulating to crime ; 
every newspaper, every prison report, tells 
the same tale. But, perhaps, the most con- 



clusive evidence on this subject (indeed, we 
need no other) is the collection of opinions 
expressed by many of our eminent judges 
on this head, who have publicly from the 
bench declared, as their deliberate opinion, 
individually, that drinking alone gave ori- 
gin to by far the largest proportion of crimes 
that came before them for trial — crimes 
from which the perpetrator would have 
shrunk, but from the short-lived insanity 
of intoxication. 

In considering the effect of alcoholic sti- 
muli upon the system, due attention must 
always be given to the form in which they 
are taken. It is certain that ardent spirits 
— which, it may be remarked, should never 
be taken but as medicine — will exert a much 
more irritating effect upon the nervous. sys- 
tem, both locally in the stomach and at 
large, than the fermented liquors. It is 
well ascertained that a certain amount of 
wine exerts less intoxicating effect than the 
spirit in the same quantity of wine would 
do, were it separated by distillation and 
then diluted with water ; and moreover, that 
"different wines, although containing the 
same absolute proportion of spirit, will be 
found to vary very considerably in their in- 
toxicating powers." 

There is no doubt that the lighter wines 
of the continent, those which contain no 
more spirit than is yielded by the simple 
fermentation of the grape-juice, are quite 
the most wholesome, and that the action 
upon the system of those stronger wines, 
such as port and sherry, to which spirit has 
been added, must, in some degree, resemble 
the action of distilled or ardent spirits. At 
least it has been proved that spirit artifi- 
cially added to a wine is not united with it 
in the same manner as the spirit formed in 
it by the natural process of fermentation, 
which does not yield above eight per cent. 
In considering the action of the various 
kinds of wine, however, the influence of 
habit must not be lost sight of; for many 
who are accustomed to the use of the strong, 
dry wines cannot change to the lighter and 
more acescent kinds, such as the hocks, &c. f 
without risk of inducing disordered diges- 
tion, a tendency to gravel, and other similar 
complaints, which, however, does not pre- 
vail among those who regularly make use of 
these wines. The brisk sparkling wines 
affect the nervous system so rapidly, con- 
sidering their small amount of spirit, that 
their effects have been in part attributed to 
the carbonic acid rising in the stomach, and 
carrying with it a portion of the alcohol 
into more intimate contact with the nerves 
of that organ. Home-made wines are apt 



STI 



512 



STI 



to disagree with many persons, in conse- 
quence of the amount of sugar they often 
contain, or from the presence of lactic and 
other acids. Many of the remarks on wine 
apply also to the malt liquors, to the articles 
on which the reader is referred for further 
information. — See Ale — Porter. Attention 
has hitherto been confined to the actions of 
alcohol, and of its various preparations, on 
the system, without reference to external 
circumstances ; and at the same time occa- 
sion has been taken to advert to the serious 
physical and mental evils which inevitably 
result from the abuse of the agent. It will 
now be pointed out under what external 
conditions and circumstances, and under 
what peculiar conditions of mind and body 
the use of alcoholic stimulants is either ser- 
viceable or necessary. 

If the question be asked, whether alco- 
holic liquors form a necessary part of the 
sustenance of healthy men generally, it must 
be answered certainly not. That they are not 
necessary is proved, not only by the history 
of many nations, both ancient and modern, 
but by the results of the total abstinence 
movement : numbers are well and active 
both in mind and body, who never touch an 
alcoholic fluid. But what is a rule for some, 
or even for many, is by no means universal, 
and the experience of medical men gene- 
rally, including those whose names stand 
highest at the present time — and they, it is 
presumed, are the most proper judges of the 
case — goes to prove that there are numbers, 
under the present artificial positions and 
modes of life, in this country at least, who 
cannot eschew the use of alcoholic stimuli 
without the risk, or rather the certainty, of 
detriment to health. Probably there are 
few medical men who cannot reckon among 
their patients (the author certainly can) 
individuals who have seriously injured them- 
selves by the unadvised adoption of, and 
rigid adherence to total abstinence prin- 
ciples. In such cases, the nervous system, 
the digestive organs, and bodily and mental 
vigour, gradually become weakened, and 
there is often great depression of spirits. It 
may be said that persons who require alco- 
holic stimulants to maintain their digestive 
and other powers, are not in a proper healthy 
condition, and possibly they are not. But 
they are in the state of numbers in this 
country at the present time — a state fostered 
by circumstances, by the debilitating effects 
of the deficient sanitary arrangements of our 
large cities, by the wear and tear of mental 
anxiety and overwork, and by the struggle 
in the perpetual battle of life, in which most 
are engaged in the throng of competition. 



These influences and others, including per- 
haps deficient natural constitution, render 
the moderate employment of alcoholic sti- 
mulants absolutely requisite for the pre- 
servation of the energies on which their 
livelihood and usefulness depend. The re- 
quirement may be artificial, but we cannot 
change the circumstances ; at least, not 
quickly; and until they are changed, it is 
folly, and worse than folly, to refuse a bene- 
ficent provision. There can be no question 
(indeed it has been proved) that the depress- 
ing influence of deficient sanitary arrange- 
ments are among the most powerful incen- 
tives to intemperance amid the workmen of 
our large towns, who, unfortunately, instead 
of wholesome moderation, too often indulge 
in excesses, especially in the use of spirits, 
Avhich entail upon them many diseases. 
Better is it, certainly, that a man should 
risk health, even if that should suffer by 
his becoming a total abstainer, rather than 
ruin both body and soul by intemperance. 
But better still, that he should be exposed 
to neither risk, by being placed beyond the 
influences of depression, and within the 
influence of those natural stimuli (see 
Excitement) which our Creator has made 
necessary to our healthful existence in this 
world. 

There are accidental circumstances in 
which all may at times be placed, in which 
the question arises whether the assistance 
of alcoholic stimulation may be had re- 
course to with benefit or not. Exhaustion 
by long exertion in extreme of heat is one 
of these — the skin, acting powerfully, dis- 
charges immense quantities of fluid, which 
must be compensated for. As long as the 
energies remain unimpaired, the compensa- 
tion should be made by unstimulating 
drinks ; by these the strength is in every 
way better preserved ; but when the ener- 
gies flag, if exertion must still be made, a 
small quantity of diluted alcoholic stimulant 
may be taken with advantage. Under con- 
tinued exposure to the effects of intense 
cold, especially if symptoms of torpidity 
supervene, the use of undiluted spirit may 
save, and has saved, many a life. In such 
cases, however, the caution must not be 
forgotten, that the spirit should not be had 
recourse to early, and not, if possible, till 
it is used to stimulate to the last effort to 
gain the place of safety. [Neither should 
it be taken in such quantity as is likely to 
inebriate.] Other cases occur, in which 
persons are compelled by circumstances to 
make continued exertions, involving loss of 
the usual rest. In these, after a time, the 
moderate use of the stimulant is highly 



STI 



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beneficial ; [but hot coffee, when it can be 
obtained, will answer better. On board 
ship, when all hands are overworked, hot 
coffee is far preferable in its effects to the 
" grog" usually given.] 

The necessity for the use of alcoholic 
stimuli, under the various external circum- 
stances which tend to depress or exhaust 
the bodily powers," is, of course, immensely 
modified by the constitution, hereditary or 
acquired, of the individual. Some indi- 
viduals there are, who from birth upward 
are always below par, who have no power 
of endurance. Such persons generally re- 
quire stimulants habitually, to enable them 
to keep up to life's duties at all ; still more 
do they do so when exposed to conditions 
of depression or exhaustion. 

The above have been considered irrespec- 
tive of those cases in which long habit has 
rendered the use of alcoholic stimulants an 
acquired necessity, especially if excess has 
debilitated the constitution. There are, 
undoubtedly, many individuals of strong 
constitution and nervous power, who can at 
once lay aside the use of these stimulants 
without inconvenience ; but there are others 
who quickly become depressed. This is 
especially the case if other depressing effects, 
such as an accident and its necessary pains 
and confinement, are in operation. Such 
cases, in hospital practice, are very com- 
mon ; the continued allowance of the alco- 
holic stimulant is necessary, not only for the 
reparation of the accident, such as a frac- 
ture, but even for the continuance of the 
functions of life. 

The question of the propriety and benefit 
of alcoholic stimulation in the treatment of 
certain phases of disease, is one which it is 
matter of surprise could ever be mooted in 
the face of the approval and enunciation of 
the highest authorities, past and present, in 
practical medicine — ignorance alone could 
ever have raised the doubt. As the use of 
alcoholic stimuli is noticed under the heads 
of the various diseases, it is unnecessary to 
enter upon its consideration again. 

Few subjects, perhaps, included in the 
present work, are more important than that 
which 'has just been discussed, briefly of 
necessity, but much too briefly to do it jus- 
tice. The evils of intemperance in England 
[as well as in the United States] are so 
deplorable, that every man who wishes well 
to his kind or to his country must earnestly 
desire to see them checked. And when it 
is looked upon as a matter of temporary bene- 
fit and expediency, must regard the total ab- 
stinence movement as one fraught with im- 
mense benefit to numbers. At the same 



o3 



time, medical men, especially, are aware 
that its uncompromising dogmas are the 
source of evil as well as good; evil, not to 
individuals only, but to the community ge- 
nerally, by turning the attention from the 
great incentives to the abuse of alcoholic 
stimuli, the depressing influences to which 
all classes of the community are exposed, 
by deficient sanitary arrangements, by the 
exhausting effects of competition in the vo- 
cations of life, and by the great absence 
of provision for, and relish of, the harm- 
less excitements. Excitement of some kind 
is necessary, and if men, uneducated, or 
partly educated, have not the natural stimuli 
of the light and air of heaven, and proper 
relaxation afforded them — if they have no 
mental stimulus presented to them as a 
change after the physical toils of the day, 
no object of interest with which to fill the 
vacuity of the mind, and no attraction, save 
that of a squalid home, most surely will they, 
in numberless instances, when they can, 
seek the artificial stimulus of alcohol, and 
the comfortable fire and comparative clean- 
liness of the tap-room. 

STINGS of Bees, Wasps, Hornets, &c. 
— Are punctured, and at the same time 
poisoned wounds, the intense pain being 
caused by the acrid poisonous fluid, which 
is pressed through the tube of the sting at 
the moment it is inserted in the skin. The 
poison is contained in a bag at the base of 
the sting, and the latter is barbed on one 
side. After the first acute pain of a sting 
subsides, a severe tingling smarting re- 
mains, and the part begins to swell. The 
amount of swelling varies greatly in differ- 
ent persons. In some it is trifling, in others 
it is very great, and in a few individuals it 
extends over the entire body, while at the 
same time there is much sick faintness, &c, 
requiring the administration of sal-volatile 
and other stimulants. If the sting has been 
inflicted about the throat, the swelling has 
been known to prove fatal. The domestic 
local applications to stings are very nume- 
rous. Oil is frequently applied, and gives 
relief ; but alkaline preparations certainly 
appear to be most serviceable. The popular 
remedy of the " blue-bag" is probably use- 
ful for this reason. Soda is also employed; 
but ammonia or hartshorn (the weaker so- 
lution) is the best form of alkaline applica- 
tion, and it may be used alone or mingled 
with oil. However, before any remedy is 
used, care should be taken to ascertain that 
the sting does not remain in the wound. If 
it does, it must be extracted by tweezers or 
by squeezing. If the pain and swelling 
remain severe, the common lead lotion, or a 



STI 



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tepid poultice, will relieve. — See Wounds, 
poisoned. 

STITCHES.— The transient pains which 
all persons are apt to experience at times, 
are probably of a neuralgic character. A 
stitch in the left side, such as occurs in con- 
sequence of exertion, quick walking, or run- 
ning, is ascribed to congestion of the spleen. 
It has also been attributed to affection of the 
diaphragm. It is relieved by pressure. — See 
Side, Pain in. 

STOMACH.— The form and position of 
this important organ have been sufficiently 
indicated in articles " Alimentary Canal" 
and "Abdomen;" to these the reader is 
referred, and at the same time to article 
"Digestion" for an account of the latter 
process. The stomach is made up of three 
different coats or layers, the outer one, 
being the " peritoneal" coat, which covers 
the contents of the abdomen generally. — 
See Peritoneum. The middle layer is the 
muscular coat, by which the churning and 
wavy motions of the stomach are performed 
during the process of digestion. The inner- 
most layer is the mucous coat, which is con- 
tinuous with the lining of the gullet and 
mouth upward, and with that of the intes- 
tines downward. In the stomach, the mu- 
cous coat is thrown into folds or wrinkles, 
called in anatomical language "rugae," 
which extend longitudinally along the organ. 
When at rest, the lining membrane of the 
stomach is of a pale pink colour, but when- 
ever its peculiar functions are called into 
exercise by the presence of food, it becomes 
much reddened by the increased determi- 
nation of blood toward it. 

The chief disorders to which the stomach 
is liable have already been entered into 
under the head of "Indigestion;" and such 
affections as cancer, perforating ulcer, 
spasm, &c. have been sufficiently consi- 
dered in the general articles on these sub- 
jects. Blows over the region of the stomach 
are often serious, and may be immediately 
fatal. — See Blows — Shock, $c. 

Gastritis. — Inflammation of the stomach 
is not a common disease in its acute form, 
and when it does occur, is usually the re- 
sult of irritant agents, such as strong spirit, 
poison, &c, applied directly to the stomach 
itself. Fever, thirst, severe pain at the pit 
of the stomach, inoreased by pressure or by 
the presence of food, vomiting, especially 
after food has been taken, hiccup, red tongue, 
and, shortly, extreme depression of the sys- 
tem, are the usual symptoms. Leeches and 
poultices to the pit of the stomach, cold, 
sometimes iced water, or barley or gum 
water, to allay thirst, and clysters, either 



aperient or opiate, will be the most useful 
remedies ; but the disease is so serious in its 
nature, and so rapid in its progress, that it 
should at once, if possible, be put under 
regular medical treatment. 

STOMACH-PUMP.— See Pump. 

STONE.— See Gall-stone— Urine, &c. 

STONE-FRUIT — Generally speaking, is 
less digestible when eaten raw than the other 
descriptions of fruit ; to healthy persons, 
however, when ripe, and consumed in mo- 
deration, it is not injurious. Plums have 
acquired a character for causing disorder 
and diarrhoea, which they scarcely deserve. 
Undoubtedly, with some persons they dis- 
agree, and, indeed, with all, if they are 
eaten immoderately or in bad condition; but 
that they, or fruits generally, are the cause 
of the regular autumnal or British cholera, 
is a fallacy which has been established in 
the popular mind, in consequence of the 
season at which plums are ripe — the "plum 
season" being coincident with that at which 
people in this country, who have been ex- 
posed to the effects of the summer's heat, 
are most liable to that outbreak of accumu- 
lated bile which is known as bowel com- 
plaint, or English, or British, or summer 
cholera, [the cholera morbus, of the United 
States.] The fallacy is principally mis- 
chievous, because it closes the eyes of peo- 
ple generally to the real cause of a disease, 
which, with more or less severity, so regu- 
larly makes its appearance, and thus pre- 
vents their adopting those measures of pre- 
caution which would insure them against its 
attacks. 

Refer to Biliary Disorder, §c. 

STONE-POCK.— A name applied to hard 
pimples. 

STOOLS. — The evacuations from the 
bowels always afford important indications 
of the state of health ; they are, therefore, 
generally watched by medical men in cases 
of illness, and as a general rule should be 
saved for their inspection. 

In infancy, the discharges from the bowels 
are generally lighter coloured than they are 
as life advances — this, perhaps, being partly, 
but not altogether, due to the usual milk 
nourishment, which, even in adults, if taken 
largely, tends to give a lighter colour to the 
stools. In infancy, moreover, the appear- 
ance of the natural evacuations is liable to 
vary greatly in colour, and, especially when 
there is disorder, acidity, &c, to assume a 
green tinge, either as directly passed from 
the bowels, or soon after exposure to the air, 
even if the motion has, in the first instance, 
been of a yellow or orange hue. The na- 
ture of these green evacuations is scarcely 



STO 



515 



STO 



satisfactorily explained ; they generally, 
however, follow attacks of pain, with su- 
perabundant acid. As children get beyond 
infant life, the stools, particularly in those 
with light hair and complexion, are apt to 
become either entirely or partially of a clay- 
colour, evidently from deficiency of bile. In 
such cases, it is not uncommon for gray 
powder or calomel to be given, with a view 
of increasing the flow of bile, which these 
medicines certainly do, and for a few days 
the motions are improved in appearance ; 
but only for a few days — they soon become 
as unhealthy looking as ever ; the benefit 
derived from the mercurials was only falla- 
cious, or worse, it was injury rather than 
benefit. The true cause of these clay- 
coloured stools, in most instances, is the in- 
ability of the blood to furnish an adequate 
supply of the healthy bile ; consequently, to 
stimulate the liver to secrete an increased 
quantity under these circumstances, is to 
impoverish the blood. A course of iron 
tonics, with a good supply of animal food, 
and, if need be, a little wine or malt liquor, 
is much more likely to bring the motions to 
the colour of health, permanently and bene- 
ficially. Not that an occasional dose of 
gray powder may not be useful, but it is 
not the remedy. In adult life, the stools 
become clay-coloured, or chalky, from a dif- 
ferent cause or causes, the most usual being 
obstruction to the flow of bile ; (see Jaun- 
dice;) but also from deficient secretion con- 
sequent upon disease of the liver, such as 
occurs in drunkards. The stools may vary 
in consistence, being either too hard or too 
liquid : the former is the case in persons of 
costive habit, in whom the fsecal contents 
pass so slowly through the bowels, that their 
liquid components are too much absorbed. 
— See Costiveness. In the latter case, the 
too liquid condition of the motions is asso- 
ciated, generally, with tendency to diarrhoea. 
— See Diarrhcea. The form of the motions 
ma y, by its peculiarity, convey important 
information : thus, in an enlarged state of 
the "prostate" gland at the neck of the 
male bladder, they assume a flattened form, 
or they may be diminished in size by nar- 
rowing of the gut. — See Stricture. The ge- 
neral bulk of the stools must of course 
depend much upon the amount and quality 
of the food ; inattention to this fact some- 
times misleads. It is not uncommon for 
persons to imagine, that if the bowels are 
regularly moved once a day, they must be 
in a perfectly free state, forgetting, that 
though they may discharge a portion of 
their contents, they do not necessarily dis- 
charge all ; and such is really the case. In 



old people especially, enormous accumula- 
tions of fsecal matter are apt to take place, 
while the person is under the impression, 
that because there is a daily stool, the 
bowels are periodically fully relieved. On 
the other hand, again, the popular impres- 
sion seems to be that the bowels fulfil no 
other office than that of a passage for the 
food refuse. This fallacy has already been 
alluded to under articles " Alimentary Ca- 
nal," "Digestion," &c. 

Various articles of food, such as the seeds 
and skins of fruits, will, as mentioned above, 
affect the appearance of the stools, and 
medicines do so more especially. Iron, in 
particular, forms an inky black with the 
colouring matter of the bile, and as persons 
are often unnecessarily alarmed at the ap- 
pearance, the circumstance should be made 
known, when iron is prescribed. Rhu- 
barb, senna, &c, in some degree, impart 
their colour to the stools. Mercurials mo- 
dify them, causing an olive or deep green 
appearance, which may be kept up for a 
length of time if mercurials are too con- 
tinuously given. Persons are thus deceived 
at times, and under the idea that the motions 
do not become healthy, go on purging with 
the mercurials, which are themselves the 
cause of the unhealthy appearance. Other 
purgatives may have the same effect in a 
lesser degree. In unhealthy states of the 
system, and especially in some febrile affec- 
tions, the stools become much more offensive 
than usual. When such is the case, the 
bowels generally require purging. The 
stools may contain blood. If this comes 
from the stomach, or high up in the intesti- 
nal canal, it is usually black and pitchy in 
appearance, and often highly offensive: 
stools of this kind often occur after severe 
bleeding at the nose, when the blood has 
been swallowed. The blood may be fresh 
and clotted, either dark or florid. — See Piles. 
In some cases the stools contain large quan- 
tities of mucus, simple or gelatinous look- 
ing, or they contain matter. In all such 
cases, the motions should be kept for inspec- 
tion, and a medical man sent for as soon as 
may be. In Asiatic cholera, and sometimes 
in its British simulator, the stools resemble 
thin gruel or "rice-water." Straining at 
stool may arise simply from costiveness, and 
therefore is probably habitual ; it is, more- 
over, one of the chief evils of costiveness, 
for not only is it apt to induce rupture in 
the predisposed, but, in the aged, it may 
bring on head attacks. Straining, or, as it 
is called medically, "tenesmus," occurs as 
a consequence of an inflamed and swollen 
condition of the lining membrane of th<? 



STO 



516 



SUF 



rectum, (see Rectum,) such as occurs in di- 
arrhoea, &c. ; there is the sensation as if 
the bowel was still unrelieved, and constant 
instinctive efforts are made to free it : they 
only increase the evil, and should, by an 
effort of the will, be desisted from if possi- 
ble. In children, straining and sitting too 
long when the bowels are evacuated, may 
cause falling down of the bowel. The cus- 
tom should be corrected. 

STOVES — For heating apartments, are 
certainly apt to prove most unwholesome 
substitutes for the common open fire-place, 
if but for the one reason, the very defective 
ventilation they afford, if they afford any at 
all. Moreover, a stove, even constructed on 
the best principles, is apt to cause a dryness 
of the air of an apartment, which not only 
causes most uncomfortable sensations, espe- 
cially about the head, but is really injurious ; 
and further, in many forms of stove, vapours 
of sulphur or of carburetted hydrogen are apt 
to escape. In any room heated by a stove, 
extra provision should be made both for 
ventilation, (see Bedroom,) and for furnish- 
ing moisture to the atmosphere. 

Refer to Chimney. 

STRAINING.— See Stools. 

STRAMONIUM.— See Thorn Apple. 

STRANGULATION.— See Suffocation. 

STRANGURY.— See Bladder. 

STRAWBERRY. — This delicious fruit 
must be classed with the most wholesome 
productions of the vegetable kingdom. It 
is recorded of Fontenelle that he attributed 
his longevity to them, in consequence of 
their having regularly cooled a fever which 
he had every spring ; and that he used to 
say, " If I can but reach the season of 
strawberries." Boerhaave looked upon 
their continual use as one of the principal 
remedies in cases of obstruction and vis- 
cidity, and in putrid disorders. Hoffman 
furnished instances of obstinate disorders 
cured by them, even consumption ; and 
Linnams says, that by eating plentifully of 
them he kept himself free from gout. Th^r 
are good even for the teeth. 

STRICTURE.— See Urethra— Urine. 

STRUMA — Scrofula. — See Scrofula. 

STRYCHNINE.— See Nux Vomica. 

STUN. — See Brain, Concussion of. 

STUPE.— A piece of cloth or flannel 
soaked in hot water as a means of fomenta- 
tion. — See Fomentation. 

STUPOR— Coma.— See Coma. 

STYE.— See Eye. 

STYPTICS— Are applications, usually of 
an astringent character, which possess the 
power of arresting hemorrhage. The re- 
medies classed under astringents may all 



be used as styptics, but many of them are 
not generally had recourse to as such — that 
is, as external means o£ arresting bleeding : 
it is to these that the term styptic is applied 
in this article. 

Oak-bark decoction, and gall-nuts in 
powder or infusion, which owe their efficacy 
to the tannin they contain, are used as 
external styptics, and "Ruspini's styptic," 
formerly much in vogue, is said to be a so- 
lution of tannin in spirit. — See Oak. In 
addition to these, matico and turpentine are 
styptics derived from the vegetable king- 
dom ; also the agaric fungus popularly 
known as the "fuzz-ball," which is frequent- 
ly applied to bleeding wounds, and with ap- 
parent benefit. From the mineral kingdom 
many styptic applications may be derived, 
such as the salts of iron, especially the sul- 
phates of copper and zinc, the acetate of lead, 
and the nitrate of silver. Cold, the actual 
cautery, or red-hot iron, &c. &c. are all styp- 
tic applications. — See the various articles. 

Refer to Hemorrhage. 

SUBSULTUS.— Spasmodic jerkings of 
the muscles, which occurs in various dis- 
eases of debility, such as fever, &c. 

SUCKLING.— See Children— Child-Bed 

"jsJttt> o'p Sec* 

SUDDEN DEATH.— See Death. 

SUDORIFIC — A promoter of perspiration, 
or diaphoretic. — See Diaphoretic. 

SUFFOCATION— Is the term usually 
applied to that condition in which the air is 
prevented from entering the lungs by agents 
which do not compress the windpipe, as 
they do in hanging or strangulation, the 
distinction being, that in the latter case 
the vessels of the neck are usually com- 
pressed, and add to the state induced in the 
chest, a congested condition or accumula- 
tion of blood in the brain. In the former, 
the effects are complicated, are purely those 
of suffocation, or as it is called in medical 
language, "asphyxia." In this condition 
the atmospheric oxygen being excluded 
from the lungs, the blood is unchanged, 
either partly or totally, according to the 
completeness of the obstruction. In this 
unaltered state it passes back to the heart, 
(see Circulation,) by which it is sent with 
more or less activity through the arteries, 
and coming in contact with the nerve tis- 
sues, it acts upon them as a poison, pro- 
duces convulsion, &c. The vessels of the 
lungs and the heart, missing their accus- 
tomed and proper stimulant, (the arterial 
blood,) gradually cease to act, and life's 
machinery stands still. 

Suffocation is the result of such accidents 
as immersion in an atmosphere of carbonic 



SUF 



517 



sua 



acid gas, or " choke damp," of drowning, 
of foreign bodies becoming lodged in the 
gullet or windpipe, of spasm. — See Larynx, 
$c. §c. As these causes of the accident are 
all treated of respectively, it is unneces- 
sary to enlarge upon them here. 

It is requisite, however, by way of cau- 
tion, to notice some causes of accidental 
suffocation, which are sometimes fatal. 

People who eat greedily, or who, as in 
the aged, are unable to chew their food 
properly, are sometimes suffocated; (see 
Gullet;) the accident, too, has sometimes 
followed vomiting in intoxication. A cu- 
rious case of the kind is recorded, in which 
a man, who, after vomiting, was put to bed 
drunk, was shortly after found dead — suffo- 
cation having been caused by a small piece 
of potato skin so fixed over the opening of 
the larynx as perfectly to stop the passage 
of air. In children, a small body like a 
pea or cherry-stone, accidentally drawn 
into the air-passages, has caused suffoca- 
tion; and, very recently, a case was record- 
ed in which a young man was killed by 
being forcibly pushed into a sack contain- 
ing bran. The bran drawn into the wind- 
pipe caused suffocation. 

Infants may be suffocated, oftener per- 
haps than comes to light, by the very re- 
prehensible practice, followed by some igno- 
rant nurses, of giving them a bag of wash- 
leather or cloth filled with sugar, to suck, 
in order to keep them quiet ; if this chances 
to get too far in the throat, it will certainly 
suffocate. Death by suffocation in infants 
" overlaid," by heavy-sleeping nurses, is 
far from being a rare occurrence; and, 
indeed, it may happen simply from too 
great an accumulation of clothes over the 
mouth and nose. 

Other causes might be cited — the above 
are perhaps sufficient to excite caution. 

SUFFUSION— Is a medical term usually 
applied to the eyes when they are blood- 
shot and watery. 

SUGAR. — This important article of food 
and luxury is for the most part a product 
of the vegetable kingdom, but not entirely 
so, for it occurs in milk, and in eggs in 
small quantity, and is also produced by the 
animal body, under conditions to be here- 
after noticed. 

Sugar is formed principally of two dis- 
tinct varieties — cane, or ordinary sugar, 
and sugar of fruits, or grape sugar. Both 
are composed of the elements, carbon, oxy- 
gen, and hydrogen, but differ somewhat in 
the proportions in which these are com- 
bined. In addition to the above sugars, Lie- 
big enumerates a third, a non-crystallizable 
2T 



variety ; and milk or manna sugar also 
differs from them slightly in composition. 
Cane, or ordinary sugar, is produced by the 
sugar-maple, by the birch, by beet-root, 
carrots, &c. ; but its chief source is the 
sugar cane, from which it is most easily 
and abundantly extracted. To effect this, 
the canes are crushed between heavy roll- 
ers, and the expressed juice, after under- 
going certain operations of heating, is left 
to crystallize, the dark uncrystallizable 
portion known as treacle or molasses being 
permitted to drain off. The crystallized 
sugar which remains is the brown or Mus- 
covado sugar of commerce. As may be 
expected, it contains many impurities ; 
moreover, the treacle which drains from it 
is rather the result of bad preparation, es- 
pecially in the application of heat, than a 
necessary product. It is, in fact, grape 
sugar, which, has been formed from the 
cane sugar by the decomposing influence 
of heat. In order to produce the refined 
sugars of the shops, other processes of re- 
solution, filtration, &c. require to be gone 
through. 

Cane and grape sugar differ from each 
other in some important particulars. The 
former is only produced naturally, "it is 
crystallizable," "and, when pure, not prone 
to deliquesce, or to alter when exposed to 
moisture, or to a moderate temperature." 

Grape sugar is also a natural production, 
but can be formed by art, from starch, &c, 
(see Fermentation;) it does not crystallize 
regularly, and the aggregations into which 
it forms are very prone to attract moisture. 
Pure cane sugar ought, therefore, to be 
crystalline and free from moisture ; when it 
contains grape sugar, which it frequently 
seems to do, either by natural formation, 
or by designed adulteration, it is liable to 
become clammy and moist. According to 
the investigations of the "Lancet Sanitary 
Commission," from which much of the in- 
formation contained in this article is de- 
rived, experiments show clearly that cane 
and grape sugars coexist in most, if not 
all, the colonial brown sugars, and even in 
some of the lump sugars, and that they 
even exist together in the cane itself. The 
amount of the admixture of grape sugar is 
important, not only from the tendency which 
it imparts to the whole to become moist,* 
but because it possesses a much lower 
sweetening power, and is much more prone 
to fermentation than the cane sugar. The 
latter, when purified, is generally free from 



* It is to be feared, howeyer, that all the moisture 
in many of the sugars retailed is not attracted from 
the atmosphere. 



sua 



518 



SUG- 



grape sugar, and from many of the other 
impurities with which the ordinary brown 
sugars are intermingled — considerations 
which render the purchase of coarse sugars 
a very doubtful piece of economy. 

The chief impurities found in brown 
sugars, as imported into England, are por- 
tions of the cane, and vegetable albumen 
which imparts a strong tendency to ferment- 
ation, and also assists to nourish the sugar 
acarus or insect, which, as shown by Dr. 
Hassal, exists in greater or less proportion 
in nearly all the brown sugars sold to the 
public. This disgusting impurity in food 
is, it is said, so considerable in size, " that 
it is plainly visible to the unaided sight." 
When present in sugar it may be detected 
by dissolving a couple of teaspoonfuls of 
the sugar in a large wineglassful of tepid 
water, the solution being permitted to re- 
main at rest for an hour, "at the end of 
that time the animalcules will be found, 
some on the surface of the liquid, some ad- 
hering to the sides of the glass, and others 
at the bottom, mixed up with the copious 
and dark sediment, formed of fragments of 
cane, woody fibre, grit, dirt, and starch 
granules, which usually subsides on the so- 
lution of even a small quantity of sugar in 
water." The idea has been suggested, 
that the disease known as the "grocers' 
itch," to which those who handle sugar 
much are liable, may be caused by this 
insect, which closely resembles the itch 
acarus in form. A minute species of fun- 
gus is also generally met with in the moist 
sugars. 

The refined sugars sometimes retain traces 
of the albuminous matters, serum of blood, 
or white of egg, &c. used in their purifica- 
tion; also, traces of lime, lead, iron, &c, 
acquired in the preparation. According to 
the Lancet reports, an examination of fifteen 
samples of lump sugar gave the following 
results : — That in nine were fragments of 
cane, of sugar insects or fungi, to be de- 
tected ; that in three there were traces of 
grape sugar ; in ten, of animal matter ; and 
in all, of flour. 

According to the same report, an exami- 
nation of thirty-six samples of moist sugar 
showed — That the sugar insect was present 
in the whole of the samples, and in many 
of them in great numbers. That fungi were 
also present in all, and besides these, the 
fragments of cane, grit, &c. already men- 
tioned. It is evident that pleasure in food, 
health, and economy, are more consulted by 
purchasing the refined than the moist sugars. 
Probably the time is not far distant when 
the latter will be unsaleable. 



Milk sugar, which differs from the sugars 
already noticed, "occurs in commerce in 
thick crystalline crusts, which are usually 
yellowish, yellowish brown, or dirty, from 
want of care and cleanliness in its prepara- 
tion;" when purified, however, it becomes 
very white and hard. Its sweetening power 
is weak, and it is capable of undergoing the 
vinous fermentation. 

As an article of nutriment, sugar is of 
course the representative of the saccharine 
principles, which include starch, gum, &c. : 
the position which these principles hold, 
and the part they fulfil in the processes of 
nutrition generally, having been sufficiently 
entered into under article " Food," it is un- 
necessary to repeat them here. 

With regard to the digestibility of sugar 
by different individuals, there is consider- 
able variation. Some persons cannot con- 
sume it, even in small quantity, without be- 
ing disordered and suffering from acidity, 
while others seem actually to digest their 
food better when an amount of saccharine 
is mingled with it. In the West Indies, and 
other countries where sugar is cultivated, 
the inhabitants, the negroes especially, are 
said to improve in health and appearance 
during the sugar season, when they consume 
it plentifully ; and, undoubtedly, a moderate 
proportion of this pleasant aliment is a 
wholesome article of nutriment for people 
generally, except under those peculiar states 
of constitution, or rather of disease, when 
the tendency of the assimilative powers 
generally is to form sugar even from diet- 
etic principles which could scarcely be ex- 
pected to yield it. This animal sugar has 
not only been detected in the blood, but in 
the stomacfe, after a person had been fed 
for days upon animal food alone. More- 
over, recent researches render it probable 
that sugar is formed, naturally, in the liver. 
In medical practice, sugar is used princi- 
pally to cover the nauseous taste of drugs, 
which, it must be confessed, are often made 
much more nauseous by the admixture ; it 
is also useful as syrup in aiding the forma- 
tion of pills, &c. Sugar is a powerful anti- 
septic. — See Diabetes. 

Refer to Fermentation — Food — Syrup, 8;c. 

SUGAR of LEAD.— See Lead. 

SUICIDE. — Suicidal Tendency. — The 
distressing state of mind which seems to 
impel individuals to self-destruction, has 
too exclusively been viewed in its metaphy- 
sical light alone, without reference to those 
states of bodily disorder which unquestion- 
ably induce great changes upon the views 
and feelings, particularly in persons natu- 
rally disposed to melancholy. The follow* 



SUI 



519 



SUI 



ing observations of Dr. Forbes Winslow, in 
a lecture recently published in the Lancet, 
are most pertinent to the question. He 
says — "It is the prevalent opinion, even 
among persons otherwise well educated and 
intelligent, that this desire of self-destruc- 
tion is, in the majority of cases, a mental 
act, unconnected with a disturbed condition 
of the bodily functions, and incurable by 
any process of medical treatment ; that the 
mental depression which is so generally as- 
sociated with the invisible tendency, is an 
affection of the mind per se; the physical 
organization having no direct connection 
with what is termed the spiritual impulse. 
This metaphysical view of the matter is 
fraught with much mischief; and, I have no 
doubt, has led to the sacrifice of many valu- 
able lives. It is a matter of the highest 
moment that the public mind should be un- 
deceived upon this point. Right views on 
this subject ought to be generally diffused. 
It is of consequence to establish the belief 
that the suicidal idea is almost generally con- 
nected with a morbid condition of the body, 
and is often the only existing evidence of 
such an affection ; that it is, with a few ex- 
ceptions, universally associated with phy- 
sical disorder, disturbing the healthy ba- 
lance of the understanding ; and that this 
bodily affection, which is in nine cases out 
of ten, the cause of mental irregularity, is 
easily curable by the judicious application 
of remedial means. The tendency of the 
spiritual or metaphysical view of the ques- 
tion is to create a distrust in remedial mea- 
sures, and the poor man who is struggling 
against an almost overwhelming desire to 
destroy himself, is induced to neglect en- 
tirely his lamentable condition, under the 
belief that he is literally placed beyond 
the reach of curative agents, and that the 
only remedy for his mental suffering is death ! 

" If a person in this unhappy state of 
mind is induced to believe that his mental 
despondency is but a consequence or effect 
of a disturbed bodily condition, influencing, 
either directly or indirectly, the natural and 
healthy operation of the brain and nervous 
system, and giving rise to perverted ideas 
— that his malady is curable — he may be 
induced to avail himself of the means which 
science has placed at the disposal of the 
physician, and thus be protected against his 
own insane impulses." 

"Where no disease is suspected, no re- 
medy will be sought. Tell a man who has 
attempted to destroy himself that he is per- 
fectly sane — that his judgment is sound — 
that his will is not perverted — that the im- 
pulse which urges him to the commission 



of suicide is not associated with any devia- 
tion from corporeal health — and you incul- 
cate ideas not only fallacious, but most per- 
nicious in their character and tendency. 
We might, with as much truth, tell a per- 
son playing with a lighted taper at the edge 
of a barrel of gunpowder, that his life is 
not in jeopardy, as to say to a person dis- 
posed to suicide, that he is in the perfect 
enjoyment of health, and requires no moral 
or medical treatment. It may be laid down 
as an indisputable axiom, that in every case 
of this kind, bodily disease may, upon a 
careful examination, be detected. I never 
yet saw a case where a desire to commit 
suicide was present, in which there was not 
corporeal indisposition." 

While it is of the highest importance that 
the connection which exists between the tend- 
ency to suicide and derangements of the 
general health, or any condition of disease, 
should be well attended to, it would per- 
haps be dangerous to lead persons to the 
idea that all depended upon physical de- 
rangement. This there maybe, (perhaps is, 
in the majority of cases,) at times giving 
rise to irresistible impulses, at least appa- 
rently irresistible, for how far they are so, 
man cannot judge ; but to base too much 
upon the bodily condition, may hold out in- 
ducements to those who are afflicted with 
the suicidal tendency to abandon that moral 
and religious control of their actions, which 
is so powerful, and which in many cases 
will overcome in the end. The subject of 
suicide is one which it is impossible to sepa- 
rate from religious considerations, when it 
is considered among Christian men ; and if 
these men truly believe that God does assist 
those who look for his aid in the hour of 
trial and temptation, they cannot think that 
in such an hour as that, when one of his 
creatures contemplates the violent destruc- 
tion of the life which he has given him, 
that God will not aid, if his help is sought, 
and strengthen the combat of the higher 
powers of the mind against the lower prin- 
ciples ; for suicide is selfish and cowardly. 
If an elevated religious and moral tone had 
nothing to do with controlling the propen- 
sity to crimes, and to that of suicide among 
the number, statistics would not furnish the 
evidence of the preponderance of these 
crimes amid people who notoriously cast 
aside the practical regulation of religion in 
their lives, individually or socially. 

By these remarks the author does not 
intend in any way to weaken the force of 
the previous ones of Dr. Winslow, but to 
caution the mind, lest the consideration of 
the physical should obscure that of the 



SUL 



520 



SUL 



spiritual. Nevertheless, it is probable, that, 
in the first instance, more benefit will be de- 
rived by treating the affection as a phy- 
sical disorder. When an individual afflicted 
with suicidal tendency can be thoroughly 
kept under surveillance in private, the effect 
of well-directed medical treatment may be 
tried ; otherwise, the best and safest plan is 
to commit the sufferer to a well-regulated 
asylum. — See Insanity. 

The subject of human responsibility, 
where, overcome by the evil tendencies ori- 
ginating in physical derangement, it ceases 
to be responsibility, is perhaps one which 
man can never fathom; but it is one which 
ought to be upheld to the utmost in such 
conditions as a tendency to suicide. While 
giving every attention to the medical treat- 
ment of the physical condition, there should 
at the same time be given every encourage- 
ment to those who show the least tendency 
to this derangement, to keep, if they can, 
and as long as they can, the reins of reason. 
The mind can, and often will, overcome 
mental depression from physical causes, but 
it must be exerted. The reader is referred 
to some observations under article Habit. 
The tendency to suicide is found to be least 
in persons who are occupied out of doors. 

SULPHATES— Are salts, in which the 
base, such as an alkali, or a metallic oxide, 
is united with sulphuric acid. — See Copper 
— Magnesia — Zinc, §c. 

SULPHUR — Belongs to the elementary 
bodies. It is found in large quantities in 
some volcanic countries, such as Sicily, from 
whence, hitherto, the chief supply has been 
obtained. It also occurs in the form of 
metallic sulphurets, such as those of iron, 
usually called pyrites, from which, in Swe- 
den and other places, sulphur is procured. 
In the combination of sulphuric acid with 
different bases, such as lime, magnesia, &c, 
sulphur is again found, so that in one way 
or other it is one of the most abundant 
constituents of the globe. In the vegetable 
kingdom, sulphur occurs, as in the mustard 
tribes, in the grains, &c. ; in the animal 
kingdom it forms a constant element of the 
albuminous and fibrinous tissues. 

The pale " sulphur yellow" colour of sul- 
phur, and its brittle crystalline texture, are 
sufficiently familiar in the form of stick or 
roll sulphur. The "flowers of sulphur" is 
made by "sublimation," that is, by exposing 
crude sulphur to heat sufficient to cause it 
to rise in the form of vapour, the latter 
being condensed in a cool receptacle, when 
it takes the form of the well-known "flowers 
of sulphur." Roll sulphur is now made by 
simply fusing the sublimed sulphur, and 



casting it in the form of sticks. In medical 
practice, sulphur, is variously employed, its 
best-known application, however, being for 
the cure of itch, in the form of ointment. — ■ 
See Itch. In various skin diseases, sulphur 
is prescribed by medical men ; it is also 
used as a mild laxative in pregnancy and 
in cases of piles. For the latter purposes 
it is advantageously mingled with three or 
four times its weight of cream of tartar, or 
with its own weight of magnesia. The 
sublimed, or flowers of sulphur, is the form 
in most common use ; but the precipitated, 
or milk of sulphur, is rather a more elegant 
preparation. One very serious objection to 
the use of sulphur is the abominable odour 
which it imparts to the person, particularly 
to the insensible perspiration. There is no 
doubt that it passes off by the skin in con- 
siderable quantity— so freely, indeed, as to 
blacken silver which the individual taking it 
may happen to carry about with him. 

The dose of sulphur as a laxative is, 
alone, two drachms ; when mixed with cream 
of tartar or magnesia, from half a drachm 
to a drachm. It is best given in a little 
milk. [Many persons, however, prefer 
taking it in molasses.] 

SULPHURIC ACID, or Oil op Vitriol 
— Belongs to the class of mineral acids. It 
is a compound of sulphur and oxygen gas, 
in the proportion of one of the former to 
three of the latter. As usually met with, 
it contains a certain amount of water, but 
it may be obtained pure, and in the form of 
a crystalline solid, " glacial sulphuric acid." 
Sulphuric acid was formerly procured solely 
by distillation from the sulphate of iron, or 
green vitriol, and indeed is so yet in some 
places. It is now made in England on 
an immense scale, by decomposing sulphur 
along with saltpetre in immense lead-lined 
chambers. As usually met with, sulphuric 
acid is a liquid of oily consistence — hence 
its name, oil of vitriol. It ought to be 
colourless, or nearly so, but frequently it 
has a brownish tinge from the presence of 
impurities. It is highly corrosive, destroying 
with great rapidity whatever textures, living 
or dead, it may happen to come in contact 
with. When mingled with water a great 
development of latent heat takes place ; in 
some proportions, indeed, so great as to 
raise the temperature of the mixture as 
high as 300° Fahr. After cooling, the bulk 
of the mixed fluids is considerably less than 
that which they occupied separately. For 
medicinal purposes, sulphuric acid is used 
diluted in the proportion of one part and a 
half of acid to fourteen and a half of water ; 
and it is better for unprofessional persons to 



SUL 



521 



SUL 



buy it thus prepared. Indeed, unless abso- 
lutely required in a concentrated form for 
some special object, sulphuric acid should 
never be kept in a private house otherwise 
than diluted. Some lamentable poisonings 
have happened in consequence of neglect of 
this precaution. When concentrated sul- 
phuric acid is mingled with water, the de- 
velopment of heat which occurs must be 
borne in mind — otherwise the vessel, espe- 
cially a glass one, may be cracked, and in- 
jury to clothes or person be the result. The 
mixture is best made by adding the acid to 
the water in small quantities at a time, and 
mixing each by agitation, before more is 
added. Indeed, the water ought to be in a 
state of agitation when the acid is added, 
for if not, the extreme weight of the latter 
will carry it to the bottom of the vessel, and 
there cause heat to be so strongly developed 
as to crack it. 

As a medicine, diluted sulphuric acid is 
extremely valuable. In relaxed states of 
the system it is one of our best tonics, given 
in doses of from ten to twenty drops in a 
large wineglassful, or two ounces of water. 
In this way it preserves tone, and checks 
the perspirations in pulmonary consumption, 
and, when the case is suitable, improves 
both appetite and digestion. It also exerts 
considerable diuretic properties. Sulphuric 
acid is a powerful controller of internal 
hemorrhage, (see Abortion;) it is also one 
of the commonest additions to gargles. 
Some persons find this medicine gripe a 
good deal, and if taken by nurses it is 
almost certain to disorder the infant. In 
other cases, however, ten drops added to 
small well-diluted doses of Epsom salts, are 
serviceable. When sulphuric acid is taken 
medicinally, it ought, like the other mineral 
acids, to be sucked through a quill, or small 
glass tube, to prevent injury to the teeth, 
on which it acts powerfully ; and it is well 
to rinse the mouth with water containing a 
small proportion of soda immediately after 
taking the dose. In consequence of its em- 
ployment for various household purposes — 

Poisoning by sulphuric acid is not very 
uncommon, and, if the acid be strong, is one 
of the most distressing accidents of this 
nature which can happen. The person is 
generally conscious of the description of 
poison which has been swallowed. Accord- 
ing to the strength of the acid, there is 
intense burning pain in all the parts, from 
the mouth to the stomach, with which it 
has come in contact, and if it be of corrosive 
strength, these parts look white and shri- 
velled. There is also vomiting of shreddy 
and bloody mucus, great constitutional de- 
2 t2 



pression, and, probably, if the acid has been 
strong, speedy death. 

In such cases, the first thing to be done 
is to neutralize the action of the poison by 
alkaline and demulcent remedies. Magne- 
sia, chalk, lime-water, potash, soda, soap- 
water, wood-ashes, milk, and oil, are all 
remedial; and in such a case, that which is 
first to be procured is the best; if there is 
power of choice, magnesia or chalk is ge- 
nerally preferable. In the absence of either 
of these antidotes, a portion of wall plaster 
or mortar, rubbed up with milk or water, 
may be used. At the same time, fluids must 
be given very copiously. When injury has 
resulted from the application of corrosive 
sulphuric acid externally, the best proceed- 
ing is to wash the parts freely with water 
alone, or with water containing an alkali, 
as soap-water does. 

Aromatic sulphuric acid is a pleasant 
form of medicine which might with advan- 
tage be more used than it is at present : 
the dose is from ten to twenty drops in a 
wineglassful of water. 

Sulphuric Ether, which is more gene- 
rally known as "ether," is procured by the 
action of sulphuric acid on alcohol, and by 
distillation. It is a perfectly colourless 
limpid fluid, of very light specific gravity, 
and very volatile : its odour, peculiar and 
penetrating, is usually called the " etherial 
odour." It is chiefly employed in medicine 
as a " diffusible" stimulant, that is, it acts 
very rapidly and energetically as a stimu- 
lant when taken into the stomach, and on 
that account is peculiarly valuable in some 
diseases, such as angina, spasms, &c, at- 
tended with sudden violent symptoms ; it is 
also a powerful restorer in the depressed 
conditions of the system, such as faintness, 
&c. For the above purposes sulphuric 
ether is given in doses of twenty drops in 
water. A more convenient form, however, 
is the spirit of sulphuric ether, which con- 
sists of one part of the ether mixed with 
two parts of alcohol ; it acts in the same 
way as sulphuric ether — the dose about forty 
or fifty drops in water. The transient effect 
of ether renders it in many cases less valu- 
able than sal-volatile, or the spirits, such as 
brandy. Its antispasmodic power is increased 
by the addition of opium. When bottles con- 
taining this ether are opened at night, its 
highly inflammable character, even in liquid, 
but especially in vapour, ought to be borne 
in mind, and care taken that lighted candles 
are not too nearly approached. In giving 
ether, it is not to be forgotten that it floats 
on the top of the water, and thus, that if a 
bottle containing three or four doses of me- 



SUP 



522 



S WE 



dicine, of which ether forms an ingredient, 
be not shaken before each dose is poured 
out, more than the proper proportion of 
ether will be poured out first. 

Ether, from its extreme volatility, eva- 
porates rapidly in the ordinary atmosphere, 
and in doing so occasions a considerable 
amount of cold ; of this, advantage is some- 
times taken in medical practice when such 
an effect is required. The power of ether, 
when inhaled, to cause "anaesthesia," or 
insensibility to pain, is the characteristic 
which has excited most attention of late 
years ; the superior and more convenient 
effect of chloroform has, however, thrown 
this, comparatively at least, into the back- 
ground. Inhalation of ether is a proceed- 
ing which should never be tampered with 
by unprofessional persons. 

SUMMER.— See Seasons— Heat, &c. 

SUN. — See Heat — Light, &c. 

SUPPER.— The last meal of the day is 
properly supper, and some of the modern 
dinners would more aptly fall under the 
former designation. Much has been said 
respecting the unwholesomeness of eating 
suppers — much depends on circumstances. 
Generally speaking, animal food once a-day 
is sufficient for most ; if, therefore, an indi- 
vidual for whom it is enough, after a suffi- 
ciently good meat dinner, adds a superfluous 
meat supper shortly before retiring to rest, 
there can be little wonder if he pays the 
penalty in sleep disturbed by dreams and 
night-mare, and by a furred tongue and 
unrefreshed waking in the morning. This 
is especially the case if the superfluity is 
indulged in after a dinner made in the latter 
part of the day. If dinner is early, if much 
exercise is taken between that and the 
evening meal, and if supper is not eaten at 
too late an hour, many persons can take 
with benefit a moderate proportion of animal 
food. 

It certainly is better not to eat a meal 
heavy, either in quantity or quality, before a 
period of inactivity and sleep so prolonged 
as that of the night ; but there is no doubt 
that much of the bad character of supper as 
a meal, has arisen from its being too often 
one of superfluity. Those to whom suppers 
are most injurious are the plethoric, or such 
as suffer from head symptoms. Some per- 
sons, however, especially dyspeptic invalids, 
do themselves harm by abstaining from 
suppers of every kind, even after the prin- 
cipal meal has been taken early in the day. 
They do this under the idea that all sup- 
pers are bad, and suffer, in consequence, 
from uneasy sensations in the stomach dur- 
ing the night, and from a sense of exhaus- 



tion in the morning, both of which may be 
prevented by a moderate supper of light 
food, such as is generally found to agree 
best ; many a dyspeptic will find his morn- 
ing meal better digested after a light sup- 
per than without. 

Refer to Breakfast— Dinner, fie. 

SUPPOSITORY— Is a medicine in a solid 
form intended to be passed up into the rectum. 
In some cases, this mode of administering 
remedies is very convenient, especially when 
the stomach cannot receive them readily. 
Generally, it is most suitable in painful dis- 
eases — such as those of the bladder, womb, 
&c. — situated in the vicinity of the lower 
bowel. In such cases, the suppository must 
of course be anodyne, usually opiate, which 
may be thus made to exercise its effects 
without disordering the stomach. A grain 
of powdered opium, with five or six of firm 
henbane extract, makes a very good sup- 
positoiy. A suppository may be introduced 
into the bowel on the point of the finger, 
both being well greased ; the operation is, 
however, better and more conveniently done 
by the suppository tube made for the pur- 
pose. 

SUPPRESSION.— The cessation, or non- 
development of an ordinary secretion or 
excretion. 

SUPPURATION.— The formation of pus, 
or matter. — See Inflammation — Pus, §c. 

SURGEON and SURGERY.— Literally, 
by the word surgeon is meant an individual 
who employs his hands in the treatment of 
diseases ; and, by consequence, one whose 
practice is limited to the external treatment 
of external affections, and such as require 
manual interference for their removal. Prac- 
tically, no such distinction can exist. 

Refer to Physician — Practitioner, $c. 

SUSPENDED ANIMATION.— See Death 
— Drowning — Carbonic Acid — Hanging — 
Suffocation, &c. 

SUTURE — In surgery, means a joining, 
by means of threads or stitches, of the edges 
of a wound. — See Wounds. 

In anatomy, the term is applied to the junc- 
tions of the bones of the skull. — See Skull. 

SWALLOWING.— See Alimentary Canal 
— Gullet — Throat, &c. 

SWEAT, or Perspiration — Is the fluid 
thrown off from the blood, " excreted," 
through the agency of the skin, or rather 
of the glands contained within the texture 
of the skin. — See Skin. 

Refer to Diaphoretics. 

SWEETMEATS.— See Confectionary. 

SWEET SPIRIT OF NITRE.— See Ni- 
trous Ether. 

SWELLED LEG.— See Leg. 



S WE 



523 



SYM 



SWELLING.— Increase of size of different 
portions of the textures of the living body- 
may arise from a variety of causes. The 
swelling may be either of a fluid or of a solid 
character. In the former case, it may be 
caused by increased accumulation or deter- 
mination of blood in or to the part, the 
blood being still contained within the blood- 
vessels. More usually, however, fluid swell- 
ing is caused by blood or other fluid not con- 
tained within the vessels, but effused into 
the textures where the swelling occurs. . Of j 
this nature is the swelling which occurs I 
after violence ; it is, in fact, the result of 
the effusion of blood — inward bleeding — or 
of serum into the tissues. The formation 
of matter also causes swelling. Fluid swell- 
ings are in many cases of rapid formation ; 
solid swellings, from their nature, are in 
general necessarily of slow increase. In 
rupture, of course, the presence of gas in 
the protruded bowel renders that a cause 
of swelling, though comparatively an un- 
frequent one. As the different forms of 
swelling are noticed under other articles, it 
is unnecessary to reiterate them here. — See 
Tumour. 

SWINE-POCK, or Swine-pox— Is a va- 
riety of chicken-pox, characterized by the 
conical form of its vesicles. — See Chicken- 
pox. 

-SWOON.— See Faixtixg. 

SYMMETRY.— The term, as applied to 
the human form, includes that proportionate 
adaptation of the various parts of the body 
to one another, which gives, not only grace 
and beauty, but strength ; and, it may be 
added, in some degree, health. The latter 
observation is especially applicable to the 
symmetrical development of the trunk of 
the body, which can scarcely be unsymme- 
trical, and still less, deformed, without the 
contained vital organs being injuriously im- 
peded in their functions. Deformed per- 
sons suffer more than others from bad health, 
and if they are subjected to an attack of 
acute disease affecting the impeded organs, 
they are more liable to succumb. Thus, an 
individual, in whom spinal curvature, by 
distorting the ribs, &c, injures the symme- 
trical development and proper capacity of 
the chest, is more liable to chronic affection 
of the lungs and heart, and such attacks as 
bronchitis, and the like, are more severely 
felt. Want of symmetry, or deformity of 
the limbs, is less important than when the 
trunk is affected, the importance varying, 
of course, with the nature of the case ; it 
may, however, and does occur, that unsym- 
metrical development, of the lower limbs 
especially, leads ultimately to greater or 



less distortion of the trunk also. More- 
over, in many cases, want of symmetry must 
be regarded as the sign of a constitution 
hereditarily weak, or as the result of sickli- 
ness in childhood. 

The subject of symmetry is an extensive 
one, embracing, as it does, the theories of 
ideal beauty, and the standards of mea- 
surement, proportional and otherwise ; into 
these it needs not to enter here, but it may 
be adopted as a general rule, that the sym- 
metrical development of a race or nation 
must in some degree be commensurate with 
their general sanitary condition, the means 
of obtaining proper nourishment, and their 
free exposure to light and air. Under arti- 
cle "Light" it was stated that Humboldt 
has attributed the absence of deformity 
among the Caribs, Mexicans, Peruvians, &c. 
to the constant exposure of the body at large 
to strong light ; and, under the same article, 
the effect of a diminished supply of light, in 
giving a tendency to the production of de- 
formed children, was also alluded to. Analo- 
gous effects will be found to follow, accord- 
ing to the fulfilment or not of other sanitary 
conditions. There is no surer sign of a peo- 
ple advancing higher in the scale of comfort- 
able subsistence than the improvement of 
their physical development and symmetry. 
The reverse of this is seen in the degene- 
racy of some of the Irish in the more re- 
mote districts on the west coast, in the In- 
dians of the Rocky Mountains, and others. 
Although comparative symmetry is to be 
met with among many nations, and in the 
persons of individuals, absolute symmetry, 
in the sense of perfect balance, and corre- 
spondence of the two halves of the body, is 
probably not to be found, and exact mea- 
surements go to prove that there always 
exists some disparity between the corre- 
sponding degrees of different sides. 

Symmetiy is not, however, confined to the 
actual development of healthy tissues : it 
extends to and influences many forms of dis- 
ease, such as often occurs in the symmetri- 
cal distortions, so to speak, of gout, rheu- 
matism, &c. 

Refer to Deformity — Spine, fyc. 

SYMPATHETIC NERYE.— See Nervous 
System. 

SYMPATHY.— In man, and probably in 
the higher animal tribes, there exists between 
certain different portions and organs of the 
same living body, a bond of connection, or 
at least of relative action, through which 
excited or diseased action in the one is ex- 
cited in the other, "sympathetically," as 
it is called, or by "sympathy." It is evi- 
dent, however, that what are called sympap- 



S YM 



524 



S YM 



thetic actions arise, apparently, at least, 
in very different ways. Some which are 
classed as such are evidently the result of 
contiguity, others of reflex action, (see 
Nervous System,) or at least of nervous com- 
munication, others of derivative action. — 
See Derivative. 

SYMPTOMS.— In a state of perfect health, 
all the functions of the living body are per- 
formed in a regular series, and according to 
certain modes of action, which we recognise 
as those of health. When, however, these 
series or modes become deranged or altered, 
there arise certain signs,' or, as they are 
generally called, " symptoms," which, as 
they vary according to the nature of the 
cause that produced them, afford to the 
medical man a clue to the detection of the 
cause, more or less perfect, according to 
the state of his knowledge, experience, and 
means of investigation — they in fact furnish 
the means by which he forms his " diag- 
nosis'' in the first instance, and which guide 
his opinion as to the treatment and ultimate 
issue of the case. 

There are certain symptoms, both general 
and special, which are too marked to escape 
detection ; some, indeed, are forced upon 
the attention by the complaints of the suf- 
ferer, and others are too palpable not to 
attract the notice even of the unobservant. 
Beyond these plain and palpable symptoms 
of disease, however, which "he who runs 
may read," there are others which lie 
deeply hidden from ordinary eyes, which it 
requires all the advantages of knowledge 
and experience, of educated ear and eye, 
and of patient attention to discover, and, 
when discovered, to read. There are many 
signs and characters brought to light in the 
explorations of the physician, both in the 
living and in the dead body, which he may 
see, but cannot read correctly, if he can 
read them all. Again, there are signs 
which one man can see as symptoms, but 
which another cannot, and therefore passes 
them by unheeded ; and further, there are 
other symptoms which one man can not only 
see, but interpret, but of which another, if 
he sees them at all, can make no use. In 
this lies the difference, in one department 
of practical medicine at least, between the 
skilled and unskilled practitioner. It does 
not follow of necessity, that the man who, 
from his knowledge of symptoms and of 
what they indicate, is most successful in 
the investigation of disease, is so likewise 
in its treatment, but the chances are greatly 
in his favour. 

If many symptoms pass before the eyes 
even of the most skilful, which either can- 



not be seen, or, if they are seen, cannot be 
correctly interpreted, how superficial must 
that knowledge of disease be which unpro- 
fessional persons can gather from the com- 
paratively few symptoms they are capable 
of observing or appreciating? How cau- 
tious, then, ought such persons to be when 
circumstances call for their management, 
temporary or permanent, of even the most 
trivial ailments ! In observing and forming 
deductions from symptoms, the first ques- 
tions ought to be — do they indicate an acute 
attack ? have they supervened suddenly ? 
and if so, to what can the attack be traced ? 
Has there been exposure to cold and wet, 
or to checked perspiration ? — those fruitful 
sources of inflammatory and rheumatic aflec- 
tions. Has there been exposure to conta- 
gion in any form, or to malaria of any kind, 
or is there any prevailing epidemic ? Can 
any violence, at no very distant date, account 
for the attack ? Careful consideration of 
the "history" of the affection will often 
throw much light upon its nature. Again, 
if the usual symptoms of fever indicate 
inflammatory affection, it is to be considered 
whether pain or uneasiness in any part, or 
disordered function of any organ, indicate 
that the disease has localized itself. If 
inflammatory symptoms are absent, the 
spasmodic character of pain, (see Spasm,) or 
the nervous character of the general dis- 
order, become question for consideration. 
Should the symptoms of ailment be chronic, 
the same consideration of the history and of 
the hereditary tendencies onght to be enter- 
ed into, and attention particularly directed 
to the fact of there having been progressive 
loss of flesh, habitual complaint of cold, 
unusual lassitude, alteration in the com- 
plexion, difference in sleeping, &c. 

By systematizing inquiries and observa- 
tions, a much clearer idea will be gained of 
the state of an individual who is an object 
of care and solicitude, than by making them 
at random. Thus, beginning at the Head, 
attention should be directed to any unusual 
sensations complained of by the person, or 
any unusual manifestations apparent to 
others. These are pain, giddiness, affec- 
tion of the senses, confusion of thought, or 
impairment of mental power; flushings, 
frwitchings, drawing of the features to one 
side ; disturbed sleep ; moaning ; grating of 
the teeth ; sleeplessness or too great somno- 
lency. Passing downward to the Organs of 
Respiration : alterations in the character of 
the voice ; in the respiration, as to the fre- 
quency or otherwise ; in the power of lying 
in any or every posture, are all matters for 
observation; also any habitual cough, and 



S YN 



525 



TAB 



its character. When the Digestive Organs 
are disordered, the period of their chief dis- 
order, as connected with taking food, is an 
important symptom ; -whether the uneasi- 
ness comes on quickly after a meal, or not 
for some hours ; whether it is worse after 
long fasting, or the reverse ; whether there 
is habitual vomiting, &c. With respect to 
the Bowels, the nature of the motions or 
stools is to be inquired into, and especially 
the fact of thorough daily relief. In in- 
quiry into the state of the urinary organs, 
the amount of the secretion, its nature as 
to colour, or its tendency to deposit sedi- 
ments immediately after being passed, or 
when it becomes cool, are principal objects. 
If the calls are too frequent, it is to be 
noticed whether this depends on increased 
quantity or on diminution, which causes 
irritation from greater concentration. In 
this way, by carefully and systematically 
considering a case, even an unprofessional 
person may acquire very considerable know- 
ledge of its leading features, sufficient pro- 
bably to enable him to refer to those articles 
in this work from which he will derive 
proper information ; in many cases, sufficient 
to open the eyes to a condition of health 
that calls for the prompt submission to 
proper medical advice. When this is 
determined on, the observation of symp- 
toms, either in his own^case or in that of 
another, such as a child, will enable any in- 
dividual to furnish a medical man, even at 
a first interview, with such a history as will 
afford him much assistance in forming his 
opinion. 

Refer to Diagnosis, §c. §c. 

SYNCOPE.— A state of swoon or fainting. 
— See Fainting. 

SYNOVIA, or Synovial Fluid— Is the 
fluid which is secreted within the joints by 
the lining or synovial membrane, for the 
purpose of lubricating the opposed cartila- 
ginous surfaces of the bones, and facilitating 
their movements upon one another. It con- 
tains a considerable amount of albumen, 
and from its unctuous quality is known 
popularly as "joint-oil." When, from any 
cause, a joint becomes the seat of irritation, 
there is apt to be a greatly increased secre- 
tion of the synovial fluid. This takes place 
in what is called "white-swelling" of the 
knee. — See Knee. 

SYPHILIS, or the Venereal Disease — 
Is a disease contracted in consequence of im- 
pure connection. The fearful constitutional 
consequences which may result from this 
affection ; consequences, the fear of which 
may haunt the mind for years, which may 
taint the whole springs of health, and be 



transmitted to circulate in the young blood 
of innocent offspring, are indeed terrible 
considerations — too terrible not to render 
the disease one of those which must un- 
hesitatingly be placed under medical care. 
In the mean time, if any delay must occur, 
the pustules (sores) which may be observable 
should be well touched with caustic, the diet 
should be reduced and deprived of stimu- 
lants, and the bowels acted upon by mode- 
rately active aperients, violent exercise 
being at the same time avoided. 

Whatever the circumstances may be, the 
author would, once and for all, warn the 
reader against placing any trust in the spe- 
cious advertisements connected with the 
disease in question, Avhich are so persever- 
ingly and disgustingly paraded before the 
public eye, by quacks, who endeavour to 
fleece the silly dupes who resort to them, by 
first exciting their fears. 

SYRINGE.— This well-known instrument 
is useful domestically for many purposes, 
and its employment is recommended in 
various articles in the present work. Gene- 
rally speaking, the ordinary pewter syringes 
are procured too small to be of much use : 
an instrument capable of holding an ounce 
of fluid will be found a convenient size. 

SYRUP. — A saturated solution of sugar in 
water. A great variety of medicinal syrups 
are made, but many of them are compara- 
tively little used. The ordinary simple 
syrup is made by dissolving, with the aid 
of gentle heat, five pounds of refined sugar 
in thirty ounces of water. Syrups made 
with unrefined sugar are much more liable 
to ferment than those made with it purified. 
— See Sugar. A syrup should always, if 
possible, be kept in a situation with the 
temperature under 55° Fahr. 

SYSTOLE— Is the contractile action of the 
heart, by which the blood is expelled from 
the cavities. It is the reverse of diastole. — 
See Diastole — Heart, §c. 

TABES, or Tabes Mesenteric^ — Means 
a disease characterized by wasting or atro- 
phy. — See Atrophy. The term is, however, 
applied to a special diseased condition which 
causes atrophy, the essential nature of which 
is a scrofulous or tuberculous affection of the 
"mesenteric glands" (see Digestion) through 
which the chyle, or nutrient fluid extracted 
from the digested food, passes on its way to 
the blood. The disease, in fact, may be 
called consumption in the belly; for, though 
differing in many respects from consump- 
tion in the lungs, there are many points of 
analogy between the two maladies. 

Mesenteric tabes is a disease almost pec* 



TAB 



526 



TAB 



liar to the scrofulous constitution, whether 
hereditary or engendered, and it usually 
occurs previous to the completion of the 
twelfth year, most frequently previous to the 
ninth ; some consider that children, while 
nursed at the breast, are less liable to be 
affected by this form of scrofula, but the 
rule is by no means absolute. 

Probably, the first symptom which at- 
tracts attention in a child becoming the 
subject of tabes, is the progressive emacia- 
tion, coincident with undiminished and often 
greatly increased appetite, sometimes with 
depraved appetite, the child evincing a 
strong desire for such indigestible food as 
cheese more especially. Along with these 
symptoms there has generally been com- 
plaint at different periods, perhaps two or 
three times in the day, of pains in the 
belly, which probably were attributed to 
griping. The stools, if attention is or has 
been directed to them, are found to be un- 
natural, irregularly costive or relaxed, often 
frothy, and the colour, especially, much 
lighter than in health, apparently from de- 
ficiency of bile — the evacuations look clayey 
or chalky. If the disease has made some 
little advance, there may, or may not, be 
some amount of tenderness of the belly on 
pressure. There is usually fretfulness and 
irritability of temper, with tendency to flush- 
ing in the evening, and a perspiration — 
which smells heavy and disagreeably — at 
night. As time advances, the emaciation 
becomes more marked, and the attenuated 
limbs contrast strongly with the abdomen, 
which, probably, but not always, becomes 
tumid. The features lose their plumpness, 
the skin of the face is wrinkled, and the 
whole countenance often approaches in ap- 
pearance that of an aged person. The veins 
are prominently marked on the white skin, 
and the latter is often strongly contrasted 
with the preternatural redness of the lips. 
When the disease reaches an advanced stage, 
hectic fever is regularly established, and 
the patient dies exhausted, if not cut off 
previously by some acute attack of inflam- 
mation. The predisposing cause of this 
disease is, certainly, in the first place, the 
scrofulous constitution ; its development, 
however, is greatly favoured by those defi- 
cient sanitary arrangements to which the 
poorer classes are exposed, especially the 
influence of damp and ill-ventilated rooms, 
combined with deficient food. 

There is a prevailing popular idea, that a 
naturally large or prominent belly is an 
indication of a tendency to the disease in 
question. This, however, does not appear 
to be the case; neither is the prominence of 



the abdomen always a marked symptom, 
unless, indeed, it be occasioned by flatu- 
lence, until the later stages of the disease ; 
and then the enlarged glands can frequently 
be felt through the thinned walls of the ab- 
domen, -which, moreover, are covered with 
enlarged, and often tortuous veins. 

Mesenteric tabes is so fatal a disease, es- 
pecially if it is allowed to make any pro- 
gress before treatment is adopted, that its 
first symptoms cannot be too soon detected 
and attended to ; and those who have chil- 
dren under their care, who exhibit scrofulous 
tendencies, (see Scrofula,) ought to be alive 
to the possibility of its taking place. Should 
its occurrence be suspected, the safest and 
best plan will be to place the patient under 
proper medical care at once. Medicine, 
however, is not more reqiusite than strict 
attention to sanitary regulations, to the 
ventilation, dryness of the sleeping and 
other apartments ; to exercise in the open 
air, to due clothing, with flannel next the 
skin, and to the food, which ought to be 
nourishing, consisting of well-cooked fresh 
meat, mutton especially, at least once a day, 
or well-made nourishing animal broth, nou- 
rishing puddings, &c. ; but with avoidance 
of all cheese, pastry, &c. A little port-wine, 
or porter, may be useful in some cases, but 
of this a medical attendant can only safely 
judge. With regard to medicine — the pale- 
ness of the motions suggesting the idea of 
deficient secretion of bile, often gives rise to 
undue perseverance in mercurial remedies. 
For remedies in this disease the reader is 
referred to article "Scrofula;" indeed, the 
general treatment of that state of constitu- 
tion is so similar to what is required in the 
mesenteric affection that it is superfluous to 
repeat it, with exception of noticing the 
almost specific powers of codliver-oil in 
many cases of this disease ; the following 
may serve as illustration : — A child eight 
months old was shown to the author, very 
reluctantly, by its mother, who, as well as 
her relatives generally, had abandoned all 
idea of its living beyond a few days. It 
was a complete specimen of the advanced 
stage of mesenteric disease ; the limbs were 
shrunk till they resembled sticks covered 
with parchment; the features withered and 
old-looking ; the prominent belly was hard, 
knotty, and covered with enlarged veins, 
and the infant screamed almost perpe- 
tually, as if in constant pain. With some 
persuasion the parents consented to try 
codliver-oil, given in teaspoonful doses 
twice a day, with the same quantity rubbed 
into the belly twice a day. Under this 
treatment the child at once began to im- 



TAM 



527 



TAR 



prove, and in the course of three or four 
months had lost every appearance of dis- 
ease. He is now a fine, healthy boy. Similar 
treatment checked the disease in an early 
stage in a younger brother of the above pa- 
tient. 

Before taking leave of the subject, it is 
proper to notice a habit by "which children 
predisposed to this and other scrofulous dis- 
eases, are apt greatly to injure themselves ; 
it is that of sleeping with their mouths and 
heads under the bedclothes. It should 
never be permitted in any child. 

Refer to Atrophy — Digestion — Scrofula, $c. 

TAMARINDS— Are produced by a tree, 
•which belongs to the leguminous or pea 
tribe, a native of India, &c, and also cul- 
tivated largely in the West Indies, for the 
sake of the acid pulp of the pods, which re- 
semble somewhat those of the common field 
bean. Tamarinds are brought to this coun- 
try either simply dried or preserved in su- 
gar, in jars or casks. The appearance of 
the pods mingled "with fibrous substance and 
seeds, and immersed in syrup, liquid, or 
partly crystallized, is sufficiently "well known. 
Preserved tamarinds are cooling and ape- 
rient, and a welcome addition to the sick- 
room dietary in many febrile diseases. They 
are most beneficially employed in the form 
of infusion made with hot water, and per- 
mitted to become cold? A pleasant ape- 
rient whey is made by boiling an ounce of 
tamarind pulp in a pint of milk. The acids 
of the tamarind are chiefly the citric and 
tartaric. 

TANNIN and GALLIC ACID.— Tannin 
is the active astringent principle of the nut- 
gall. — See Gall — Nut. When exposed to the 
atmosphere in a state of moisture, it ap- 
pears to attract oxygen, and to be converted 
into gallic acid. Both tannin and gallic 
acid are powerful astringents, and are 
widely diffused as the astringent principle 
throughout the vegetable kingdom. The 
former is met with in the form of a yellow- 
ish powder, the latter in fine, white, silky- 
looking crystals. Both are soluble in water, 
and in solution are used externally for the 
same purposes as astringents generally ; 
from half a drachm to a drachm in half a 
pint of water forming an astringent lotion. 
Tannin or gallic acid is generally given in- 
ternally in the form of a pill, in hemorrhage 
and other similar affections, in doses of three 
to six grains every two or three hours if re- 
quisite. 

TAPEWORM— Also called Tjenia.— See 
Worms. [Pumpkin seeds have been already 
mentioned as a cure for this complaint. — 
See Pumpkin.] 



TAPIOCA — Is a starchy substance, or 
fecula, like sago. It is procured from the 
root of a shrub, which is cultivated chiefly 
in the West Indies. The root, which is 
known as the "bitter cassava," contains a 
juice possessed of highly narcotic poisonous 
qualities; this juice is thoroughly removed 
by washing, and the starch, or tapioca, dried 
in the form of grains, resembling, (but two 
or three times the size of,) the sago grain. 
Tapioca is used in sick-room cookery for 
the same purposes as arrow-root and sago. 
Dr. Christison remarks of tapioca, "no 
amylaceous substance is so much relished 
by infants about the time of weaning ; and 
in them it is less apt to become sour during 
digestion than any other farinaceous food, 
even arrow-root not excepted." 

An imitation "British tapioca" is made 
from potatoes, and is very wholesome. 

Refer to Fecula. 

TAPPING — In medical practice, is the 
withdrawal of fluid which has collected in 
unnatural quantity in any of the natural 
cavities of the body. The operation can 
only be performed by a medical man. 

TAR and PITCH.— The well-known black 
viscid substance tar, is obtained from the 
wood chiefly of the Scotch fir, by the agency 
of heat. The process, which varies in detail 
according to the situation, is essentially 
what is called " distillation per descensum," 
that is to say, the wood, being placed in a 
hollow of the ground, or in a pot, is kindled, 
and being covered up, is allowed to burn 
with a smothered combustion; by this means 
the tar is formed, and is collected by suit- 
able arrangements at the bottom of the re- 
ceptacle in which the process is carried on. 
For medical purposes, tar has been used 
from the most ancient times, and within re- 
cent dates its employment has been strongly 
advocated by different persons, more espe- 
cially by Bishop Berkely, as a remedy in 
chest affections, chronic bronchitis, incipient 
consumption, &c. Tar is usually adminis- 
tered in the form of tar-water, which is best 
made by digesting — stirring occasionally — 
one ounce of tar in thirty-two ounces of 
water for seven or eight days, and then 
straining. The dose is half a pint twice a 
day mixed with milk. The vapour of tar 
has also been recommended, but has not 
been generally employed. Tar is now chiefly 
used as an external application in some cases 
of skin disease, either in the form of water, 
or in that of ointment, made by melting to- 
gether by heat, equal parts of tar and suet, 
and squeezing through linen. Pitch is the 
hard black brittle residue left after tar has 
been exposed to heat. It is little used. Pills 



TAR 



528 



TEA 



made of pitch are a popular, and certainly 
at times a successful remedy, in bleeding 
piles. 

Refer to Piles. 

TARANTULA — Is a species of lai-ge spi- 
der, common in southern Europe, the ve- 
nomous bite of which produces effects similar 
to those of the scorpion sting. Many fabu- 
lous tales of the effect of the tarantula bite 
were formerly currently received. 

TARAXACUM.— See Dandelion. 

TARTAR on the TEETH.— See Teeth. 

TARTAR EMETIC, or Tartarized An- 
timony. — See Antimony. 

TARTARIC ACID— Belongs to the class 
of vegetable acids. It is the characteristic 
acid of the grape, from which source it is 
procured. In the fruit it exists in com- 
bination with potash, as bitartrate of potash, 
or cream of tartar, the acid when prepared 
being separated from the alkali by chemical 
process. For an account of the mode ,in 
which cream of tartar is obtained, the 
reader is referred to article "Potash." 

Tartaric acid is met with both in crystal 
and powder, generally the latter. Its prin- 
cipal use is to form the acid ingredient for 
effervescing mixtures of various kinds ; and 
for this purpose it is well adapted, whole- 
some, and cheap. It is also a good solvent 
for quinine. 

Refer to Effervescing. 

TASTE.— See Tongue. 

TAXIS.— See Rupture. 

TEA. — Few articles consumed by man 
as food, require more careful consideration 
in every point of "view than this important 
and widely-used product of the vegetable 
kingdom ; which, as we shall see, is not 
only a luxury, a cheering but not inebriat- 
ing stimulant, but a valuable addition to 
the essentials of healthy nutrition. The 
tea-plant is a native of China, Japan, and 
Tonquin ; and until late years, the supplies 
to this country were all brought from 
China. Its cultivation, however, in the pro- 
vince of Assam, in India, has opened up a 
new source, and one which promises even- 
tually to be advantageous in every way. 

" The principal varieties of black tea* 
are Bohea, which is the commonest and 
coarsest description, Congou, Souchong, 
Caper, and Padre-^Souchong, and Pekoe, 
which are of the highest quality, the last 
consisting of the very young, and of the un- 
expanded leaves ; and which, when clothed 
with down, constitute flowery Pekoe. The 
principal varieties of green tea are Twan- 

* The above extract, and much of the information 
contained in this article, is derived from the Lancet 
Peports. 



kay, Hysonskin, Young Hyson, Hyson, Im- 
perial, and Gunpowder, which, in green tea, 
correspond with flowery Pekoe in black. 
There is but one species of the tea-plant, 
from which the whole of the above and 
many other varieties of tea are obtained — • 
the differences depending upon soil, climate, 
weather, age of the leaves, and mode of 
preparation. The plants from which black 
teas are prepared, are grown chiefly on the 
slopes of hills and ledges of mountains ; 
while the green-tea shrubs are cultivated 
chiefly in manured soils." 

Tea in itself possesses a natural fragrance 
which requires no addition, the Chinese 
themselves saying, "that only common tea 
requires scenting;" nevertheless, there are 
various scented teas which are said to be 
in high estimation even in China. The 
principal constituent of tea which it yields 
for solution when infused, in addition to 
its characteristic nitrogenized constituent 
"theine," is the astringent principle tan- 
nin. — See Tannin. 

Tea, it is well known, is liable to im- 
mense adulteration — much after it reaches 
this country, but partly in China. It is 
said "the Chinese annually dry many mil- 
lions of pounds of the leaves of different 
plants to mingle with the genuine," and 
" the leaves of the following species have 
been detected from time to time in samples 
of tea of British fabrication : — beech, elm, 
horse-chestnut, plane, bastard-plane, fancy 
oak, willow, poplar, hawthorn, and sloe." 

One of the most frequent adulterations of 
tea is its admixture with exhausted leaves 
which have been redried. " It was sup- 
posed, in 1843, that there were eight manu- 
factories for the purpose of redrying ex- 
hausted tea-leaves in London alone, and 
several besides in various parts of the 
country. Persons were employed to buy 
up the exhausted leaves at hotels, coffee- 
houses, and other places, at 2\d. and 3d. per 
pound. These were taken to the factories, 
mixed with a solution of gum, and redried. 
After this, the dried leaves, if for black 
tea, were mixed with rose-pink and black- 
lead, to face them, as it is termed by the 
trade." 

Catechu is a frequent addition to the 
exhausted and other leaves, in order to 
supply the astringency which is wanting. 
This drug forms also a principal constituent 
of such articles as "La Veno Beno," 
"Chinese Botanical Powder," &c, which 
are sold to be added to tea, as chicory is to 
coffee. It is perhaps superfluous to add, 
that such additions are highly deleterious, 
and should never be employed. Sulphate 



TEA 



529 



TEA 



of iron or green vitriol, rose-pink, logwood, 
plumbago, indigo, &c, are all used at times 
in the adulteration of tea. Adulterated 
teas are seldom sold alone, but are mixed 
in greater or less proportion with the ge- 
nuine. In the Lancet Report it is stated, 
''That out of twenty-four samples of black 
tea purchased of tea-dealers and grocers 
resident in the metropolis, [of England,] 
twenty were genuine, and four adulterated ; 
the former being Congous and Souchongs, 
and the latter samples of scented Pekoe 
and scented Caper." 

Green tea is so greatly adulterated, that 
although there certainly is a genuine pre- 
paration of this kind, it seems doubtful 
whether any is sold pure. From authentic 
examinations, "it appears that all the 
green teas that are imported into Eng- 
land are faced or covered superficially with 
a powder consisting either of Prussian blue, 
or sulphate of lime, or gypsum," or of some 
other colouring-matters. The principal 
conclusions arrived at in the Lancet Reports 
from the examination of many different 
samples of green tea are — 

" First. That these teas, with the excep- 
tion of a few of British growth and manu- 
facture from Assam, are invariably adulte- 
rated — that is to say, are glazed with colour- 
ing-matters of different kinds. 

" Second. That the* colouring-matters 
used are in general Prussian blue, turmeric 
powder, and China clay, other ingredients 
being sometimes, but not frequently, em- 
ployed. 

"Third. That of these colouring-matters, 
Prussian blue possesses properties calculated 
to affect health injuriously. 

"Fourth. That in England there is 
really no such thing as a green tea — that 
is, one which possesses the natural green 
hue considered to characterize that kind of 
tea. 

"Fifth. That green teas, and more espe- 
cially the gunpowders, in addition to being 
faced and glazed, are more subject to 
adulteration in other ways than black 
teas." 

The chief adulteration is the spurious or 
"lie tea," manufactured in China from 
other leaves than those of the tea-plant. 
It is impossible that any systematic adul- 
teration of an article of diet of such uni- 
versal consumption as tea can fail to be 
most injurious to the health of the com- 
munity at large, and especially to that of 
the poorer classes, who buy the low-priced 
teas in small quantities at a time; and who, 
moreover, in many places at least, have a 
strange predilection for green teas, which 
2 V 34 



we have just seen are scarcely to be met 
with free from adulteration. The subject 
is one which demands attention from every 
one. Nor is the adulteration an active 
evil only — it is a passive one also ; for, by 
diminishing the amount of the " theine," 
the active principle of tea, it deprives the 
poor consumer of nitrogenized aliment, 
which to him stands partly in lieu of ani- 
mal food. 

It is probable that there are few more 
remarkable facts in the history of mankind, 
than that which has been brought to light 
by the recent researches of organic chemis- 
try, respecting the identity of composition 
of the principles to which tea, coffee, and 
also cocoa, owe their characteristic proper- 
ties. On this head Liebig remarks, "We 
shall certainly never be able to discover 
how men were led to the use of the hot in- 
fusion of the leaves of a certain shrub — tea 
— or of a decoction of certain roasted seeds 
— coffee. Some cause there must be, which 
would explain how the practice has become 
a necessary of life to whole nations. But 
it is surely still more remarkable, that the 
beneficial effect of both plants on the health 
must be ascribed to one and the same sub- 
stance, the presence of which in two vege- 
tables belonging to different natural fami- 
lies, and the produce of different quarters 
of the globe, could hardly have presented 
itself to the boldest imagination. Yet re- 
cent researches have shown, in such a 
manner as to exclude all doubt, that caf- 
feine, the peculiar principle of coffee, and 
theine, that of tea, are in all respects iden- 
tical." The above facts are the strongest 
possible argument in favour of the assump- 
tion, that man, as he advanced in civiliza- 
tion, required for comfort, and probably 
also for health, some, at least, occasional 
addition to the simple element. What can 
be more significant of design than this — 
that we find in two distinct quarters of the 
habitable globe, man using, as a daily 
drink, two distinct forms of vegetable in- 
fusion, made, the one from a leaf, the other 
from a berry, each produced by totally 
different plants, and yet each exerting 
nearly the same physiological action upon 
man ? This was calculated to excite admi- 
ration ; but how much more when the re- 
searches of modern science elucidated the 
startling fact, that nations in different 
quarters of the globe had ignorantly but 
instinctively been led — we speak now as 
regards science — to adopt for the same 
purpose, these apparently dissimilar mate- 
rials, which yet owed their characteristic 
properties to active principles identical in 



TEA 



530 



TEA 



composition. Nay, further, that the nations 
among whom tea and coffee were originally 
met with, were those whose diet is chiefly 
vegetable, consequently who consumed a 
larger quantity of non-nitrogenized food, at 
least of food which did not contain a due 
proportion of nitrogen for supplying the 
wants of the healthy system, and especially 
for furaishing sufficient for the nitrogenized 
constituents of bile ? Nay, science has 
further pointed out, and Liebig has shown, 
that from the relation existing between the 
azotized vegetable principles, theine, caf- 
feine, (and also theo-bromine,) and the 
azotized constituents of bile, that tea and 
coffee "are, in virtue of their composition, 
better adapted to this purpose," to supply 
the biliary azotized principles, "than all 
other nitrogenized vegetable principles." It 
is further singular, that the above is sup- 
ported by what we might almost call an 
instinctive habit among many of the poor of 
our own country, who are unable to procure 
animal (azotized) food, but who will make 
every effort to procure tea and coffee. The 
custom is, and is no doubt felt to be, a 
salutary one, although injury is frequently 
done by the unnecessary large quantity of 
tepid liquid consumed. Indeed, if we con- 
sider the sugar taken with tea as furnishing 
the carbon of the bile, and the theine its 
nitrogenized material, whether the bile be 
formed in the blood or in the liver, we here 
have its essential constituents. Tea and 
coffee, moreover, are particularly adapted 
for the use of the sedentary, a class pecu- 
liar to civilized life. In these persons, the 
metamorphoses of the tissues being reduced 
for want of motion, the amount of azotized 
material available for the formation of bile 
is diminished. Persons of sedentary habits 
are also extremely apt to take an excess of 
non-azotized food. Tea and coffee being 
capable of furnishing the proper azotized 
compound, the use of these substances may 
promote the conversion of that excess into 
bile ; and accordingly may favour the com- 
bustion of carbonaceous materials, which 
would otherwise accumulate in the blood 
and produce languor, lassitude, and oppres- 
sion. We have here a chemico-vital effect 
exerted upon the living system by the active 
principles of tea and coffee, analogous to, 
but perfectly distinct from that exerted by 
alcohol ; we have also to consider the effects 
of these principles upon the nervous system, 
different but parallel to those of the spirit. 
Like alcohol, the first effect of tea and cof- 
fee is exerted upon the stomach and its 
nerves, these effects doubtless being modi- 
fied by the hot liquid in which the articles 



are generally taken. The first effect is 
stimulant. 

Probably, there is no substance, not 
strictly medicinal, which exerts so powerful 
an influence upon the nervous system as tea, 
especially the green variety, of which many 
individuals cannot take even the smallest 
quantity without experiencing the most dis- 
agreeable effects; they become faint; the 
action of the nervous system is disturbed, 
the hand trembles, the heart palpitates ; 
sometimes gastric spasm is induced, but 
more generally a feeling of raking at the sto- 
mach, and of extreme hunger shortly after 
a full meal ; lastly, there is extreme wake- 
fulness. " There are some females upon 
whom green tea produces nearly the same 
effect as digitalis ; and it has been medi- 
cinally employed in the diseases for which 
that herb has so decidedly obtained a high 
reputation. Desbois, of Rochfort, has, by 
the use of it, cured many nervous diseases, 
which have arisen from accelerated circula- 
tion. Dr. Percival had an idea that green 
tea possessed nearly the same power as does 
digitalis, of controlling and abating the 
action of the heart. "It is upon the nerv- 
ous system that the effects of tea are chiefly 
manifested ; green tea, especially, is dis- 
tinguished by this property. It is said that 
a strong solution of it, applied to the sciatic 
nerve for half an hour, has caused death. 
Introduced in only a small quantity beneath 
the abdominal integuments of a frog, it pro- 
duced complete paralysis of the hind legs, 
lasting for some hours." Administered as 
an injection to a dog, it caused a perfect 
paralysis of the bladder and intestinal 
sphincters, a partial loss of power in the 
hind legs, and a total loss in the tail." "A 
poultice of green tea-leaves, applied over 
the human stomach, has caused sickness 
and vomiting ; over the abdomen, colicky 
pains and purgings ; over the heart, faint- 
ness and irregularity of pulsation ; over the 
kidneys, diuresis." Were it requisite here, 
many more instances of the poisonous effects 
of this herb might be cited. True, these 
are chiefly the results of green tea ; but in 
some, black tea will produce nearly similar 
symptoms. Where individuals have any 
tendency to dyspeptic affections, they are 
very apt to be aggravated by the use of tea, 
which occasions severe gastralgia ; these 
cases are familiar to every medical man ; 
they are frequently cured, solely by enforc- 
ing the disuse of the beverage, which, in- 
deed, ought to be done in all such cases. 

Mr. Corfe, in his lectures on the "Physi- 
ognomy of Diseases," mentions a case very 
closely imitating cancer of the stomach, 



TEA 



531 



TEE 



■which completely and rapidly recovered as 
soon as the tea was given up ; and in the 
Lancet very many cases are recorded to the 
same effect. The action of tea, in exciting 
mental phenomena, is equally remarkable 
with its influences upon the body. Most 
students are familiar with its power of 
clearing the mind and facilitating its work- 
ing ; many, too, have experienced its bane- 
ful effect, in preventing sleep and occasion- 
ing mental irritability. At times, however, 
the disorder of the faculties of the mind, 
under the influence of strong tea, amounts 
nearly to insanity. Millingen says of it, 
*' In some it is highly stimulating and ex- 
hilarating ; in others its effects are oppres- 
sion and lowness of spirits ; and I have 
known a person who could never indulge in 
this beverage without experiencing a dispo- 
sition to commit suicide." 

Many cases of hypochondriasis are trace- 
able to the inordinate use of tea. Enough 
has now been said to prove the powerful 
immediate action exerted by tea upon the 
constitution and nervous system when taken 
immoderately, or even in moderation, by 
people of peculiar idiosyncrasy. Generally 
speaking, however, black tea (green tea 
ought never to be an article of regular con- 
sumption) when taken in moderation, pro- 
duces effects at once agreeable and bene- 
ficial ; the gentle stimulation to the stomach 
certainly assists digestion, especially if the 
beverage be taken toward the close of the 
process, or three or four hours after a full 
meal. Taken along with food it is at times 
serviceable ; it is thus used by the Tartars 
to counteract indigestion occasioned by the 
use of raw flesh. The stimulant properties 
of tea are not so strongly exhibited when it 
is taken with a solid meal as when with a 
small quantity of light food. When taken 
in excess at any time, or too soon after a 
full meal, the warm liquid is apt to debili- 
tate the stomach, and to interfere with the 
regular process of digestion. Notwithstand- 
ing, however, the evils resulting from the 
abuse of tea-drinking by some, or its dele- 
terious effects upon a few peculiarly con- 
stituted individuals, there can be no doubt 
that the salubrity of the infusion to the ge- 
neral mass of the community is established 
on sufficient testimony to outweigh any ar- 
gument founded on individual cases. 

The moderate use of the beverage is of 
course alluded to. In cases where it evi- 
dently disagrees, it ought to be given up 
altogether ; and it may be taken as a rule 
for most, that two cups of moderately strong 
tea, morning and evening, are sufficient, and 
not too much for health. If this quantity 



is exceeded, not only is it apt to cause nerv- 
ousness, but the amount of warm fluid de- 
bilitates the stomach. 

Refer to Breakfast, Coffee, Opium, §c. 

TEARS. — The watery saline secretion 
named the tears, is formed by the "lachry- 
mal gland," (see Eye,) which is situated in 
the outer and upper corner of the socket or 
orbit. The secretion is continually passing 
over the forepart of the eyeball, keeping it 
clear, bright, and free from dirt, and facili- 
tating the movements of the eyelids, any 
superfluity of moisture being taken up at 
the inner angle of the lids, and conveyed 
into the nose. — See Eye. The increased 
secretion of tears is a remarkable instance 
of mental influence over the body; still more 
so when it is reflected that infants do not 
shed tears in their crying. It would seem 
that mere crying from physical causes is not 
sufficient to cause increased secretion, and 
that some amount of intelligent mental emo- 
tion must be conjoined. 

TEETH — Are hard substances placed ge- 
nerally at the entrance of the alimentary 
canal of animals, for the purpose of com- 
minuting the food. True bony teeth are 
met with only in the higher or vertebrated 
classes of animals ; and in the highest class, 
the mammalia, to which man himself be- 
longs they are found to be placed in single 
rows in each jaw. Even a superficial exa- 
mination of the teeth of different animals, 
makes evident how specially they are con- 
structed with reference to the habits and 
food of the being whose purposes they sub- 
serve. There are the sharp-edged, chisel- 
like " incisor" teeth of the rabbit or hare ; 
the sharp-pointed, conical "canine" teeth 
of the dog, and of other carnivora ; the 
broad, crushing "molar," or back teeth, of 
the graminivora and grain-feeding animals. 
In the case of a man, who is calculated to 
subsist on a mixed diet, we find all the 



Fig. cxxviii. 




above forms of teeth, but in a modified de- 
gree. The teeth of the human adult are 
thirty-two in number, arranged in two 
arched rows, containing sixteen in each. 



TEE 



532 



TEE 



The teeth in each of the arches correspond 
to one another, but those of the upper arch 
in most jaws overlap the lower. Fig. cxxviii. 
represents the teeth of one-half of the adult 
lower jaw. Of these, 1 marks the two in- 
cisors ; 2 the canine teeth ; 3 the two 
"bicuspid," or two-pointed, or false molar 
teeth ; and 4 the true molars, three in 
number ; that is, eight teeth in all, on one 
side of the one jaw, giving, of course, six- 
teen for the single jaw, or thirty-two for 
both upper and lower jaws. In the child, 
the number of the first temporary or "milk 
teeth," is not so great as in the adult by 
twelve. There are the four incisor and 
two canine teeth in each jaw, but the true 
molars (fig. cxxviii. 4) are entirely absent, 
their place being supplied by four tempo- 
rary molar teeth, two on each side, which 
occupy the situation of the bicuspid teeth 
(fig. cxxviii. 2) in the adult. About the 
seventh year of age, when the shedding of 
the first teeth is commencing, but it may be 
later, the child cuts the first of the true or 
permanent molars. These teeth appear 
without direct reference to the shedding of 
the first set of teeth, as they do not occupy 
the site of any of the latter, but, so to speak, 
break new ground for themselves. 

Every tooth is divided externally into a 
crown, (fig. cxxix. 1,) and into a fang, or 

Pig. cxxix. 




root, (3.) At the point where the gum 
ceases, the tooth is slightly contracted, (2,) 
and this, which marks the division between 
the two other portions, is called the neck of 
the tooth. When a tooth is divided verti- 
cally, as shown in the magnified section of 
an incisor tooth, (fig. cxxix.,)* there is seen 
covering its exposed portion, or crown, the 



* Todd and Bowman's Physiological Anatomy. 



"enamel," (4,) which thickest at the supe- 
rior part, and gradually thins off toward the 
neck, where it ceases. At this point, how- 
ever, begins another substance, the " ce- 
mentum," or " crusta petrosa," (6,) which 
gradually increases in thickness toward 
the extremity of the fang, where it leaves a 
perforation, through which the vessels and 
nerve pass to the interior or pulp cavity, 
(7,) which occupies the centre of the tooth. 
Between this pulp cavity and the enamel 
on the crown, and between it and the outer 
bony casing or cementum on the fang, lies 
the tooth bone, dentine or ivory, (5,) which 
constitutes the great bulk of the tooth. 

Probably, no structure in the animal 
body, not even the eye itself, evinces more 
striking evidence of wise design than 
is to be found in a completely developed 
tooth — still more when the processes of its 
development are traced, as they have been, 
from the first papilla or appearance of pre- 
paration for the future structure. These, 
indeed, are wonderful and beautiful, but 
how much more wonderful to find that 
before an infant has yet breathed the air of 
this world, the preparation is made in its 
jaws for the development of its future per- 
manent teeth, not to be made apparent for 
eight or nine years after, when the enlarge- 
ment of the bones permits this development 
and renders it necessary. 

Fig. cxxx. 




Fig. cxxxi. 



sSBHBSsf 



The calcareous enamel of the teeth is com- 
posed almost entirely of earthy or mineral 
constituent, the animal matter not constitut- 
ing more than two per cent, of the whole 



TEE 



533 



TEE 



It covers the entire exposed portion, or 
crown of the teeth, (fig. cxxix.) The ena- 
mel is not, as might be supposed, a homoge- 
neous structure, but is composed of numbers 
of minute hexagonal fibres or rods, or, ac- 
cording to some, "prismatic cells," as shown 
when magnified, (fig. cxxxi.,) placed side by 
side ; a transverse section of these fibres, 
presenting the hexagonal divisions, (fig. 
cxxx.) The diameter of these fibres is said 
to be about the 5 J ? ^ of an inch. They are 
not straight, but, as represented, have a 
wavy appearance ; their inner extremities 
rest in shallow depressions on the surface of 
the tooth-bone, or ivory; their outer ends form 
the surface of the crown of the tooth. By 
this arrangement of its structure, the enamel 
is evidently most perfectly adapted for sus- 
taining the pressure, &c. to which it must 
be liable in the process of mastication. The 
"tooth-bone," "dentine," or ivory, which 
constitutes the great bulk of the tooth, 
(fig. cxxix.,) and on which the enamel rests, 
is composed of numbers of branched tubes, 
which radiate from the central cavity. 
Through these tubes, the branches of which 
intercommunicate in all directions, the 
fluids of the tooth permeate ; moreover, the 
firmness of their walls and of the surround- 
ing fibrous substance, and the radiating and 
waved course of the tubes, gives the entire 
mass of dentine or ivory- the greatest possi- 
ble power of resistance. The cementum, or 
crusta, which forms the thin bony covering 
of the fang or root of the tooth, (fig. cxxix.,) 
resembles ordinary bone in structure. It is 
the enlargement of this bony crust which is 
sometimes found upon the fangs of teeth. 
The pulp (fig. cxxix.) contained in the tooth 
cavity, is largely supplied both with blood- 
vessels and nerves, which enter at the per- 
foration in the extremity of the fang, (8.) 

The separate sockets, or "alveoli," into 
which the teeth are so firmly fitted, corre- 
spond to the shape and directions of the 
fangs, to which they are united by a some- 
what elastic "periosteum," and by commu- 
nicating blood-vessels. 

The bicuspid or false molar teeth fre- 
quently have a fang forked at the extremity, 
each division being perforated. The true 
molar teeth have two, three, and sometimes 
four fangs each. 

In infancy, the period of teething, or the 
coming forward of the first set, the tem- 
porary or milk teeth, always occasions some 
amount of disturbance in the susceptible 
young constitution. — See Children. 

The order in which the teeth are succes- 
sively developed varies considerably: the 
following average of periods is given by Mr. 
2u2 



Erasmus Wilson. The teeth of the lower 
jaw generally appearing before the corre- 
sponding ones of the upper. 

TEMPORARY TEETH. 

7th month, two middle incisors. 

9th " two lateral incisors. 
12th " first molars. 
18th " canine. 
24th " last molars. 

PERMANENT TEETH. 

6J year, first permanent molars. 
7th " two middle incisors. 
8th " two lateral incisors. 
9th " first bicuspids. 

10th " second bicuspids. 

11th, 12th, canine. 

12th, 13th, second permanent molars. 

17th, 21st, third, or last permanent molars, 
or " wisdom teeth." 

The first teething in infancy is always 
somewhat critical, (see Children,) but even 
the second is not always free from irritant 
effects upon the constitution, and epileptic 
and other attacks have dated from this 
cause and period. 

There are a few instances on record of a 
third partial teething even in old age. 

The carelessness or neglect in the pre- 
servation of the teeth, which prevails among 
all classes, and especially among the lower 
orders, can result only from ignorance of 
the important purposes they subserve in the 
animal economy, and of how closely their 
perfection and efficiency are linked with 
health ; there is no question that the pos- 
session of a good set of teeth may make all 
the difference between a hale and prolonged 
old age, and premature decay of the powers 
of life. — See Digestion. Moreover, the dis- 
order of the stomach produced by the insuf- 
ficient mastication and comminution of the 
food, which must be the consequence of 
deficient teeth, tends still more to increase 
the evil. For since the teeth may, as nails 
and hair on the skin, be considered as de- 
velopments from the mucous membrane 
which lines the digestive organs, they sym- 
pathize with, and suffer from, whatever 
affects that lining membrane ; consequently, 
there is no more certain cause of decay in 
teeth than indigestion, and particularly if 
the saliva becomes acid. 

There is no question, however, that al- 
though chronic indigestion is very liable to 
assist decay in teeth, the process takes place 
much more quickly, from any cause, in some 
persons than it does in others. There cer- 
tainly is hereditary tendency in this as in 
other peculiarities of constitution ; for the 
members of one family preserve their teeth 
sound much longer than those of another, 



TEE 



534 



TEE 



though equal care is bestowed on them. At 
the same time, proper attention to the teeth 
will do much to preserve a naturally defi- 
cient set, and vice versa. 

The teeth being constantly moistened with 
the saliva, are continually liable to become 
incrusted with the animal matter and earthy 
salts contained in that fluid, forming what 
is popularly known as the "tartar" upon 
the teeth. This formation would accumulate 
much more rapidly than it does in those 
who neglect their teeth, were it not par- 
tially removed at each meal by the friction 
of the food in course of mastication ; this 
is seen when persons, as they do in fever, 
lie long without food ; the teeth become at 
times quite crusted over. The author met 
with a strong example of the kind lately in 
the case of a girl of bad constitution, in 
whom, from avoiding eating on one side of 
the mouth in consequence of a tender de- 
cayed tooth, an accumulation of tartar of 
considerable thickness entirely covered not 
only the decayed tooth itself, but those next 
it, requiring considerable force and chisel- 
ling to detach. It formed, in fact, a calca- 
reous case over the tooth. Although partly 
removed by the food during mastication, the 
tartar cannot be so entirely, consequently 
it tends to accumulate around the necks of 
the teeth at the margin of the gum, and in 
time drives back, as it were, the gum, ex- 
posing the parts of the tooth which are not 
protected by the hard and resisting enamel, 
to the action of the influences which speedily 
induce decay. Besides the tartar, there has 
been observed to accumulate from neglect, 
especially between the teeth, a filiform fun- 
goid-like growth. In no way is it possible 
to remove these continually forming incrus- 
tations but by the brush, or at least by some 
substitute for the brush, by which tolerably 
active friction can be employed. Neither is 
it well to trust too much to dentifrices, or 
tooth-powders : the brush and plain water is 
amply sufficient for most purposes ; a small 
addition of fine white soap is found to faci- 
litate the cleaning of teeth in some cases, 
but never should rough or acid tooth-pow- 
ders be used: they may, it is true, clean 
the teeth more quickly, but they do this at 
the expense of the enamel, which, in the 
first instance, is gradually worn away me- 
chanically, and in the case of the acid, 
chemically dissolved. If a tooth-powder is 
perfectly impalpable, it is difficult to see 
now it can. assist the cleaning of the teeth 
at all; and is, therefore, just as well dis- 
pensed with. When, however, the gums be- 
come spongy, and the teeth inclined to 
loosen, it may be well to use some astringent 



application for the purpose" of strengthening 
the gums ; tincture of camphor dropped into 
water is commonly used, but — although not 
fully proved — it has been thought to injure 
the integrity of the teeth themselves ; it is, 
therefore, as well avoided, especially as a 
few drops of tincture of myrrh on the tooth- 
brush is equally efficacious, and is free from 
suspicion. The powder or tincture of rha- 
tany-root may be used for the same pur- 
pose. [A useful and harmless tooth-powder 
is the following: — Take of powdered Peru- 
vian bark and myrrh, each half an ounce, 
powdered orris-root two ounces, and pre- 
pared chalk one ounce, the whole being 
finely sifted.] As a general rule, however, 
the use of a tolerably firm brush twice a 
day, or after each meal, and with water 
alone, is quite sufficient to preserve most 
teeth in purity and soundness. It is really 
surprising to what an extent cleaning the 
teeth is neglected, even by persons in re- 
spectable stations in life; and among the 
majority of the lower-classes it seems never 
to be thought of. Putting comfort, cleanli- 
ness, and refinement aside, on the score of 
health alone the habit ought to be prac^ 
tised, and among all classes ought to be 
taught to children. There is no doubt that 
where the food is simple, and health and di- 
gestion good, there is much less tendency 
to the accumulation of tartar about the 
teeth ; but this immunity is certainly not 
enjoyed by the lower classes in England, 
who suffer greatly from decayed teeth. It 
has been thought that the hot food and fluids 
used by civilized man tends to promote the 
decay of the teeth, and probably they do, 
if the habit is acquired, as it is by some, of 
taking these very hot. The use of the 
teeth to crack nuts, to bite hard substances, 
and the like, is apt to chip off the enamel, 
and thus to expose the tooth to certain de- 
cay. Some medicines have an undoubted 
tendency to injure the teeth ; certainly mer- 
cury given to affect the gums does so, and 
this should always be a serious considera- 
tion with a medical man in using the drug 
to this extent, in the case of the young es- 
pecially. The mineral acids act chemically, 
by dissolving the enamel ; they ought, there- 
fore, always to be sucked through a quill or 
glass tube, and the mouth rinsed with water 
afterward, [or with water containing a lit- 
tle super-carbonate of soda.] Prussic acid 
given medicinally has been thought to 
injure the teeth ; iron medicines discolour 
them, if the teeth are not brushed after the 
dose. Under article " Grape," the author 
has noticed a singular effect of the acid of 
that fruit in dissolving off the enamel. 



TEE 



535 



TEE 



Another cause of decay is the lodgment of 
particles of food in the interstices between 
them ; these the brush will remove, but 
the use of toothpicks of any kind is most 
injurious. 

As the calcareous, almost crystalline, 
enamel is the great protection of the inner 
and more easily acted on components of the 
tooth, its removal quickly gives a tendency 
to decay, which, once begun, tends to spread, 
unless means are used to stop it. This is 
best done by means of the "stopping" pro- 
cess, with gold or other material, as prac- 
tised by dentists. To be thoroughly done, 
stopping requires considerable care, the re- 
moving — scraping out — of the decayed por- 
tions of the tooth, &c. ; it therefore requires 
to be effected by the dentist, and he should 
always be resorted to for the purpose, care 
being taken to ascertain that the stoppage 
is not — as has occurred — of such a metallic 
nature as will injure the constitution. As 
a temporary stopping, which any one may 
insert for themselves, nothing answers bet- 
ter than a piece of gutta-percha, softened 
in water, and pressed well into the cavity, 
which it should fill ; it will thus often retain 
its place for months. Care must be taken, 
however, that this or any other stopping 
does not press injuriously upon the nerve — 
otherwise severe suffering may ensue. When, 
in the course of decay, the cavity of the 
tooth, which contains the nerve pulp, is 
opened into, toothache begins ; the nerve 
becomes highly sensitive, probably inflamed, 
and not only is extreme pain excited by the 
slightest cause — a crumb lodging in the ca- 
vity, or a draught of hot or cold fluid — but 
the slightest jar upon any portion of the 
tooth is most acutely felt. The pain of 
toothache may continue with more or less 
severity and intermission for a long time, 
till either the sufferer is driven to the per- 
manenjt cure of having the tooth extracted, 
or, as often happens, the pain ceases of itself, 
or under the use of some application. Un- 
doubtedly, extraction is the only certain 
cure for toothache ; and when a tooth is so 
utterly decayed that it cannot be stopped, 
and is of no use, its removal cannot too 
soon be submitted to. At the same time, it 
is worth while to suffer a little pain to save 
a tooth that is likely to do after-service, and 
that will bear stopping after the irritation 
of the nerve has subsided or been subdued. 
The aching of a decayed tooth is very often 
excited by cold, by disorder of the digestive 
organs, &c. &c. ; when, therefore, the pain 
commences, the possibility of such causes 
should be investigated, and if they exist, 



they should be rectified. — See Cold— Indi- 
gestion, §c. If, however, after this has been 
done, the neuralgic irritation still continues, 
it may be advisable to give quinine, and 
alse opium, as recommended under article 
"Neuralgia ;" counter-irritation, in the form 
of blister or mustard-plaster behind the ear, 
being also used. The agonizing ache of the 
tooth itself requires to be quickly relieved, 
if possible, independent of the above reme- 
dies, which are to remove the tendency. 
The applications used to cure toothache 
would make a long list ; among the latest, 
chloroform and creasote are the most use- 
ful, especially the latter, the chief objection 
to which is its disagreeable smell. Strong 
ammonia is also sometimes used with suc- 
cess ; it probably acts partly by neutralizing 
acid matters within the decaying tooth. The 
most effectual application which the author 
has ever used is composed of creasote and 
strong solution of ammonia, of each one 
part, tincture of myrrh two parts. In some 
cases the ammonia and myrrh is effectual 
without the creasote. [Laudanum and oil 
of cloves are favourite domestic remedies, 
and sometimes afford relief.] All these 
liquid applications are best introduced into 
the decayed tooth by means of a small pellet 
of cotton wool, soaked in them, and lightly 
laid in the cavity. If pressed in, its me- 
chanical pressure on the nerve may coun- 
teract the good effects of the remedy, or 
even aggravate the pain. If the first use 
of an application does not relieve, the piece 
of cotton should be removed, and a fresh- 
charged portion introduced; this is often 
successful. The applications which are 
most generally serviceable in toothache, 
are stimulants, which seem to act by de- 
stroying the sensibility of the nerve. This 
is sometimes more effectually done by means 
of a red, or rather white, hot wire, which 
destroys the nerve pulp altogether ; the mo- 
mentary pain is severe, but if the operation 
is well done, the tooth is rendered insensi- 
ble, and consequently serviceable. Recently 
this operation has been performed in a more 
elegant and agreeable manner, by means of 
electric heat. The wire is fitted into the 
tooth cold, and momentarily heated to in- 
candescence by a galvanic current. The 
operation requires to be managed by a den- 
tist. It is sometimes difficult to find the 
opening into the pulp cavity of a tooth when 
small ; not unfrequently it is situated at the 
neck of the tooth, where both enamel and 
cementum are thinnest. 

The wisdom-teeth, or Last molars, are pe~ 
culiarly susceptible of this species of decay. 



TEE 



536 



TEM 



"When the gums are much inflamed in tooth- 
ache, much relief is sometimes given by 
lancing them freely around the tooth. 

To extract a tooth, being merely a me- 
chanical operation, certainly requires no 
great amount of knowledge, and is one per- 
formed in some villages, still, by the black- 
smiths, some of whom, by practice, tact, 
and strength of arm, perform it very well, 
though perhaps not so easily as the pro- 
fessed dentist, who uses improved instru- 
ments. The fact, however, is sufficient to 
show that any one, such as an emigrant, 
inclined to render himself useful, and per- 
haps make a little odd money, in an out-of- 
the-way place, may acquire the art. At the 
same time, perhaps, few would willingly 
trust themselves in the hands of an ama- 
teur, except from the dire necessity of a fit 
of toothache ; but as that necessity is not 
an uncommon one, the accomplishment of 
tooth-drawing may be found not at all a 
useless one in some situations. The faculty 
can scarcely be acquired properly, without 
a few practical lessons, which there can be 
little difficulty in obtaining, in this country 
at least. Various instruments are used for 
the purpose of tooth-drawing ; the forceps 
or pincers for the single, and the key for 
the double, being the old and most com- 
monly used forms. Some dentists now dis- 
card the key, and use forceps only, of varied 
shape and construction, to suit the different 
positions of the tooth to be extracted. Pro- 
bably, an unprofessional person will find 
the key and the forceps the instruments of 
the use of which it will be the most service- 
able to acquire a knowledge ; and as this to 
be sufficient must be practical, all that is 
requisite here is to add a few memoranda 
of the proceedings which might escape the 
memory. 

The key (fig. cxxxii.) is of the form repre- 
sented, with the handle placed crosswise. 
Fig. cxxxii. 




The bolster (1) acts as a fulcrum ; the claw 
(2) is fixed to the neck of the tooth, inside 
or outside, as may be most convenient for 
drawing, and the bolster made to press 
against the gum on the other side. The 
head of the patient being fixed by an assist- 
ant, if the operation is on the lower jaw, 
the tooth is twisted out by the force of the 
leverage of the bolster against the gum or 
jaw. When the upper jaw is dealt with, it 
is most convenient to seat the patient on the 
floor, or on a very low stool. The bolster 
should be padded by a piece of lint wrapped 
round, otherwise it bruises the gum unne- 
cessarily. It is better with a gum-lancet 
to separate the gum from the tooth pre- 
viously to drawing, otherwise the former 
may be torn. 

For the single teeth the forceps are used. 
These vary somewhat in form, and should be 
selected by some professional friend ; they 
should not be so close or sharp as to risk 
cutting the tooth through. When used, one 
blade is to be fixed behind, and the other 
in front of the tooth, just within the gum 
margin, and the head being fixed, the tooth 
is drawn straight out of its socket by the 
force of traction, accompanied with a slight 
rotatory motion. 

It is impossible in the space of this work 
to enter as fully into this subject as might 
be ; for those who desire more information, 
there are popular works published upon it 
at a moderate price. 

TEETOTALISM. — See Intoxication — 
Stimulants. 

TEMPER.— See Passion. 

TEMPERAMENT— Is a term which took 
its origin in the earlier stages of medical 
science, when the constitution of the body 
was supposed to depend upon the propor- 
tional mixture or "tempering" of the four 
principal fluids or humours — the blood, the 
phlegm or lymph, the yellow, and the black 
bile. Hence, corresponding with these, 
there was the " sanguine," or blood tem- 
perament, the "phlegmatic," or "lympha- 
tic," the "bilious," and the "atrabilious," 
or " melancholic." As these distinctions 
are applicable to certain recognised types of 
constitution, they are still retained, with the 
addition of the "nervous" temperament. 
The sanguine temperament is usually dis- 
tinguished by the ruddy complexion, blue 
eyes, and brown hair, and generally full 
large habit of body, with vigorous perform- 
ance of the functions of life. The phleg- 
matic, generally now called lymphatic tem- 
perament, is almost the reverse of the first. 
The functions of life are usually more feebly 
performed, probably owing to the deficient 



TEM 



537 



TEN 



quality of the "blood, the skin is pale, the 
hair light in colour. The choleric or bilious 
temperament is characterized by black, often 
curling hair and beard, the latter being 
generally thick and strong ; the eyes dark, 
the complexion ruddy though dark, and 
the circulation good. In the melancholic 
temperament the hair is black but straight, 
the skin is dark, but wants the red tinge 
of the true bilious ; the circulation and the 
functions are slow and languid. The above 
temperaments are not unfrequently met 
with strongly defined in individuals, but in 
the majority they are mixed up one with 
another. 

Refer to Complexion — Diathesis. 

TEMPERANCE.— See Stimulants. 

TEMPORAL.— Connected with the tem- 
ples. 

TENACULUM— Is a slender hook, (fig. 
cxxxiii.,) to which a handle is attached, used 
by surgeons for laying hold of and pulling 
Fig. cxxxiii. 



forward a bleeding artery, so as to permit 
of its being secured. The instrument may 
be made to shut up into a handle or not, as 
convenient. It might be found useful in 
emigrant life. — See Artery — Instruments. 

TENDERNESS— On pressure of any por- 
tion of the body, is a symptom which is al- 
ways much regarded in the investigation of 
disease, seeing that it is in most instances, 
if itls not in all, indicative of irritation or 
acute inflammation. In making pressure, 
however, to ascertain the existence of ten- 
derness, care must be taken, if possible, to 
bear upon the part examined with a suffi- 
ciently extended surface of the hand, and 
not to press too quickly or forcibly — other- 
wise the mere roughness of the examination 
may cause pain, and give the appearance 
of tenderness. 

TENDO-ACHILLIS— Is the remarkably 
strong tendon which connects the muscles 
of the calf of the leg with the heel. Any 
one may feel it in his own person. It is 
chiefly to be noticed here, on account of the 
not very uncommon accident of rupture, 
to which it is liable, particularly in heavy 
individuals. Perhaps, in making some un- 



usual exertion, there is felt the sensation as 
of a violent blow upon the tendon, and if 
the person does not fall to the ground, he at 
once finds the power over the foot is lost. 
If the place is examined, the space left 
between the ruptured ends of the tendon 
may be distinctly felt. It is, of course, im- 
portant that the injury to a part on which 
locomotion so greatly depends, should be 
efficiently repaired ; the case, therefore, 
should always, when possible, be treated 
by a medical man. The accident, however, 
is one liable to happen in out-of-the-way 
places ; with a little care its treatment may 
be efficiently managed even by an unpro- 
fessional person, at all events till skilled 
assistance is obtained. The principle of 
treatment is, by relaxing the muscles of the 
calf, to permit the ruptured ends of the 
tendon to approach one another. To effect 
this, the palpable proceeding is to bend the 
knee and foot, as represented, (fig. cxxxiv.) 

Fig. cxxxiv. 




To retain the position, it is sufficient to 
attach a strong cord or tape (1) to the heel 
of a slipper placed upon the foot ; to attach 
a corresponding cord (2) to a band of some 
stout material, (3,) — stout calico will do — put 
round the lower part of the thigh ; and this 
being done, to tie the two cords together, 
so as to preserve the requisite amount of 
flexure, which must be kept up for at least 
four or five weeks, at the end of which 
period, gentle and gradual extension of 
the heel may be tried, but no attempt at 
walking should be made for a considerably 
longer period. Ultimately, if the case is 
properly treated, perfect recovery takes 
place. For some time after the above acci- 
dent, it is advisable for the person to wear 
a high-heeled, laced boot. Some apply a 
light bandage in addition to the apparatus 
described above. 
Refer to Wounds. 



TEN 



538 



THI 



TENDONS — Popularly called " the 
guides," [and "leaders," or " sinews,"] are 
the strong fibrous extensions, by means of 
which the muscles are attached to the bones. 
All tendons are liable to be divided by 
wound or by rupture ; in these cases the 
nature of the accident is indicated by the 
loss of power over the limb or members. 
The treatment required is similar in prin- 
ciple to that for ruptured Achillis tendon — 
the relaxation of all the muscles which are 
connected with the injured part, for a suffi- 
cient period to permit union. 

Refer to Ganglion. 

TENESMUS— Is the sensation in the rec- 
tum (see Rectum) which causes involuntary 
straining, or effort, to empty the bowels. 
It is a frequent symptom in diarrhoea, dy- 
sentery, &c. 

Refer to Diarrhoea — Dysentery — Stool. 

TENT. — A piece of .lint, sponge, or other 
material used for dilating openings, or for 
keeping open wounds. 

TERTIAN.— See Ague. 

TESTICLES— The male organs, are liable 
to various affections. Inflammation is ac- 
companied with severe pain and swelling ; 
it requires the treatment of inflammation 
generally — leeching, fomentation, poultices, 
calomel, and Dover's powder, and aperients, 
with perfect rest in bed and low diet. En- 
largement of the veins — varicocele — accumu- 
lation of fluid, (see Hydrocele,) and various 
chronic enlargements and diseases, occur in 
connection with these glands, but, for all, a 
medical man's attendance is absolutely ne- 
cessary. In the mean time, if the symptoms 
are urgent and painful, perfect rest in bed, 
avoidance of all stimuli, and attention to the 
state of the bowels are the best measures. 
If circumstances prevent absolute rest, sup- 
port should be given by a bag-truss, or by 
some such contrivance as that recommended 
in article "Prolapsus." 

TETANUS— Lock-Jaw.— See Lock-Jaw. 

TETTER.— A term applied to various 
forms of skin disease. — See Skin, Diseases 

of- 

THEINE.— The active principle of tea.— 
See Tea. 

THEOBROMINE.— The active principle 
of cocoa, resembling theine and caffeine in 
composition. — See Cofioa. 

THERAPEUTICS— Is the art and science 
of the application of remedies for the cure 
of disease. — See Medicine, and Medicine, 
Practice of. 

THERMOMETER, or Measurer of Heat. 
— The principle upon which this instrument 
depends is the expansion or contraction of 
a fluid according to the increase or diminu- 



tion of sensible heat. The fluid used is 
sometimes spirit, but more generally it is 
mercury, on account of the equable manner 
in which this fluid metal alters its volume 
with change of temperature. For the 
purposes of the measurement of heat, a 
thermometer is constructed by enclosing 
the mercury (or spirit) in a perfectly closed 
or "hermetically sealed" glass tube, with a 
bulb or expansion at one end. To this tube 
a regularly marked or graduated scale is 
attached, which indicates the changes under- 
gone by the mercury within the tube, in 
accordance with the changes in tempera- 
ture. These scales may be, and are, dif- 
ferently graduated. It is here sufficient to 
notice the scale of " Fahrenheit," which is 
universally used in this country. In the 
Fahrenheit scale, or thermometer, the zero 
or starting point, or 0°, is placed 32 de- 
grees below the temperature at which water 
freezes, consequently the freezing point of 
water is placed at 32°. Between this and 
the boiling point of water there are 180°; 
the latter, consequently is marked on the 
scale 212°. Between these points, there 
are other temperatures recognised, and usu- 
ally marked on most thermometers — they 
are "temperate" at 55°; "summer-heat" 
about 76° ; animal or blood-heat" 98°; and 
"fever-heat" about 109°. A thermometer 
is an instrument which ought now (con- 
sidering the low price) to be found in every 
house. For practical purposes, such as as- 
certaining the temperature of baths, &c, it 
is best to have the tube fixed to a metallic 
scale. 

Refer to Bath — Bedroom, Sfc. 

THIGH.— The portion of the body which 
extends from the hip to the knee is com- 
posed principally of a mass of fleshy, power- 
ful muscles. The fold (the groin) at the 
junction of the thigh with the trunk, is one 
of the most important regions of the body 
in a surgical point of view, for here is the 
most usual seat of rupture, (see Rupture,) 
and at this point, toward the lower end, 
the large vessels which pass to and from 
the lower extremity lie very superficially. 
Wounds of the groin are, therefore, parti- 
cularly dangerous, and, if the main artery 
be perforated, life is placed in the most im- 
mediate peril. — See Artery. A little below 
the groin, the vessel becomes more deeply 
imbedded in the muscles, and ultimately 
passes round the inner side of the thigh- 
bone to reach the ham. The thigh-bones 
(see Skeleton, fig. cxvii. 12) are the longest 
bones of the skeleton. From their ball and 
socket-joint at the hip, they incline inward 
toward one another at the knee. This in- 



THI 



539 



TIN 



clination is more especially marked in the 
female, in consequence of the greater width 
of the pelvic bones. 

Refer to Hip — Knee — Pelvis — Fractures, 
$c. 

THIRST.— See Diluents. 

THORAX.— The chest.— See Chest. 

THORN-APPLE, or Datura Stramoni- 
um, ["Jamestown" weed.] — Thorn-apple is 
naturalized in Britain. It is an annual plant, 
and grows about four feet in height. The 
leaves are much toothed, of a light green, and 
the flowers white and trumpet-shaped. The 
fruit, which is the most conspicuous part of 
the plant, is about the size of a walnut, and 
is covered with prickles or thorns, whence 
the name. In the shops, the leaves, stems, 
and capsules or fruit, with the seeds, are 
sold, cut up together, for smoking, the mode 
in which the drug is principally used in 
this country. It relieves the paroxysms of 
asthma, and other affections of the breath- 
ing dependent upon spasmodic causes. It 
is also now made up in the form of segars 
for the same purpose ; but, being a some- 
what powerful narcotic, in either way must 
be used with caution. At first, not more 
than ten grains weight of the leaves should 
be smoked, the dose being gradually in- 
creased to thrice that quantity. 

THREAD-WORM.— Ses Worms. 

THROAT.— The throat comprehends the 
parts situated at the back of the mouth, 
and includes the uvula and soft palate, with 
its arches, and the tonsils ; also the pha- 
rynx, or funnel-like muscular expansion at 
the top of the gullet, (fig. cxxxv.) The ap- 
pearance of the throat, looking through 
the mouth, any one may verify in his own 
person. In the illustration* the view is 
supposed to be from behind, the pharynx, 
or upper portion of the gullet, being laid 
open. The openings of the nostrils are 
seen, (fig. cxxxv. 1.) At 2 is the uvula with 
the arches of the soft palate on each side ; 
3 is the back part of the tongue, just 
behind which is situated (4) the glottis or 
opening of the windpipe. These parts are 
attached above to the skull, (7.) At 5 is 
represented a portion of the gullet-tube 
not laid open, and at 6 the tube of the 
trachea or windpipe, which lies in front of 
the gullet. — See Neck. A little considera- 
tion of the figure will enable any one to 
get a tolerably clear idea of the parts, and 
their relative positions, of this most im- 
portant region of the body. For further 
information the reader is referred to articles 

* For this figure and some others in this work the 
author is indebted to the valuable Manuals of Mr. 
Churchill. 



Tig. cxxxv. 




Cut-Throat — Gullet, which includes choking 
— Mouth — Neck — Palates — Tongue — Tonsils — 
Sore-Throat — Digestion. Also Larynx, in 
article Lungs. 

THROMBUS.— A small tumour caused by 
the escape of blood into the surrounding 
tissues, after a vein has been opened, as it is 
in bleeding from the arm. 

THRUSH.— See Aphtha. 

THYMUS GLAND.— A glandular body 
situated behind the upper portion of the 
breast-bone. It is larger at birth, and dur- 
ing the first year of infancy, than at any 
future period of life. 

TIC-DOULEUREUX.— See Neuralgia. 

TIGHT-LACING.— See Education. 

TINCTURES— Are solutions of medicinal 
substances in alcoholic spirit, either "rec- 
tified" or "proof." Rectified spirit, which 
consists of eight parts of alcohol to one of 
water, ought to have a specific gravity of 
838. Proof spirit, which consists of five 
parts of rectified spirit to three of water, 
ought to have a specific gravity of 920. 
The above different strengths are employed 
according to the solubility in spirit of the 
active principles of the drug from which 
the tincture is made. Some drugs, such 
as camphor, are entirely dissolved in rec- 
tified spirit. The general directions for 
making tinctures are, that the drug, if it is 
in solid substance, should be divided into 
small fragments, or into coarse or fine 
powder, as the case may be. It is then to 
be macerated in the spirit in a closed bottle 
for a certain period — generally from seven 
days to a fortnight, and after that strained 
through a cloth, or filtered through paper, 
or both. — See Filter. During the macera- 
tion, the bottle is to be frequently shaken, 
and when the straining takes place, the 



TIN 



540 



TOB 



solid is to be freed from the fluid as 
thoroughly as possible, by pressure in a 
cloth. This may be, and is done by hand, 
but much more effectually by means of a 
" tincture press" for the purpose. Indeed, 
some substances, such as squill, cannot be 
at all properly exhausted without the aid 
of a press. Within the last few years, the 
system of preparing tinctures by "perco- 
lation" has been adopted, especially in 
Edinburgh. It is a very excellent method, 
but requires considerable practice to carry 
out well. 

As medical preparations, tinctures pos- 
sess many special advantages, not the least 
being their preservative properties; more- 
over, the form of tincture often facilitates 
the use of a drug in a state of solubility, and 
therefore of activity, which could not be 
attained in any other way. Except in those 
cases, when the stimulant action of the spirit 
is desirable, tinctures are best adapted as 
vehicles for such medicines as act in small 
doses. If the action required from medicine 
be not stimulant, or rather the reverse, the 
form of tincture cannot be employed with 
advantage, that is, if such a dose is required 
that the stimulant properties of the spirit 
will be sensibly manifested. For instance, 
although rhubarb is an aperient medicine, 
which may safely be given alone, even when 
fever exists, it would be very injurious un- 
der such circumstances to give it for its 
aperient action in the form of tincture, in 
which case the dose must be from half an 
ounce to an ounce or more. Even in the 
case of the comparatively mild antimonial 
wine, the author has frequently had to point 
out the injury which may result from dosing 
children — suffering from inflammatory at- 
tacks, or head affection— with this prepara- 
tion, in quantity certainly sufficient to in- 
jure. Of course, when tinctures, such as 
those of rhubarb, ginger, orange-peel, &c. 
&c, are avowedly stimulant, and given for 
stimulant purposes, the presence of the 
spirit is rather an assistance than other- 
wise ; but the rule should be borne in mind, 
that unless stimulant action is required or 
at least admissible, a medicine ought never to 
be given in tincture, if the dose which mast be 
administered involves an amount of spirit 
which will be felt by the system. 

The list of tinctures is a very long one ; 
the following will be found most useful for 
domestic use : — 

Tincture of Arnica — Columbo — Camphor 
— Cardamoms compound — Catechu — Gin- 
ger — Henbane — Iron Muriate, or Tincture 
of Steel — Lavender compound — Myrrh — 
Opium, or Laudanum — Opium compound, 



or Paregoric — Orange-Peel— Rhubarb com- 
pound — Squill. 

To the individual articles the reader is 
referred : in a few, directions for preparing 
the tincture are given ; but, generally speak- 
ing, it is both more convenient and econo- 
mical for domestic purposes to purchase 
the tinctures ready prepared. 

TOAD. — The poisonous properties of this 
reptile have at times been doubted, but it 
seems well ascertained that the follicles of 
the skin do contain an extremely acrid fluid, 
capable of acting on the body like the poi- 
son of the wasp, or of snakes. — See Wounds, 
Po isoned — Stings. 

TOASTED BREAD— If not cut too thick, 
and if toasted slowly, is probably somewhat 
more digestible than simple bread — it is 
more thoroughly cooked. Toast, when soaked 
with melted butter, is one of the most un- 
wholesome and irritating articles of diet an 
invalid can take. 

TOAST-WATER.— See Cookery. 

TOBACCO.— This article, a luxury, a 
drug, or a poison, is the leaf of the Nicoiiana 
tabacum, a native of America, both Northern 
and Southern, but now cultivated exten- 
sively throughout the world, and even capa- 
ble of being so in the climate of England. 
The leaf is large and oval-shaped. Very 
many kinds of tobacco are met with ; the 
Virginia, which is one of the strongest, is 
used in medical practice in the form of in- 
fusion, but is no remedy for domestic em- 
ployment. Tobacco, however, requires con- 
sideration on account of its too widely 
extended use, as a stimulant or sedative, as 
the case may be, by so many individuals in 
every quarter of the globe. The effects of 
tobacco upon the human system vary ac- 
cording to the mode in which it is taken into 
the body. Applied locally, as in the familiar 
form of snuff, it acts as a powerful irritant ; 
taken into the stomach, or injected into the 
bowels — as it sometimes is by medical men 
— in the form of infusion, it depresses pow- 
erfully the action of the heart, causing 
fluttering, and a sense of sinking about that 
vital organ, with deadly faintness, and a 
tendency to relaxation of the bowels, and if 
the dose be large, death. Taken into the 
system by the lungs, in the form of vapour, 
as it is in smoking, its narcotic rather than 
its sedative action is exhibited ; it acts 
upon the brain, causing giddiness, inclina- 
tion to vomit, &c, and at the same time it 
depresses. The effects of tobacco, especial- 
ly as it is usually employed, vary of course 
according to the strength and nature of 
the variety used, and also according to the 
original constitution and acquired habits of 



TOB 



541 



TOB 



the individual. There are few, perhaps, if 
any, who, on first commencing the use of to- 
bacco, escape unpleasant effects from its 
narcotic and sedative properties, and some 
individuals never lose their susceptibility to 
be affected thereby. Yet others become so far 
habituated to the use of the drug, that these 
effects are not developed ; and others seem 
to become capable of deriving peculiar 
restorative influences from its use, experi- 
encing, especially under conditions of ex- 
haustion or irritability, a mixture of stimu- 
lant and sedative action which is described 
as peculiarly grateful. 

A drug which is capable of acting so 
powerfully upon the system as tobacco, can- 
not, certainly, be habitually made use of, 
without its influencing the functions of the 
body more or less ; much more, probably, 
in some than in others, but to a consider- 
able extent in all. Opinions vary greatly 
as to the actual influence which tobacco, 
when habitually used, exerts upon the con- 
stitution; this may perhaps be accounted 
for by the fact that some from whom the 
opinions have proceeded have themselves 
been lovers of the "weed," and naturally 
prejudiced in its favour; few, however, are 
found to defend it as entirely innocuous, 
and medical men generally are agreed, that 
in some constitutions at least, it is highly 
injurious. Upon those of the melancholic 
temperament, it seems to exert peculiarly 
injurious effects. 

When the habit of snuffing causes injury, 
it is more usually to the digestive organs, 
and in some persons it certainly gives rise 
to dyspepsia ; indeed, according to Dr. Prout, 
it may occasion malignant disease of the 
stomach and liver. Chewing tobacco acts 
as an excitant upon the salivary glands ; if 
the saliva is swallowed, the narcotic proper- 
ties of the drug are called into action. 

The most obvious injury which is apt to 
result from smoking, more or less, accord- 
ing to the extent in which it is indulged, 
is disorder and irritation of the digestive 
organs, frequently accompanied with de- 
pression of spirits, and at times with ex- 
treme nervous irritability, the latter being 
more especially manifested in an inveterate 
smoker, if, from illness or any cause, his 
habitual indulgence is interfered with. Very 
recently, the author saw this well exempli- 
fied in the case of a strong countryman, a 
constant smoker, but otherwise not intem- 
perate. He was attacked with fever ; in the 
course of a few days, in consequence, ap- 
parently, of the interrupted use of the to- 
bacco — for by no other reason could they be 
accounted for — nervous symptoms set in 
2V 



with extreme violence, threatening a speedy 
fatal termination, and requiring the con- 
tinual use of opium to keep them in any 
way under control. In many persons ad- 
dicted to smoking, especially in those who 
naturally possess the "melancholic" com- 
plexion, the skin seems to acquire a darker, 
and somewhat of a greenish hue. Accord- 
ing to Dr. Prout, a tendency to urinary dis- 
order — oxalic acid — is excited. The local 
injury caused by tobacco-smoking is well 
ascertained ; the bad effects, doubtless, are 
partly due to the heat of the process. Under 
article "Lip," the occurrence of cancer, in 
those who habitually smoke from a short 
pipe, was noticed ; the injury to the teeth 
from smoking, and especially their disco- 
louration, is notorious ; and, further, we 
have the valuable authority of Dr. Green, 
of New York, to prove that disease of the 
throat and air passages is apt to follow in- 
dulgence in this useless petty vice. He re- 
marks, " as an exciting cause, the use of 
tobacco, in my experience, has proved a 
powerful agent in the production of follicu- 
lar disease of the throat. Acting as a sti- 
mulant, directly and constantly, upon the 
mucous follicles of the fauces and throat, 
and greatly increasing, as it does, the secre- 
tion of these glands, its employment, as we 
should conclude, d, priori, must have a direct 
tendency to develop the disease, especially 
if a predisposion to the affection exists ; 
hence it has occurred to me, to notice that 
of a great number of cases of throat-evil, 
which during the last year or two have come 
under my observation, a large proportion 
of them have taken place in individuals who 
had been, or were at the time, in the habi- 
tual use of tobacco. My attention has been 
called more particularly to this subject, 
from having noticed, several years ago, some 
observations on the use of tobacco, in laryn- 
geal and bronchial affections, by an eminent 
surgeon of this city. After having alluded 
to the almost universal use of tobacco in 
the countries of Northern Europe, he ob- 
serves, ' In one very fatal and distressing 
form of disease, to wit, laryngeal phthisis 
and bronchitis, among public speakers, the 
fact is very clearly established, that the 
moderate habit of smoking, by the drain it 
accomplishes, and its anodyne qualities, has 
been eminently useful, at least as a preven- 
tive of that peculiar malady so frequent in 
the United States, especially among the 
clergy.' From this opinion of my distin- 
guished countryman and friend, I am com- 
pelled to differ entirely, by the statistical 
facts which I have obtained on this subject. 
Not only has the use of tobacco, in any and 



TOE 



542 



TON 



all its forms, proved to my experience an 
exciting cause of laryngeal disease, but 
where its employment has been persisted in 
during the treatment of any case, I have 
found it impossible to restore such to per- 
fect health." 

Enough, perhaps, has now been said to 
convince, that, although the use of tobacco 
may be indulged in by some, perhaps by 
many, and to a considerable extent, with- 
out very evident injury, there is a large pro- 
portion of constitutions to which it is almost 
a direct poison, sapping the whole founda- 
tions of health. The wide extension of the 
use of tobacco by man since its introduc- 
tion from the "new world," in the middle 
of the sixteenth century, is one of the most 
singular facts of human history : for it is to 
all, perhaps, at first, a nauseous, acrid, dis- 
agreeable drug, which causes uncomfortable 
sensations in whatever form it is used. Pity 
it is, it should ever prove otherwise, and 
that men should continue to poison them- 
selves, and render their neighbours uncom- 
fortable, by indulgence in so hurtful a 
custom. 

The objections to smoking tobacco as a 
mere habit do not of course extend to its 
employment as a remedy in disease, parti- 
cularly of an asthmatic character, in which 
some persons derive the greatest benefit 
from its moderate use. 

In any case, in which the use of tobacco 
has produced the symptoms described at the 
commencement of this article in an alarm- 
ing degree, general treatment, somewhat 
similar to that pointed out under article 
"Belladonna," may be employed. 

TOES. — See Bunion — Corn — Fracture, 
&c. 

TOLU.— See Balsam. 

TONGUE. — The organ of speech and 
taste (fig. cxxxvi.) is composed of muscular 
fibres running through it in different direc- 
tions, mingled with a considerable amount 
of cellular and fatty matter ; it is abun- 
dantly supplied with vessels and nerves. 
The tongue is divided in the centre by a de- 
pressed line, the "raphe," (fig. cxxxvi. 3.) 
It is covered by a dense mucous membrane, 
continuous with that of the mouth, on which 
are numerous "papillae," small toward the 
tip, but becoming -much enlarged (fig. 
cxxxvi. 2) toward the base of the tongue. 
At the tip, underneath, the tongue, as any 
may see in their own person, is confined by a 
bridle or tie, or "freenum;" at its root, the 
tongue is connected by a curved bone, the 
"hyoid," the extremities of which are re- 
presented, (4, 4 ;) between these, at the base 



of the tongue, is the "epiglottis," (5.) — See 
Throat — Larynx, $c. 

Fig. cxxxvi. 




It is superfluous here to dwell upon the 
well-known facility of motion and acute 
sensation by which the tongue is enabled to 
perform its well-known functions of speech. 
— See Speech. Taste may be regarded as 
similar in kind to the sense of touch, but 
as more exalted in degree : some amount 
of solubility in the substance placed in the 
mouth appears requisite for its develop- 
ment. Taste, like other sensations, is liable 
to alteration and perversion in disordered 
states of the system. 

In a medical point of view, the tongue 
has to be regarded both with reference to 
its own disorders, and to the indications it 
affords of disorder in other parts of the sys- 
tem. The tongue is liable to inflammation, 
although cases of it are rare. When it occurs, 
the most prominent symptom, in addition to 
the constitutional affection, is the enormous 
swelling, which causes the organ to pro- 
trude from the mouth, and at the same time 
threatens suffocation ; it is, therefore, a very 
serious affection, and one which requires 
the immediate attention of a medical man. 
The remedial measure which gives most re- 
lief is to make two free longitudinal inci- 
sions down each side of the tongue ; these, 
of course, admit of copious bleeding, but 
as the tongue diminishes in size, the cuts 
and the flow of blood also diminish. The 
remedy is one which might be practised by 
an unprofessional person in a-case of urgent 
necessity ; at least it would be better to do it, 
even at some risk, than to permit an indi- 
vidual to die of suffocation, while medical 
assistance was being procured. Ulceration 
of the tongue may occur as a symptom of 



TON 



543 



TON 



digestive disorder, as a consequence of mer- 
curial salivation, or from, local causes, such 
as the presence of decayed teeth, especially 
with ragged or sharp edges. — See Aphtha — 
Indigestion — Mercury, §c. Of course, when 
teeth-stumps are the exciting cause, they 
should at once be removed. In any cases of 
ulceration, the local treatment recommended 
under "Aphtha" may be pursued with ad- 
vantage. 

Cancer of the tongue is one of the most 
distressing maladies to which humanity is 
liable ; it may in some cases be removed with 
advantage by an operation ; at all events, 
any persistent sore upon the organ should 
be submitted, without delay, to the examina- 
tion of a medical man. The disease is most 
frequent in women. For Tongue-tie. — See 
Children — Speech. 

As all are aware, the condition and ap- 
pearance of the tongue are indications almost 
always consulted by a medical man in inves- 
tigating a case of disease, and most valuable 
guides they are at times, when experience, 
observation, &c. have given the power of 
reading them aright. When the appear- 
ances of the tongue, however, are admitted 
as evidence, consideration must always be 
given to the natural state of the organ in 
the individual, for some never have a clean 
tongue, while in others it scarcely becomes 
furred, even when considerable disorder is 
going on in the system. In chronic disorders, 
especially of the digestive organs, the most 
valuable indications are often afforded by 
the tongue, immediately after the night's 
sleep, before food has been taken. Persons 
who sleep with their mouths open generally 
have a dry tongue in consequence, but in 
most persons in health, the mouth should 
be pleasantly moist on awakening in the 
morning ; if it is the reverse, if the tongue 
is dry, or clammy, or viscid, and covered 
with fur, there is usually disorder of the 
digestive organs, permanent or temporary, 
from some indiscretion in food, and espe- 
cially in the use of stimulants. In feverish 
conditions of the system generally, the 
tongue is liable to become dry. The ap- 
pearance of the fur on the tongue varies 
greatly ; it may be thick and dirty-white, 
as it is in stomach and febrile disorders, 
and especially in sore-throat ; it may be a 
thin creamy-looking white, as in inflamma- 
tory disease within the abdomen ; or it may 
be yellow, as in biliary disorder. It may be 
patchy, as in scarlatina ; or, the centre and 
sides of the tongue being preternaturally 
red, as in some forms of intestinal irrita- 
tion, may contrast with the white fur in other 
parts. Further, the tongue may be morbidly 



clean and red also in intestinal irritation 
and in hemorrhage ; in the former case, 
perhaps, feeling sore as if scalded ; or the 
papillae may be elongated as in scarlatina. 
Again, partaking of the general anaemic 
condition of the system, the tongue may be 
pale, when it is also usually broad and flat, 
indicating general want of tone and flac- 
cidity of fibre. The motions of the tongue, 
moreover, when it is protruded, give a clue 
to the state of the nervous system espe- 
cially ; thus, in paralysis, it is drawn to one 
side ; in delirium tremens and nervous affec- 
tions, it is tremulous ; in the low stages of 
fever, it perhaps cannot be protruded at all. 

Such are a few indications afforded by the 
tongue. As the appearances in each parti- 
cular disease are adverted to under the in- 
dividual articles, it is unnecessary to pursue 
the subject here. 

TONICS — Are remedies which improve 
the health, muscular tone, or vigour of the 
system; many medicines, properly so called, 
possess this power, and are therefore classed 
as tonics ; but other means of health, both 
mental and physical, are included in the 
category. 

When an individual is in good health, the 
muscular fibre throughout the body, both 
voluntary and involuntary, possesses a cer- 
tain amount of tone, or "tonicity," the 
flesh feels firm, and the actions performed in 
obedience to the will are effected regularly 
and decidedly. When, on the other hand, 
the health becomes impaired, the muscles 
and fibres generally become "flabby and 
incapable of continued exertion, but are 
sometimes irritable with the tremulousnes3 
of debility." These changes in tone are 
most strikingly manifested in children, in 
whom they take place with great rapidity ; 
every mother and nurse is practically aware 
of the fact, and judges greatly — and rightly 
— of the health of her young charges, by 
the firmness of the flesh. The connection 
between a state of proper tone or the re- 
verse, with the actual physical condition of 
the muscular fibre, may be " demonstrated 
by detaching a muscle from the bodies of 
two animals in these opposite conditions, 
and ascertaining the strength by appending 
weights to it ; the muscle taken from the 
healthy animal, or that in a state of tone, 
will sustain a much greater weight than 
that which is in the opposite state." Tonics, 
therefore, are remedies which tend to cor 
rect the want of the tone above described, 
by exciting the reverse or tonic condition. 
In this way, food of particular kinds may 
be regarded as tonic. The "condition" of 
the horse, as all know, is a state in which 



TON 



544 



TOE 



the muscular power and endurance is aug- 
mented to a high pitch, by means of the 
stimulant power of dry corn food, in con- 
trast to the comparatively weak muscular 
tone which can be obtained from green food. 

Indeed, if the word tonic be taken in its 
widest sense, it would include a vast number 
of agents ; medically, however, it is used 
more restrictedly. 

The medicinal tonics may be classed 
as — 

Tonics which act indirectly, by first influ- 
encing the stomach, and increasing its di- 
gestive powers. 

Tonics which act directly by passing into 
and exerting their influence through the 
blood. 

The first, or the indirect or stomach tonics, 
are chiefly the vegetable bitters ; of these 
the most important, at least in a domestic 
point of view, are — 

Buckbean, Gentian, 

Columbo, Quassia, 

Chamomile, Salicine. 

Peruvian Bark, 

The second, or direct tonics, include 

Iron in its various preparations, and 

The Mineral Acids ; 
to which, perhaps, may be added the vege- 
table acids. 

The non-medicinal tonics are — 

Cold in its various forms and applications, 

Exercise, and 

Mental emotions of a pleasing and stimu- 
lating character. 

From the above it may be seen that the 
action of a tonic is of a stimulant or ex- 
citant character ; it is, however, distin- 
guished by its permanency, in contradis- 
tinction to the transient action of stimulants 
proper. In order, therefore, to insure the 
proper action of a tonic, it is requisite to 
administer it in small doses — which do not 
cause appreciable stimulation — but at short 
intervals, once, twice, or three times, ac- 
cording to circumstances, in the twenty- 
four hours. At the same time there is a 
limit to the use of tonics ; some, such as 
iron, if too long continued, are apt to occa- 
sion uncomfortable sensations in the head 
and elsewhere; and bitter tonics, if given 
regularly for a length of time, at last tend 
rather to weaken than to strengthen the di- 
gestive powers. On this account, it is to be 
feared, that the now fashionable "bitter 
beer," although a most excellent beverage 
and tonic in some states of the system, may, 
if taken too continuously, tend rather to mis- 
chief than benefit. As the employment of 
tonics in different affections and states of 
the body is entered into in the individual 



articles, it is unnecessary to pursue the 
subject further here. — Refer to Excitants. 

_ TONSILS. — Are the almond-shaped bodies 
situated on each side of the " fauces," (see 
Throat,) and between the folds or "pillars" 
of the soft palate. — See Palate. They are 
glands which secrete a mucous fluid. 

The tonsils are liable to inflammation, 
constituting "sore-throat," or quinsy. — See 
Sore-throat. They may also be the seat of 
ulcerations, and often become enlarged. In 
the former case (ulceration) astringent 
gargles may be used, and any disorder of 
the general health attended to. Enlarge- 
ment of the tonsils is a very common affec- 
tion, particularly in scrofulous constitutions, 
and may come on very early in life. When 
considerable, it may occasion some difficulty 
in swallowing, and always gives rise to 
thickness of speech; the subjects of it, too, 
are more than usually subject to attacks of 
Sore-throat, or quinsy. When the enlarge- 
ment is great, and causes much inconveni- 
ence, it is remedied by the simple and not 
very painful operation of slicing off the most 
prominent portion of each gland ; this of 
course must be done by a surgeon. When, 
however, the operation is not required, or is 
objected to, much may be done to reduce the 
size of the glands, by the persevering use of 
astringent gargles, (see Gargles,) [or by 
painting them occasionally with tincture of 
iodine,] and by attention to any deficiency, 
as want of tone in the general health. 

See Scrofula — Sore-throat — Debility, 
&c. 

TOOTH-ACHE.— See Teeth. 

TORMENTIL, or Tormentilla Officina- 
lis — is a plant native to England, and com- 
mon on moor-ground or hill pastures. It 
bears a small yellow flower, with four (rarely 
five) petals, and the stems are straggling. 
The root of the tormentil is so powerfully 
astringent that it is used in various places 
for tanning, and the same property gives it 
active remedial powers, which have been, 
perhaps, too much overlooked. There is no 
reason why tormentil should not be used in 
place of more expensive and farther fetched 
astringents. The root, which is the part 
used, is short and thick for the size of the 
plant ; dark brown externally, and reddish 
within. When powdered it is given in from 
half-drachm to drachm doses. The decoc- 
tion is made by boiling two ounces of the 
bruised root in thirty ounces of water, till 
it is reduced one-third, and straining. The 
dose of the decoction is an ounce and half. 
It may also be used as an astringent gargle 
or lotion. 

TORPOR.— See Debility, &q. 



TOT 



545 



TEA 



TOTAL ABSTINENCE.-See Stimulants. 

TOUS-LES-MOIS.— A substitute for ar- 
row-root, now imported into this country 
from the West Indies, where it is said to be 
equally esteemed with the latter for dietetic 
purposes. The starch granules are con- 
siderably larger than those of arrow-root. 

TOURNIQUET— From the French, to turn, 
is an instrument (fig. cxxxvii.) used by sur- 

Fig. cxxxvii. 




geons to stop the flow of blood in a limb 
during operations, or after accidents. For 
the latter purpose, the tourniquet might be 
found of great service in out-of-the-way 
places, and might well form an addition to 
the outfit of the emigrant. The instrument 
consists, essentially, of an upper and lower 
plate, (1 and 2,) which can be separated 
from each other by means of a strong screw, 
(3.) Connected with the plates are rollers, 
(4,4,) and through these rollers is run a 
strong band of webbing or other material, 
(5,) with a buckle (6) at one end, and a 
movable pad, (7.) When the tourniquet is 
applied, the band (5) is buckled round the 
limb, and the pad (7) is so adjusted as to 
press upon the course of the main vessel. — 
See Artery. A moment's consideration will 
make it evident how a turn of the screw (5) 
will, by shortening or lengthening the band 
round the limb, either tighten or relax the 
pressure exerted by the pad, (7,) and so 
control the flow of blood through any vessel 
over which the latter may be placed. The 
size of the pad may of course be increased 
if desirable. 

The above remarks will probably make 
evident the invaluable assistance which may 
be derived from the tourniquet, in cases of 
wound or accident. As, however, the in- 
strument may not be always forthcoming, it 
is to be borne in mind, that its principle of 
2 v2 S5 



application is pressure on the course of a 
bleeding vessel, by means of a pad, secured 
by a band round the limb, which can be 
tightened or relaxed at pleasure, and that 
these effects may be brought to bear by 
means of a pad of the first convenient ma- 
terial at hand — a folded stocking will do — a 
pocket-handkerchief tied round the limb, 
and a short stick to tighten the latter by 
twisting. Refer to Artery, Arterial Hemor- 
rhage. 

TOWN. — See Houses, Life, and the various 
articles referred to under Sanitary. 

TOXICOLOGY.— The study of poisons.— 
See Poisons. 

TRACHEA.— The windpipe.— See Lungs. 

TRAGACANTH GUM.— See Gum. 

TRAINING — Is a system which has been 
practised both in ancient and modern times, 
for bringing the animal body up to as high 
a pitch of health, tone, and muscular power 
as possible. If the ulterior purposes for 
which training is practised in these days are 
neither desirable nor elevated, the system 
itself, and the effects of it, are worthy of 
attention as bearing upon the subject of 
health and development. Of course, those 
in whom great muscular power is desired 
as the result of training, must possess at 
first some amount of constitutional vigour, 
good assimilative powers, and be free from 
disease, or even disorder of a temporary 
nature ; if the latter should exist, it must 
be removed by medicine or otherwise. 

The body being in good health, the object 
in training must be to get as much food 
as possible, containing "albuminous prin- 
ciples," well assimilated, (see Food,) that is 
to say, although saccharine and vegetable 
substances must be taken in sufficient 
though small proportion to maintain health, 
it is upon the animal muscular fibre, that 
of beef or mutton especially, and also upon 
the dry farinacea, such as bread, on which 
reliance must be placed to supply the albu- 
minous or plastic elements of muscular de- 
velopment and power. Animal food, there- 
fore, (beef and mutton especially, as being 
most easily digested,) must be freely al- 
lowed, and must, moreover, be well digested. 
In order to insure proper assimilation and 
health, coincident with the consumption of 
a large allowance of animal food, abundant 
exercise is absolutely requisite. This, it is 
true, must exhaust a greater amount of 
muscular tissue than if the individual kept 
at rest ; but by the stimulus it imparts to 
all the functions, and to those of digestion 
and circulation in particular, it seems to 
confer the* power of assimilating strong 
nourishment in greater proportion than is 



TKA 



546 



TRO 



requisite to repair the loss by the waste 
arising from increased muscular movement. 
Thus, there are the two first principles of 
training, the healthy assimilation of abun- 
dant strong nourishment — lean animal food 
— and the working up, so to speak, of that 
nourishment into the system by the aid of 
regular exercise, not carried to that stage 
of excess in which the stomach and other 
assimilative organs partake of the exhaus- 
tion, and fail in their functions. In order, 
however, that the assimilative processes 
may work to full advantage, the other func- 
tions must be in healthy working order ; the 
capacity of the lungs should be good where 
great strength is required, and the air drawn 
in pure and dry ; the skin should be clear of 
all impediments to its important fulfilments ; 
sleep should be sufficient to thoroughly re- 
cruit the frame, (see Sleep,) and should be 
taken on a tolerably hard bed, with light 
covering, which will not tend to cause per- 
spiration, or to relax. Much fluid is to be 
avoided, and if stimulants are taken, table 
beer is perhaps the best ; wine, mingled 
with water, next ; but spirits never. As 
above stated, where muscular development 
is the object, animal food, with bread, must 
be the staple ; vegetables being used only 
in sufficient quantity to preserve health; 
but all puddings, pastry, or soft food of any 
kind, is incompatible with the end in view. 

In fact, training, being the endeavour to 
bring the physical power and endurance up 
to the highest possible pitch, is a system of 
hygiene, from which all may derive informa- 
tion respecting the management and im- 
provement of health, without their object 
being the cultivation of brute force. 

It must not, however, be imagined that 
it is laid down as a principle, that animal 
food in large quantity, or even at all, is ab- 
solutely requisite for the development of 
great muscular power: this experience tells 
us it is not. Some of the most powerful 
and hardy nations of old subsisted solely 
on vegetable food, and many modern tribes, 
noted for strength and endurance, do so. 
These facts, and many others which might 
be cited, prove that great muscular power 
is quite compatible with a vegetable diet, 
if combined with habitual muscular exertion. 
There can be no question, however, that by 
means of animal food, the system may be 
more quickly worked up to a state of high 
tone and condition, but for temporary pur- 
poses only ; the state is one, in fact, of arti- 
ficial excitement, and cannot be maintained 
for any great length of time. 

Refer to Food, $c. 

TRANCE.— Catalepsy.— See Catalepsy. 



TRAVELLING— Is both an excitant and 
a tonic, and, as a remedial measure, in some 
cases offers advantages by no other mode 
attainable. — See Recreation. Most persons, 
when undergoing continued travelling, suf- 
fer from slight irritable feverishness of the 
system, particularly if the usual rest be 
interfered with ; the effects of this are best 
counteracted by spare diet and avoidance 
of stimulants. Animal food, if taken at 
all, should be so sparingly ; and the best 
restorative — except, of course, in real de- 
bility, when wine is required — is a cup of 
tea or coffee. A warm bath at about 92° is 
an excellent soother of the system after 
travelling. 

TREMOR, or Trembling — Is a symptom 
and accompaniment of nervous debility and 
exhaustion, as exemplified in those who 
exhaust the system by the abuse of ardent 
spirits. In some diseases, such as fever, 
the occurrence of tremor is a grave symp- 
tom, indicative of giving way of the vital 
power. 

Refer to Nervous — Delirium Tremens. 

TREPHINE. — A circular saw used by sur- 
geons, for removing portions of the skull. 

TROCAR — Is an instrument used for 
piercing cavities of the body, such as the 
abdomen or chest, for the purpose of giv- 
ing exit to fluid. The trocar is usually so 
fitted inside a metallic tube, or " canula," 
that when it pierces the body it carries the 
latter along with it ; the trocar being then 
withdrawn from the tube, leaves a clear 
passage for the fluid. 

TROCHES — Lozenges.— See Lozenge. 

TROPICS and TROPICAL DISEASES.— 
As might be expected, the forms and types 
of disease, which occur in hot, tropical cli- 
mates, are frequently very different from 
those which are met with in this and other 
temperate regions. Under articles, "Accli- 
mation," "Bile," "Cholera," "Dysentery," 
"Fever," "Heat," "Liver," &c. the reader 
will find information illustrative of the ef- 
fects of a residence in a warm climate 
upon the system ; to enter into the subject 
further, here, would answer no good pur- 
pose. The author would strongly advise 
all individuals about to proceed to a warm 
climate, to consult some medical man of 
repute — and there are many to be met with 
— who, from practical experience and re- 
sidence in such climates, is competent to 
advise upon the subject, and to point out, 
in writing, if possible, the peculiar causes 
and symptoms of disease to be guarded 
against and attended to. Beriberi is a 
disease attended with dropsical symptoms, 
which is almost peculiar to India. Bar* 



TRU 



547 



TUR 



biers, a disease which was at one time con- 
founded with the above, is also peculiar to 
the Indian coasts, but is accompanied with 
paralysis. Like many other tropical dis- 
eases, it is said to be induced by imprudent 
exposure to night air. 

TRUSS.— See Rupture. 

[In the United States, those who require 
a truss should go to a good surgeon, in pre- 
ference to those advertising quacks so often 
consulted.] 

TUBERCLE.— See Scrofula. 

TUMOUR.— A swelling of any kind, in the 
widest sense of the word, but the term is 
usually restricted to a permanent swelling. 
Tumours are met with in every situation in 
the body, and differ greatly in their charac- 
ters and tendencies. Of these, it would be 
perfectly impossible for inexperienced and 
unprofessional persons to judge ; as an inva- 
riable rule, therefore, whenever a tumour is 
discovered to exist, it should be submitted 
to the examination of a medical man with- 
out delay, and all rubbings and the like 
avoided ; they are not likely to do good, and 
may do much harm by irritating, and there- 
by causing increased growth. Tumours are 
dangerous from their nature, or from their 
situation. In some parts of the body simple, 
unmalignant tumours may attain a very 
large— an enormous — size, without threat- 
ening life, or, indeed," causing inconveni- 
ence, except from their bulk. Rapid and 
great increase of bulk is most usual in tu- 
mours which are pendent. Of all tumours, 
those of a malignant or cancerous nature 
are most dreaded, and generally cause the 
most pain. — See Cancer. 

A tumour, however, may give rise to many 
painful symptoms, particularly if its growth 
be rapid, simply from the stretching of the 
parts around it, or of the nerves which pass 
over it ; this often occurs in tumour in the 
neck. 

If, after a tumour has been discovered, 
any delay must necessarily arise before it 
can be examined by a medical man, and 
if it exhibits signs of irritation or inflam- 
mation, the best remedies are perfect rest, 
low diet free from stimulants, the regula- 
tion of the bowels, and the application of 
cloths wet with cold or tepid water, or, if 
need be, of a few leeches. If a tumour is 
inconvenient from its weight, it should be 
supported. 

Refer to Cancer — Cyst — Swelling, Sj-c. 

TUNBRIDGE WELLS— "Is one of the 
most agreeable summer retreats in England." 
"But it is in the absence of humidity, as 
deduced from hydrometric observations, the 
rain-gauge, &c, that the climate of Tun- 



bridge Wells surpasses that of most places;" 
"its true distinctive character and pre- 
eminence ' consisting' in the momentous ele- 
ment of atmospheric dryness." The nature 
and medicinal qualities of the Tunbridge 
Wells mineral spring are well calculated to 
aid this very salubrious property of the air, 
as it holds iron in solution in its purest 
and simplest state of combination, that of 
a carbonate, with very little other foreign 
ingredient, and with a sufficient quantity 
of carbonic gas to render it a grateful and 
wholesome stimulant to the stomach. The 
water from this spring proves highly bene- 
ficial in all cases of simple debility, and in 
such debility as is complicated with sluggish 
movements in the glandular system, where 
no inflammatory action or serious obstruc- 
tions exist. 

"People troubled with any fulness about the 
head should avoid Tunbridge or its wells."* 

Refer to Chalybcatcs — Iron, Jfc. 

TURMERIC — Is procured from the root 
of a plant — the Curcuma longa — cultivated in 
Hindostan, China, &c. It is usually sold in 
powder of a dark lemon-yellow colour. Tur- 
meric is awarm aromatic, and is used chiefly 
for its colour, and as a condiment, especially 
in the formation of curry powder. 

TURN of LIFE.— See Menstruation. 

TURPENTINE— Of various kinds, is an 
exudation, chiefly from different species of, 
pines. Common turpentine is the fluid re- 
sinous exudation from the Finns sylvestris, or 
Scotch fir, and others of the pine tribe. 
From this the volatile oil of turpentine, or 
" spirits of turpentine," as it is often called, 
is obtained by distillation, the dry substance 
which remains constituting resin. — See Re- 
sin. Oil or spirits of turpentine is a valu- 
able remedy, either externally or internally. 
In the former case, if applied to the skin, 
by means of cloths soaked in it, it is a pow- 
erful counter-rrritant, acting like mustard, 
and sometimes even blistering. It js often 
employed for purposes of counter-irritation 
in inflammatory diseases in the abdomen. 
When thus used, it should be warmed by 
placing the pot or bottle containing the 
turpentine in hot water. In rheumatic af- 
fections, lumbago, sciatica, &c, turpentine 
is a valuable addition to liniments. One 
part to two of the ordinary soap liniment 
may be used. As an external application 
in bmms, turpentine has been much used. — 
See Burns. 

Internally, in small doses, turpentine acts 
chiefly upon the kidneys, increasing the 
flow of urine considerably, and giving it at 

* Lee's Baths of England. 



TUR 



548 



ULC 



the same time the odour of sweet violets. 
In larger doses, turpentine acts as a purga- 
tive, and has been chiefly used in this way 
in half-ounce doses, combined with an equal 
portion of castor-oil, to destroy and carry off 
worms in the intestinal canal. — See Worms. 
As an internal remedy in rheumatic cases, 
turpentine often proves of much service, in 
fifteen-drop doses given twice or three times 
a day in milk. It may also be given in simi- 
lar doses in cases of hemorrhage, as from the 
bowels, or in purpura. — See Purpura. 

When a large dose of turpentine is taken 
internally, it is apt to cause sickness, with 
a feeling of giddiness resembling intoxica- 
tion ; after this it usually purges freely, 
especially if combined with another purga- 
tive, such as castor-oil. If the purgative 
action of turpentine is not freely developed, 
it will, in some persons, affect the kidneys 
severely, causing symptoms of strangury, 
similar to those which occasionally follow a 
blister, and to be alleviated in the same 
way. — See Blister. 

Various methods of taking oil of turpen- 
tine are recommended, one of the most usual 
being that of emulsion, made with the yolk 
of one egg for every two drachms of the oil, 
and distilled or soft water. The author 
generally gives it and finds it well taken in 
milk, the oil being added to the milk just 
before it is swallowed. 

As an addition to clysters in stoppage of 
the bowels, in worms, &c, turpentine is fre- 
quently used in the proportion of from half 
an ounce to an ounce and a half to the pint 
of gruel or barley-water. After turpentine 
has been used in a clyster instrument, the 
latter should be well cleansed by warm soap- 
water being passed through it. 

Refer to Clyster, fyc. 

TURNIPS.— The turnip belongs to the 
cruciferous plants, or mustard tribes. It is 
nutritious, containing vegetable albumen 
and fibrine in considerable proportion, and 
also saccharine matters ; these, however, 
are combined with much water. The turnip 
is somewhat laxative and diuretic ; it is, 
however, liable to disagree and cause flatu- 
lence in persons of weak digestion. A turnip 
poultice is sometimes used, but is disagree- 
able from its smell. 

TYMPANITIS— Is Unusual distension of 
the stomach and intestines with gas. This 
is apt to occur in fever and in acute inflam- 
mation within the abdomen. In such cases 
it is a symptom which must often be seri- 
ously regarded. Tympanitis, however, some- 
times occurs as a chronic affection. In any 
case, it may proceed to a great extent, dis- 
tending enormously the whole abdomen and 



impeding the breathing. Clysters of assa- 
foetida, rue, turpentine, or other stimulant 
aromatics give relief; and aromatics, sal- 
volatile, tincture of cardamoms, &c, are 
often given internally, but many cases de- 
rive more benefit from the mineral acids. 

Refer to Clyster — Rue — Mineral Acids. 

TYMPANUM.— See Ear. 

TYPE of a DISEASE— Is the combina- 
nation of characteristic, prominent symp- 
toms, which mark all the cases of a prevail- 
ing disease, such as fever, &c. 

TYPHUS.— See Fever. 

ULCER and ULCERATION.— An ulcer is 
a sore which discharges matter, and which 
arises from loss of substance, or separation 
of continuity in any of the living structures. 
When a wound, instead of healing up at 
once " by the first intention," remains open, 
discharges healthy pus or matter, and pre- 
sents upon the surface small red points or 
granulations, it is a specimen of a healthy 
ulcer, or one tending to heal. But though 
ulcers, whether healthy or the reverse, may 
be the result of external violence or wound, 
they more generally take their origin in 
causes from within ; they depend upon some 
constitutional or bodily cause, usually one 
which produces debility of circulation, gene- 
ral or local: as a consequence, the. nutri- 
tion of these tissues dependent on healthy 
circulation is interfered with, and the pro- 
cess of absorption which is ever going on 
within the body, (see Absorbents,) by remov- 
ing the tissues more rapidly than the loss 
can be supplied, gives rise to loss of sub- 
stance or ulceration. At least this is one 
of the explanations given of the nature of 
the process. Ulceration may occur both 
within and on the surface of the body ; 
under article "Bone," caries was described 
as an ulceration of bone. Ulcers also oc- 
cur in the mouth and throat, and, indeed, 
on any portion of the membrane lining 
either the respiratory or digestive passages. 
Respecting these forms of ulceration what- 
ever is requisite has been entered into in 
other articles ; in this place, external ulce- 
ration of the skin is only treated of. 

Ulcers may occur on any portion of the 
surface, but their most frequent site, out of 
all proportion, is upon the legs, and upon 
the left oftener than upon the right : they 
are moreover much more common in the 
aged than in the young. If it be borne in 
mind what was said about the dependence 
of ulcers upon impaired efficiency of the 
circulation in a part, the reason for their 
occurrence on the lower extremities will be 
obvious, when it is reflected how far these 



ULC 



549 



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members are removed from the centre of the 
circulating power, and how greatly the re- 
turn of the blood upward must be inter- 
fered with by the influence of gravity. The 
upward flow of the blood (see Veins) is pro- 
moted by a variety of agents, and is greatly 
assisted by the valves with which the veins 
are provided. When these valves, as they 
often do, become deficient or useless, the 
important uses they subserved become ob- 
vious ; the veins of the leg are now exposed 
to the full weight of the column of blood 
above, no longer supported by the valves, 
and they become tortuous and swollen, or 
as it is called, "varicose." — See Veins. In 
this condition of the veins there exists the 
commonest cause of ulcer : the blood in the 
large veins being retarded, reacts upon the 
circulation in the smaller, or "capillary" 
branches, and sooner or later ulceration is 
the result. This ulceration may arise spon- 
taneously, without obvious cause, but very 
often it is determined by some slight injury; 
a scratch, a bruise, or an abrasion causes 
slight inflammation, and gives the first start 
to the ulcerative process, which extends 
with greater or less rapidity, according to 
circumstances, and gives rise to ulcers pre- 
senting very different appearances. Into 
the minutiae of these appearances it would 
be useless to enter here; some ulcers pre- 
sent an angry, inflamed appearance, with a 
blush of inflammation extending for a con- 
siderable distance around ; some are sur- 
rounded with hard swelling, without much 
apparent inflammation, and the sore ap- 
pears to lie deep, surrounded by thick edges. 
In some the surface of the sore seems glazed 
and smooth, in others the granulations are 
large, prominent, and pale, constituting what 
is called proud flesh. Some of the sores 
are but little felt, others are intensely pain- 
ful and irritable. Although it has been 
said that a large proportion of ulcers de- 
pend upon a "varicose" condition of the 
veins, all do not ; many are occasioned by 
constitutional or other causes. Indeed, the 
existence and appearance of an ulcer will 
often afford to a medical man a good index 
to the state of the system generally. 

There are cases of ulceration which re- 
quire all the skill and patience which a me- 
dical man can bring to bear upon their 
treatment, and where an ulcer is continued, 
and appears to extend, it should always be 
placed under proper medical superintend- 
ence. There are, however, certain general 
rules of management which may be adopted 
with advantage by unprofessional persons, 
either in their own persons or on those of 
others. 



The great requisite in the treatment of 
ulcers of the lower extremity is rest, and 
rest in bed, or at least in the horizontal pos- 
ture, so that the circulation of the affected 
limb may become properly balanced. It is 
often surprising how quickly, under this 
proceeding alone, and without other treat- 
ment, the swelling around an ulcer subsides, 
and the sore itself alters to a more healthy 
character. Indeed, there are cases which 
only require rest to get well. In many cases, 
however, especially of old standing, further 
treatment is requisite. If there is angry- 
looking inflammation and a foul sore, the 
one has to be subdued and the other cleansed, 
in the first instance by poultices continued 
for two or three days, after which water- 
dressing (see Dressing) may be substituted, 
and if the ulcer improves under its use, 
continue till the cure is complete. It may 
be necessary, however, if the surface of the 
ulcer appears pale, and the granulations 
large and flabby, to substitute for the water 
an astringent lotion of lead, zinc, or tincture 
of myrrh, or to touch the surface of the 
sore lightly with lunar-caustic, or sulphate 
of copper or blue-stone. These liquid dress- 
ings of water or lotion are far preferable 
in every way to ointments. It is desirable, 
even while the patient is confined to bed, 
to support the limb and retain the dressings 
by means of a roller bandage applied from 
the toes upward ; and this is especially re- 
quisite if, or when, the rest of the recum- 
bent posture is abandoned. In many cases 
of ulcer, however, it occurs that rest cannot 
possibly be taken ; in such, the treatment 
by strapping with plaster, and by the use 
of a supporting well applied bandage, offers 
the most benefit, and best chance of cure ; 
even in these cases, however, it is desirable 
if possible, to procure the subsidence of the 
inflammation and swelling by a few days' 
rest. When strapping is used, the leg ought 
in the first instance to be well washed, and 
the hairs shaved off ; a roller bandage (see 
Bandage, fig. ix.) is then to be applied from 
the toes to a little below the sore. Strips 
of plaster rather more than an inch broad, 
and long enough to go once and a third 
round the limb, as shown in the figure on 
the following page, (cxxxviii. 1,) are then 
applied, piece by piece, each one overlapping 
the preceding, from an inch below to an 
inch above the sore. The mode of applica- 
tion is this : — The strip being heated, its 
centre is applied to the side of the limb op- 
posite the sore, and the ends are brought 
round to overlap as represented, care be- 
ing taken in the application of both strap- 
ping and bandage, that they lie evenly, so 



ULC 



550 



UKI 



Fig. cxxxviii. 




as to afford equable and sufficient support 
to the limb, and especially to the veins. 
With such a dressing as the above, an indi- 
vidual may be permitted to take a consider- 
able amount of exercise. [Many cures 
have been accomplished by it.] The dress- 
ing will require changing every two, three, 
or four days, according to circumstances ; 
if the discharge is very profuse, it is well 
to cut a piece out of the plaster directly 
over the sore. [Or pour cold water over it 
daily, and then dry the limb with a towel.] 
Diachylon plaster is commonly used for 
strapping, but for irritable skins soap plas- 
ter is preferable ; in some cases even this 
cannot be borne. Of course these rules as 
to position, support, &c, apply more espe- 
cially to ulcers situated on the lower ex- 
tremities. When an ulcer appears to depend 
on any particular derangement of the ge- 
neral health, the latter should be attended 
to ; the bowels especially must be kept un- 
loaded, the contrary condition tending 
greatly to cause and keep up the varicose 
condition of the veins. In the aged, in 
whom the functions and circulation gene- 
rally are torpid, much benefit often results 
from the use of moderate doses of opium — 
this is a point, however, which ought to be 
regulated by a medical man. 

In some cases, in which an ulcer has been 
in existence so long that it has become as 
it were an established excretory outlet for 
the system, it cannot be healed up without 
danger of some other disease, such as apo- 
plexy, &c. supervening. As circumstances 
may, however, render the healing of even 
an old sore both safe and desirable, a me- 
dical man should be consulted. Serious 
accidents occasionally occur in consequence 
of an ulcer on the leg opening into one of 
the veins. When this occurs, a large, or 
even fatal quantity of blood may be lost in 
a short time, unless the individual, or some 
other, has sense enoughto elevate the limb 
above the level of the body. — See Hemor- 



rhage, Veins, §c. In dressing ulcers, the 
mistake is often committed of being too 
assiduous in cleansing their surface, wash- 
ing off the pus or matter which lies upon 
it, and which in some measure is a protec- 
tion against irritation. This should not be 
done. The pain of an ulcer underneath 
either bandage, or plaster and bandage, 
may often be alleviated by simply soaking 
the dressings with cold or tepid water, with- 
out removing them. 

Refer to Bandages — Veins, Sfc. 

UMBILICUS.— The navel.— See Childbed 
— Children — Rupture, §c. 

URETER.— The tube which conveys the 
urine from the kidney into the bladder. — 
See Kidney. 

URETHRA — Is the passage of the urine 
from the bladder.; — See Bladder. This 
passage is liable to be affected in various 
ways, especially in males. Sometimes it is 
injured by violence ; at others, small stones, 
or calculi, are apt to be impacted in it, and 
cause much suffering. — See Urine. The most 
frequent affection, however, of the urethra, 
is stricture, or diminution of its calibre. 
This painful disorder in males generally 
takes its origin from diseases contracted in 
the irregularities of early life, especially, 
but may continue to afflict (or punish) 
even in old age. Stricture is, of course, of 
every degree, but sometimes proceeds so far 
as to occasion complete impediment to the 
discharge of urine, causing much distress 
and suffering, and requiring the instru- 
mental interference of the surgeon. — See 
Catheter. If there is any necessary delay 
in procuring assistance, the measures re- 
commended in article Bladder — Stoppage of 
Urine — will give relief in the mean while. 
In this disease, as well as in others which 
affect the urinary organs, it is again re- 
peated, avoid the quacks. 

URINE. — This most important excretion, 
is purely an excretion; that is to say, it 
does not, after its formation, fulfil any pur- 
pose connected with the living system, be- 
fore it is thrown out of the body ; in this 
respect, differing from such an excretion as 
the bile, which, although it is constituted 
of elements filtered off from the blood, to 
the purification of the vital fluid, yet, cer- 
tainly fulfils important ends in the digestive 
processes, and, if Liebig be correct, in the 
development of animal heat also. 

The minute structural arrangements in 
the kidney, whereby the secretion of the 
urine from the blood is effected, have 
already been sufficiently entered into. To 
article " Kidney" the reader is referred. 

The urine being separated or "secreted," 






URI 



551 



URI 



solely from the blood, and being thrown out 
without serving any purpose in the living 
economy, must, by simple reasoning, be 
supposed to contain ingredients from which 
the body ought necessarily to be freed, and 
which could not be retained without injury. 
Such proves to be the case, for, complete 
suppression of the secretion cannot con- 
tinue above a few hours without symptoms 
of narcotic poisoning being developed, and 
death ensuing, if the function be not re- 
stored. Urine consists of water holding in 
solution certain animal principles and a 
proportion of saline constituents. The 
principal and most characteristic ingredient 
of the urine, however, is its urea, a body 
which acts as a base to, or combines with 
acids. It is the retention of this compound 
in the blood which causes the symptoms of 
narcotic poisoning already alluded to, when 
the urinary secretion is suppressed. Above 
half an ounce, on the average, of urea is 
excreted in the urine of an adult in the 
twenty-four hours ; but in some cases, when 
rapid emaciation goes on, the proportion is 
greater, the urea being in fact a product 
formed from the used-up tissues of the body. 
Next in importance to the urea of the 
urine is its peculiar acid, generally known 
as uric or lithic acid. It js this acid, which, 
when in excess, constitutes the yellow or 
red crystalline gravel, or " sand," which is 
so frequent in many persons. This acid 
exists partly in combination with ammonia, 
forming what is known as the "lithate," or 
"urate of ammonia." 

In addition to these two principal and 
characteristic constituents, urine contains 
various animal and colouring matters, also 
muriatic, sulphuric, and phosphoric acids, 
in combination with lime, magnesia, and 
soda, all these being derived from the blood. 
Further, there is always mixed with the 
urine a certain proportion of " mucus" 
derived from the bladder and urinary pas- 
sages. Moreover, other ingredients, not 
natural to it, are apt to be intruded into 
this fluid, such as the albumen of the blood, 
or blood itself, pus or matter, oxalic acid, 
&c. The average quantity of urine secreted 
by the kidneys of a healthy man in the 
twenty-four hours is from thirty-five to 
forty ounces, containing from six to seven 
hundred grains of solid matter. Both fluid 
and solid matters, as already stated, are de- 
rived solely from the blood ; not, however, 
we have every reason to believe, from the 
healthy constituents of the blood, but from 
those which have become " effete," which, 
having served their purpose in the economy, 
have been taken into the current of the cir- 



culation, probably, for the sole purpose of 
being brought under the power of the ex- 
creting organs. Not only, however, do the 
kidneys separate the used-up materials 
which have formed part of the organized 
frame — they also lay hold of, so to speak, 
and throw out from the blood, many ill- 
digested and useless matters which have 
been derived from the food. 

From the above account of the sources of 
the urine constituents, it cannot excite sur- 
prise to find the fluid varying, as all know 
it does, at different times. Even within the 
limits of health, the variations are regular, 
almost periodic. Thus, after a fluid meal, 
such as breakfast, or after much fluid has 
been taken, the kidneys secrete largely, the 
urine is plentiful, but generally pale in 
colour — it is the urine from fluids. Again, 
after a solid meal, such as dinner, the urine 
is less abundant, it is darker in colour, and 
probably has the odour of some ingredient 
of the previous meal — this is the urine of 
solids. Lastly, if no heavy meal has been 
taken just before retiring to rest, the urine 
is probably a mean between that of the fluids 
and that of the solids— -it is the urine of the 
blood, and, being less likely to be influenced 
either by solids or fluids which have been 
taken into the system, affords the best index, 
as far as the urine is concerned, of the bodily 
condition. This is the reason why the 
"morning urine" is so often examined, in 
preference to that passed during other pe- 
riods of the twenty-four hours. Although 
exposed to the above sources of variation, 
urine, if perfectly healthy, ought to be 
transparent, not only when passed, but 
when it becomes cool, a just perceptible 
cloud, composed of healthy mucus, being 
only visible at the bottom of the vessel. The 
colour ought not to be too dark, and the fluid 
should be acid when examined by means of 
litmus. The specific gravity ought not to 
vary greatly from the healthy average of 
1-018 — that is to say, for any length of time, 
or except from some obvious cause. In hot 
weather, in this climate, and in hot climates 
generally, when the action of the skin is 
so much increased, it, of course, leaves less 
fluid to be drained from the blood by the 
kidneys ; and as the solids to be carried off 
by these glands still remain the same, or 
nearly so, the specific gravity of the smaller 
amount of fluid must be proportionally in- 
creased. Here we have an obvious cause for 
the change, no less obvious than that which 
gives a large quantity of pale urine of low 
gravity if an individual indulges in fluids. 
Further, we know that nervous individuals, 
of both sexes, and especially hysterical fe- 



URI 



552 



um 



males, will occasionally secrete very large 
quantities of colourless urine. Such varia- 
tions, therefore, cannot be considered to be 
the result of disease, but when permanent 
increase or diminution of the quantity of 
urine (see Diabetes — Dropsy — BrighCs Dis- 
ease) occurs, without being accounted for, 
and especially if symptoms of constitutional 
disorder or debility, or of dropsy, show 
themselves, a medical man should at once 
be consulted. ' 

Perhaps the most common disorder to 
which the urine is liable, is excess of its 
usual constituents, the lithic or uric acid. 
That is, in such excess, that instead of re- 
maining dissolved, as in healthy urine, it 
becomes "precipitated;" in other words, 
there is so much of it that the urine cannot 
hold it dissolved. Thus, uric acid may 
exist uncombined, in which case it is depo- 
sited in the form of crystalline sand, of a 
yellow or red hue ; very commonly, however, 
it exists in the combination with ammonia, 
as a "urate of ammonia," in which case it 
does not crystallize, but takes the form of a 
cloudy precipitate. This urate of ammonia 
forms the fawn-coloured sediment, with 
which most are familiar, as a consequence 
of a chill or of a common cold. It also as- 
sumes a pink, sometimes a deep red or pur- 
ple hue, especially in affections of the liver ; 
indeed, whatever colouring-matter exists in 
the urine, the urate seems to attract it 
strongly. Urate of ammonia is extremely 
soluble in warm water or urine, and much 
less so in cold, so that, although when the 
urine is passed, it may contain it abundantly, 
the secretion is perfectly transparent, and 
it is only as it cools, and can no longer hold 
the urate in solution, that the latter becomes 
visible. This excess of lithic 'acid, alone or 
combined, in the urine, may arise from a 
variety of causes. One of the most frequent 
temporary occasions of it is suppressed per- 
spiration. The skin is constantly excreting 
acid (lactic acid) along with the perspira- 
tion, so that when the latter is checked, the 
acid is thrown back upon the system. Here 
the wonderful power by which one organ 
"compensates" for the deficiencies of an- 
other, is brought into action : the kidneys 
assume in some measure the office of the 
temporarily disordered skin, and cast out 
the acid, not as lactic, but as uric acid, from 
the system. Another frequent cause of 
excess of uric acid is the introduction of 
injurious (probably often lactic) acid into 
the system in food or drinks. The malt 
liquors, especially when in the least "hard," 
or old and acid, are most fertile sources of 
uric acid, from which brewery-men and 



labourers, who often drink largely of old 
and acid beer, are extremely apt to suffer. 
—See Ale. A third source of uric acid, or 
red or pink gravel, is disorder of the digestive 
organs, especially if too full a diet of ani- 
mal food, be indulged in. There are other 
causes of uric acid excess, such as extra 
fatigue, especially if it gives rise to feverish- 
ness, &c. Moreover, uric acid may exist 
in excess in the blood, and yet may not be 
manifested in the urine ; such is the case in 
gout. — See Gout. 

The white sand or gravel is by no means 
so common as the red, and is usually con- 
nected with an alkaline condition of the 
urine ; it, and indeed the white sediments 
generally, are more usually met with in the 
aged, and in states of debility. Oxalic acid 
occurs frequently in the urine of dyspeptic 
persons, but may be occasioned by food 
which contains the acid naturally, such as 
rhubarb. Its presence cannot be detected 
without the aid of the microscope. Albu- 
men in the urine has been already alluded 
to. — See Brighfs Disease. Blood may occur 
in the urine in small quantity, giving the 
fluid merely a dark smoky tinge, or it may 
be discharged in large quantity as nearly 
pure blood. In some cases, matter and 
thick glairy mucus are discharged with the 
urine. In pregnancy, occasionally, a thin 
creamy-like scum forms on the urine, if it 
be allowed to stand for a day or two. De- 
viations from the healthy character of the 
urine are important, first, as indicative of 
deranged states of the system ; and, second, 
from their own local effects. Some indivi- 
duals are much more liable to have the urine 
disordered than others, but in none can the 
condition be permitted to continue without 
risk, nor ought it to be without the cause 
being investigated. Such temporary dis- 
orders as that produced by cold are in 
themselves comparatively unimportant, and 
the best remedy is to restore the functions 
of the skin by warm baths, diaphoretics, &c. 

When red, or pink, or fawn-coloured gra- 
vel appears to be permanent, and to be con- 
nected with derangement of the digestive 
organs, the symptoms should not be neg- 
lected. If food has been taken at all in 
excess, it should be reduced, and the allow- 
ance of animal food especially, moderated, 
malt liquor of every kind being sedulously 
avoided. If stimulants are necessary, a little 
sound sherry, or brandy, or gin with water 
are the best. Exercise should be taken 
freely, but not to exhaust ; the skin should 
be well cared for by frequent ablution. As 
regards medicine, the alkalies at once natu- 
rally suggest themselves as remedies, and 



URI 



553 



URI 



most valuable they are, (see Potash — Soda ;) 
they quickly cause the acid to disappear, 
and were the disappearance of the acid all 
that is required, they alone might suffice ; 
but the cause of the gravel, especially of the 
pink variety, is generally some derangement 
of the digestive processes, which must be 
rectified if permanent amendment is desired. 
On this account, the safest plan is to con- 
sult a medical man on the subject; but if 
this is not done, some one of the tonic bit- 
ters should be combined with the alkalies ; 
in fact, the digestive organs should be at- 
tended to as recommended in article "In- 
digestion." 

One caution is here requisite. Persons 
who have been the subject of red gravel 
are very apt to continue too long the use 
of alkaline remedies, and thus seriously to 
injure the constitution and the digestive 
powers, and in the end to induce a perma- 
nent alkaline condition of the urine, which 
is a more serious and intractable malady 
than the opposite acid state. The presence 
of white gravel is often so indicative of 
serious disease, that as soon as its presence 
is suspected, a medical man ought to be 
consulted. The tendency to its formation 
is frequently difficult to remove. One of 
the best remedies in alkaline urine is the 
nitro-muriatic acid ; it is likewise a most 
valuable remedy in the* oxalic acid urine. 
Oxalic acid is itself very soluble, but occurs 
in urine in a comparatively insoluble form, 
in combination with lime, in the shape, as 
seen under the microscope, of beautiful 
eight-sided crystals. This form of gravel 
is far from being uncommon, but when 
abundant and persistent, it is often asso- 
ciated with hypochondriac indigestion in the 
melancholic temperament. Whatever the 
form of the gravel, the skin and the digestive 
organs require especial attention. It is 
always desirable to keep the flow of urine 
free, and for this purpose sweet nitre, or 
infusion of broom or dandelion, are well 
adapted. Many find gin, used in modera- 
tion, of much service. When, however, the 
symptoms of gravel are constant, a medical 
man ought to be consulted, for it is not solely 
the immediate inconvenience which is to be 
obviated, but the liability of the gravel, 
whatever its nature, to accumulate, either 
in the kidney or bladder — in which case the 
result is either a most painful attack, a 
"fit of the gravel," or the formation of 
"stone." 

"A fit of the gravel" is caused by a small 

gravelly concretion, or stone, passing either 

from the kidney down the ureter into the 

bladder or through the passage — the ure- 

2 W 



thra — from the bladder ; in either case giv- 
ing rise to intense suffering. When the pas- 
sage is from the kidney to the bladder, the 
pain often comes on suddenly, is felt chiefly 
in the groins and down the thighs, some- 
times occasioning cramp ; it remits, and if 
pressure be made deep in the groin, there is 
tenderness. The symptoms of the passage 
of a small stone from the bladder are some- 
what similar, varied of course by situation ; 
there is often sickness and vomiting. In 
such cases, the best means of relief, till a 
medical man sees the case, are the warm 
bath, hip or general, and hot applications 
generally. Opiates in tolerably large doses, 
equal to twenty or thirty drops of the tinc- 
ture, are required at intervals to allay pain, 
given either by the mouth, or in warm clys- 
ters of tolerable bulk, which give relief by 
acting as an internal fomentation. Copious 
draughts of demulcent drinks, barley-water 
and the like, are advisable. Sweet spirits 
of nitre may be given, and if the acid is 
known to be red habitually, the alkalies will 
be useful. Solution of potash, in twenty- 
drop doses, is perhaps the best. Should 
great tenderness at the seat of pain come 
on, leeches may be required; but the above 
measures will suffice to give much relief, till 
the case is visited by a medical man. 

Stone, that is, a concretion of gravel so 
large that it cannot pass by the natural out- 
lets, may form either in the cavity of the 
kidney or in that of the bladder. This 
affection is more common either before pu- 
berty or after middle age. 

When a stone forms in the kidney, it gives 
rise to a constant sense of uneasiness, or of 
pain in the back and loins, extending down 
the thighs. These uneasy sensations are 
always aggravated by motion, especially 
that of riding, either on horseback or in a 
carriage, and after such exercise the urine 
is apt to be tinged more or less with blood, 
or to contain small blood-clots. When the 
pain is severe, sickness may be produced. 
The stone in the kidney may continue with- 
out change of situation, and with but little 
enlargement, for an indefinite time ; but if 
it descends into the ureter, it then gives 
rise to the painful symptoms, a fit of the 
gravel, above described. When a stone has 
descended into the bladder, the symptoms 
it occasions are in some respects similar to 
those caused by one lodged in the kidney, 
but are more severe. The calls to empty 
the bladder are increased in frequency, the 
attempt causes pain more or less, and the 
stream of urine is apt to be suddenly 
checked, probably by the stone falling 
against the opening. In such cases, if long 



UTE 



554 



YE I 



continued, the urine is apt to become loaded 
■with, thick mucus, or with pus or matter. 
The suspicion of such a malady as stone 
ought at once to he the signal for the case 
being properly examined. In the mean 
while, as little movement as possible should 
be made ; demulcents (see Demulcents) taken 
freely will be found useful ; and if there is 
much pain, it may be soothed by opiates, 
given either by the mouth or in the form of 
injection. 

Incontinence of urine in the aged, stop- 
page of the urine, and strangury are suffi- 
ciently entered into in article "Bladder," 
to which the reader is referred. 

Incontinence of urine in the young, wet- 
ting the bed, is frequently a most ^annoying 
habit, and one, moreover, which is often not 
to be overcome without much difficulty; it 
may even continue up to the time of pu- 
berty, or beyond it. Various methods of 
treatment are employed— nitrate of potash, 
saltpetre, given for some time to the amount 
of half a drachm in the twenty-four hours, 
to a child of seven or eight years of age, is 
said to be sometimes successful. The quan- 
tity may be given in three doses of ten 
grains each, dissolved in barley-water. Ben- 
zoic acid, in six-grain doses, in the form of 
pill, given twice a day, is used by some; the 
author has found the tincture of muriate of 
iron, "tincture of steel," answer well, in 
doses of ten drops, twice or thrice a day. 
This remedy is peculiarly adapted for 
weakly children. In all such cases it is 
extremely important that, without being 
purged, the bowels are kept lax. The quan- 
tity of fluid permitted should be kept at a 
medium, but the amount taken in the after- 
noon and evening must be curtailed as much 
as possible. In addition to the above reme- 
dies, either the cold douche to the lower part 
of the back, or the cold hip-bath at night 
or in the morning, whichever is found most 
beneficial, may be employed. 

Dribbling of urine, either in the aged or 
in those confined to bed by some continued 
and exhausting diseases, is a not unfrequent 
occurrence, which occasions much discom- 
fort both to the patient and others, in con- 
sequence of the offensive ammoniacal odour. 
This is best counteracted by bags filled with 
peat charcoal, when it can be procured, 
placed under the patient, or by bags of bran 
slightly moistened with diluted sulphuric 
acid. — See Sulphuric Acid. 

Refer to Urethra. 

UTERUS.— See Womb. 

UVAURSI. — Bear-berry is a low, creeping 
shrub, which grows in rocky heath ground 
throughout Northern Europe, including Bri- 



tain [as well as in the United States.] Its 
leaves, which are used in medicine for their 
astringent properties, are deep green in co- 
lour, somewhatresemble those of the box, but 
are thicker and more leathery. As an as- 
tringent, particularly in urinary affections, 
the uva ursi might be advantageously used 
in localities where it is found. The dose of 
the dried, powdered leaves is from ten to 
forty grains. The decoction is made with 
one ounce of the bruised leaves to one pint 
and a half of water, boiling down to a pint, 
the dose one and a half fluid ounces. 
UVULA.— See Palate— Throat, &c. 

VACCINATION.— See Cow-pox. 

VALERIAN.— The root of the Valeriana 
officinalis, or common valerian, is one of the 
most useful and generally used remedies in 
hysteria, and in spasmodic attacks generally. 
This plant grows commonly in England, usu- 
ally about moist hedge-bottoms, woods, &c, 
showing its heads of lilac-coloured flowers 
in the month of August. The root, which 
has a powerful peculiar odour, consists of a 
number of rootlets, about the thickness of a 
crowquill, which proceed from a central 
stock. Valerian is given internally in va- 
rious forms, but the preparation generally 
employed is the ammoniated tincture, in 
drachm or drachm and a half doses, in an 
ounce and a half of water ; this preparation 
ought to be purchased ready made. The 
common tincture, of which the dose is the 
same as the above, is made by macerating 
five ounces of the bruised root in two pints 
of proof spirit. The dose of the powdered 
root is half a drachm. [The fluid extract 
is also an excellent preparation. It may 
be given in doses of from thirty drops to a 
teaspoonful.] 

VALVES.— These mechanical agents are 
found connected with the circulating system. 

Refer to Heart — Veins. 

VAPOUR-BATH.— See Bath. 

VARIOLA — Small-Pox. — See Small- 
Pox. 

VEAL — Like young meats generally, is 
not so digestible as the flesh of the adult 
animal, but it is rendered more injurious to 
persons of weak digestion by the conven- • 
tional modes of cooking with melted butter, 
&c. The objection to veal, as invalid diet, 
does not extend to the broth made from it, 
which is often peculiarly adapted to the re- 
quirements of convalescence and illness, 
from the amount of gelatine it contains. 

VEGETABLES. — See Foon — Grains — 
and articles on individual vegetables. 

VEINS. — The veins are the vessels or 
membranous canals through which the blood 



VEI 



555 



VEI 



is conducted back to the heart (see Circu- 
lation) after it has passed through the capil- 
lary vessels, and been brought into intimate 
contact with the tissues of the body. While 
passing through the capillaries, the blood 
undergoes the change from arterial or red 
blood to venous or black, or rather dark 
purple blood. Its mode of progression is at 
the same time altered ; instead of the for- 
cible, intermittent propulsion which at- 
tended its passage through the arteries, it 
moves through the veins more equably, and 
without pulsation, except occasionally in 
the large veins of the neck. Its progress, 
however, is accelerated by muscular move- 
ments. Moreover, as the aggregate calibre 
of the branches of the veins distributed 
throughout the body is considerably greater 
than that of the large trunks into which the 
blood is collected as it approaches the 
heart, the current of the venous blood must 
be accelerated as it enters these large vessels. 
Like the arteries, the veins have three 
coats, an external or protective, an inner 
or lining, and a middle or fibrous. It 
is in the latter that the principal differ- 
ence as to thickness between the two sets 
of vessels principally exists, the middle 
coat of the vein wanting the elastic fibre 
of the artery ; consequently, when veins 
are emptied of their blood they become flat 
and collapsed, whereas arteries preserve 
their cylindrical form. A further differ- 
ence exists in the interior of the two vessels 
— the veins, particularly of the extremities, 
are furnished with valves, distributed at 
intervals. These valves are so arranged, 
that while they permit the free flow of the 
blood toward the heart, they do not permit 
its retrocedence. A moment's reflection 
will make evident how greatly this valvu- 
lar arrangement must assist the (for the 
most part upward) current of the blood in 
its return toward the heart; how great the 
inconvenience attendant upon its impaired 
efficiency will be shown presently. The 
veins generally are divided into those which 
lie deep and accompany the arteries, and 
into the superficial veins. The most im- 
portant of the latter, as far as a work like 
the present is concerned, are the external 
jugular veins of the neck, generally so evi- 
dent in thin people ; the veins at the bend 
of the arm, (see Blood-letting,) the veins of 
the lower extremity, and those of the rec- 
tum, the hemorrhoidal veins ; moreover, in 
addition to the veins properly so called, 
there are the venous sinuses. — See Sinus. 
"When a vein is wounded, either by accident 
or design, the blood flows from it in a con- 
tinuous stream, with much less force than 



from an artery, and dark in colour ; more- 
over, the bleeding from a vein is generally 
more easily arrested than it is from the 
elastic, muscular, arterial tube, assisted by 
the pulsation of the heart ; comparatively 
slight pressure by a pad, or otherwise, 
being sufficient to restrain the flow from 
the former. — See Hemorrhage. A wounded 
vein generally heals quickly, and the cur- 
rent of the blood through it is uninter- 
rupted. In order to arrest the flow of blood 
through an artery, it is necessary to make 
pressure between the bleeding point and 
the heart, or trunk of the body ; in the case 
of a vein, the reverse must be done. In 
almost all cases, however, in which it is 
desired to stop bleeding from a vein, press- 
ure directly over the wound is the best 
remedy. — See Ulcer — Varicose. 

Veins are liable to inflammation from 
wounds, from inflammation extending from 
the adjacent parts, &c. This is a most 
dangerous affection, and frequently resists 
the best-directed efforts of medical skill. 
The affected vessel is painful, feels hard, 
the skin covering it and the parts around 
are red and inflamed ; and there is much 
constitutional fever, which tends quickly 
to a low or typhoid form. The most that 
could be done by an unprofessional person 
in such a case would be to use repeated 
fomentations to the inflamed parts, and to 
administer from quarter to half grain doses 
of opium with two grain doses of calomel, 
every three, four, or five hours, according 
to circumstances, until the arrival of a me- 
dical man. 

A "varicose" condition of the veins is 
chiefly met with on the lower extremities. 
The affection consists, essentially, in the 
veins becoming elongated, so as to permit 
of their assuming a tortuous knotted condi- 
tion, while they are at the same time en- 
larged. The state is usually associated 
with obliteration or deficiency, more or less, 
of the valves within the veins, so that the 
weight of the entire superincumbent column 
of blood bears with distensive force upon 
the vessels, and upon those parts of them 
which are most dependent. The most fre- 
quent causes of the varicose veins are such 
as cause impediment to the upward flow of 
-the blood through the large veins of the ab- 
domen. In this way, pregnancy, if frequent, 
is a most common exciter of the condition: 
habitual costiveness, diseases of the liver, 
tumours of any kind within the abdomen, 
act in a similar manner. The truss worn 
on account of rupture, or garters too tightly 
tied, likewise excite the varicose condition, 
which is usually more common in persons 



YEN 



556 



VEN 



whose occupations require much standing, 
especially if they are of tall stature. The 
inconveniences which ultimately result from 
a varicose condition of the veins of the leg 
have been sufficiently pointed out under 
article "Ulcer." The causes of it, which 
have been just alluded to, naturally suggest 
the best means of alleviation and cure, that 
is, the removal as far as possible of all in- 
terruptions to the upward flow of the blood, 
and the horizontal posture of the body or 
limb. As these conditions, however, cannot 
in all probability be perfectly carried out, 
it is desirable that in all cases of varix the 
veins and limbs generally should be sup- 
ported by some one of the forms of elastic 
stocking : these can now be obtained at so 
moderate a price, that none need be without 
their valuable aid. It is often surprising 
how immediately the use of well-applied me- 
chanical support, such as the elastic stock- 
ing affords, removes the uneasy and painful 
sensations connected with the condition of 
the veins in question. Some individuals 
cannot, however, wear an elastic stocking 
of any kind ; for such cases, an elastic tape 
fixed to the foot by a stirrup, and wound 
spirally round the limb, has been success- 
fully employed. Spaces of about three 
inches being left between the spirals, each 
time the band crosses the vein, it acts like 
a valve. Other methods of curing varicose 
veins, such as tying, &c, are had recourse 
to by surgeons, but as long as sufficient 
comfort and relief can be obtained by the 
use of elastic supports, they are perhaps 
better avoided. 

VENEREAL.— See Syphilis. 

VENESECTION.— See Blood-Letting. 

VENISON.— The flesh of the deer, like 
that of other wild or hunted animals, is par- 
ticularly digestible, and is probably ren- 
dered more so by the custom of long keeping. 
In Dr. Beaumont's table of the digestibility 
of various articles of food, "venison-steak" 
is noted as taking but one hour and thirty- 
five minutes for digestion ; beef-steak being 
noted in the same table as requiring three 
hours. 
# VENTILATION— Is the renewal of the 
air contained in enclosed spaces. The ob- 
ject of the operation is to .provide in the first 
place for the escape or withdrawal of aifc 
which has become deteriorated from any 
cause, such as animal respiration ; and in 
the second to supply the place of the dete- 
riorated withdrawn air, by that which is 
fresh and pure. Under the head of ventila- 
tion, moreover, the heating and cooling of 
air may, perhaps, be included. Under such 
articles as Air, Aeration, Blood, Lungs, &c, 



the requirements of the animal constitution, 
which render a regular supply of pure air 
necessary for health, have been sufficiently 
entered into, and need not be repeated ; and 
under article Bedroom, information on the 
subject itself will be found — to these the 
reader is referred. The entire surface of 
earth is subject to a vast system of ventila- 
tion, effected by means of the currents of 
air, or winds, which are continually passing 
over it, especially by those which, like the 
" trade," and other winds, blow continu- 
ously in one direction for months together. 
In some respect ventilation is the neces- 
sity of a nation living in a variable and cool 
climate, and of a people who have attained 
proficiency in architecture, and particularly 
in domestic architecture. In hot climates, 
where the breezes from without are rather 
courted than shunned at all times, ventila- 
tion, except in the way of cooling, is un- 
called for as a systematic arrangement. In 
the ruder ages of our own country, when 
shuttered instead of glazed windows pre- 
vailed, and when buildings and fittings ge- 
nerally were defective, ventilation was abun- 
dantly, though unintentionally provided for, 
and especially as long as the wide, lofty 
chimney-place remained. — SeeChimney. But 
at length, when the art of building attained 
greater perfection, when doors and windows 
were made to fit tight and well, the ventila- 
tion was interfered with by the very perfec- 
tion of the work, and as practical, scientific 
knowledge of sanitary matters was but little 
diffused or cultivated, we have the fact of a 
community suffering evil in consequence of 
an art being more rapidly advanced than 
the practical science which ought neces- 
sarily to accompany it. Now, however, not 
only are scientific and professional men well 
aware of the necessity for providing proper 
ventilation of all enclosed places occupied by 
man or animals, but most educated people 
generally are alive to the fact, and have 
some idea at least of the principles on which 
the necessity is based. We cannot return 
to the old unintentional ventilation of badly 
built dwellings and old-fashioned chimneys, 
consequently, the desideratum has been to 
find those systems of ventilation which shall 
combine efficiency with comfort and economy, 
and which in many instances can be most 
easily adapted to buildings already con- 
structed, without reference to any plan of 
ventilation at all. Unfortunately, even of 
the public erections, liable as they are to be 
filled with living beings, there are too many 
destitute of any provision for renewing the 
air deteriorated by the breath and exhala- 
tions of the assembled crowds. Moreover, 



VEN 



557 



VEN 



in many instances where an attempt at ven- 
tilation is made, the unscientific mode of 
its execution and arrangements renders it 
abortive, or nearly so. Apertures may be 
made in walls or roofs, but without some 
method of renewing the air, they are com- 
paratively of but little use. Ventilation, 
that is movement of the air, may and is ef- 
fected in various ways. Bellows, which force' 
the air through the place to be ventilated, 
have been employed, but except in special 
cases they are not used; screen and fan 
ventilators to withdraw the air have also 
been constructed, but by far the most effi- 
cient and, in a country like Britain, gene- 
rally applicable ventilating agent, is heat. 
As heated air has a natural tendency to 
ascend, and as all air and vapour which 
passes off from the animal lungs or skin is 
heated, in obedience to the above law it 
ascends, and in doing so must leave space 
to be supplied by the surrounding cooler 
air. Such is the natural ventilation under 
which we all live; but to be efficient, it is 
evident that the air which supplies the place 
of the impure, warm, respired air which has 
ascended, must be pure also. If one or 
more persons are seated in a closed room, 
which has no exit for the air above the level 
of the nostrils and mouths of the occupiers, 
the heated air which has ascended can only 
accumulate above, thafis at the top of the 
room ; and as it gradually cools, being dis- 
placed by fresh supplies of warm air, it must 
necessarily descend to be rebreathed. In 
this way the circulation of the confined air 
goes on, every breath rendering it more de- 
teriorated and unfit to support animal life, 

Fi£. cxxxix. 




till at length, if the circumstances were con- 
tinued, life could not be supported at all. 
The first remedy for this state of things, 
2 w2 



which presents itself to the mind, is to make 
apertures in the roof above, to permit the 
bad air to escape, and when nothing else 
can be done, such a proceeding is better 
than no provision at all. Moreover, the 
efficiency of such apertures as ventilating 
agents may be considerably increased, by 
fitting them with a short tube of some kind, 
divided by a partition, so as to admit of a 
double current, one upward of heated, and 
another downward of cold fresh air. When 
there is both roof and ceiling to an apart- 
ment, (fig. cxxxix.,) the ventilation may be 
considerably assisted by "cowls" (fig. 
cxxxix. 1) fixed to the roof, so that the 
wind blowing through them may tend to 
draw off the air admitted into the space (2) 
from the apartment below by means of the 
apertures, (3, 3.) 

Dr. Boswell Keid found in his experi- 
ments, that cool air admitted into a crowded 

j room by the floor, was raised from ten to 
twenty degrees of heat before it reached the 

j heads of the people, solely by the heat of 
their bodies, evidently showing that this 
natural ventilation, as it may be called, if 
simply facilitated by openings in the roof 

j for the escape of the ascending impure and 

1 heated air, is capable to a certain extent of 
correcting the necessarily deteriorated at- 
mosphere of a crowded room. But even 
under the most advantageous circumstances, 
the effects- it can produce must be very in- 
ferior to thoae which result from the em- 
ployment of artificial heat, which, whenever 
it is in any way available, ought to be made 
an active agent in the processes of venti- 
lation. 

In mild climates, and in fine summer 
weather, open doors and windows are at 
once the readiest and best means of renew- 
ing the air of dwellings and other places; 
as these, however, cannot be available in 
cold weather, or during the night, it is ab- 
solutely requisite that sleeping and other 
apartments, in which no fire is burned, 
should be provided with some means for 
permitting the free admission of fresh, and 
exit of deteriorated air. These means, how-" 
ever, must necessarily vary with circum- 
stances, such as the relative situation of the 
apartment, its height, window, &c. They 
may be directed so as to accomplish the re- 
newal of the air in two distinct ways. The 
first, by providing for the escape of the im- 
pure air by openings in some portion of the 
walls, windows, or ceiling above the ordi- 
nary level of the head of an occupier, and 
for the admission of fresh air in such a man- 
ner that no injurious current or draught is 
established. 



VEN 



558 



VIC 



The second mode may be effected as fol- 
lows : — 

If a house is small, and especially if a 
fire, as in a kitchen, is left lighted during 
the night, there are currents of air which 
set to that fire from every room. In this 
way, if means for admitting the fresh ex- 
ternal air into a bedroom are established, 
the door being left ajar, or having a perfo- 
rated panel, there is a continued but gentle 
flow of air through the apartment to the 
door. Even without a fire actually burning, 
there will be a current of cold air toward 
the portions of a dwelling which have been 
warmed by the fires and occupation of the 
day. This mode of ventilating, however, 
belongs rather to that effected by artificial 
heat. A brisk fire is undoubtedly an excel- 
lent ventilator, but even this, with the low 
chimney-piece, must in a great measure 
supply itself from the fresh air which comes 
in at the lower parts of the room, and leave 
that in the higher parts, which most re- 
quires renewal, untouched. To obviate this, 
chimney-ventilators, such as that of Dr. 
Arnott's, (see Bedroom,) have been intro- 
duced, and probably offer the most efficient 
mode, and that which is most generally ap- 
plicable, of drawing off the deteriorated air 
of a room. In the absence of a regular fire, 
or in combination with it, gas-burners are 
commonly employed as ventilators, each 
light being placed under a tube, with a bell- 
shaped mouth, and the tube itself made to 
communicate with the chimney. By this 
arrangement, not only is the general air of 
the room carried off, but also that which is 
rendered impure by the burning gas. In- 
deed, the arrangement is one which in some 
modification or other ought to be connected 
with all gas-lights. 

While, however, every care is taken to 
renew the air in the interior of dwellings, 
obviously the measure will be a useless one, 
unless the air introduced from without is 
itself pure. In this way the system of ven- 
tilation becomes connected with sanitary 
arrangements generally, such as drainage, 
&c, and, indeed, with whatever tends to 
render the air around dwellings unwhole- 
some. Whatever the condition of the sur- 
rounding atmosphere, that portion of it 
which is admitted into dwellings for pur- 
poses of ventilation, ought not to be taken 
from too near the level of the soil ; for not 
only is it liable to be more damp, but also 
to be impregnated with any malarious agen- 
cies which may possibly exist. — See Ague. 

One other mode of ventilation requires 
notice : it is that exerted by the chemical 
action of lime, which, by absorbing the 



carbonic acid gas of the atmosphere, not 
only removes a noxious agent, but by the 
removal of the gas gives space to be occu- 
pied by fresh air from without. The method 
may be useful in some situations, which 
cannot be otherwise ventilated. It is best 
effected by a quantity of newly slaked lime, 
spread on a board. 

In a brief sketch like the foregoing, it 
would be useless to attempt more than an 
outline of the principles of a subject so ex- 
tensive as ventilation ; neither would it be 
necessary here, as the most useful details 
will be found under the heads of the various 
subjects alluded to in the article. One 
instance alone, related by Mr. Chadwick, 
and well known to those who take interest 
in such matters, will be related to illustrate 
the powerful influence of ventilation upon 
health. There existed in Glasgow a large 
tenement, known by the name of the "Bar- 
rack;'.' it consisted of many rooms, each let 
out to one or more families, so that not less 
than 500 poor people inhabited the building. 
The consequence of this overcrowding was, 
that fever was always in the place, and "in 
the last two months of 1831, there occurred 
fifty-seven cases of the disease. At the 
suggestion of a medical man, there was fixed 
into the ceiling of each room a tube, which 
was made to communicate with the chimney 
of a neighbouring factory. In this way an 
efficient system of ventilation was esta- 
blished with such good effect, that, there- 
after, fever was almost entirely banished 
from the place." 

VENTEICLE.— See Circulation— Heart. 

VERDIGRIS — Is an acetate of copper. 
It is prepared chiefly in the wine countries, 
by acting upon plates of copper, by means 
of the husks and other refuse of the grape, 
which are made to undergo the acetous fer- 
mentation. Poisoning by verdigris some- 
times occurs : it is to be treated in a similar 
manner to that from the sulphate of copper, 
or blue vitriol. — See Copper. \ 

VERTEBRiE.— See Spine. 

VERTIGO.— See Giddiness. 

VESICATION.— Blistering.— See Blister. 

VESICLE.— A little blister, or elevation 
of the epidermis or scarf-skin, by clear fluid. 
In the first stage the cow-pock is in the state 
of a vesicle, but in the later stages, when 
the clear fluid becomes turbid, like matter, 
it becomes a pustule. 

Refer to Skin, $c. 

VICARIOUS ACTION— Is action set up 
in one part of the body as a substitute for a 
similar action in another. It occurs chiefly 
in connection with menstruation.— See Men- 
strua lion. 



VIN 



559 



VIN 



VINEGAR, or Acetic Acid. — Acetic 
acid is the volatile acid principle, which, 
diluted with water, constitutes vinegar. The 
acetic acid itself may be got very strong and 
concentrated by various chemical processes ; 
it is also obtained of considerable strength 
by the destructive distillation of wood; when 
thus procured, it is named pyroligneous 
acid, or "wood-vinegar." Vinegar is a so- 
lution of acetic acid in water ; it is of vari- 
able strength, and contains colouring-mat- 
ter, and usually, also, spirituous and etherial 
principles. It is prepared from wine, malt, 
sugar, cider, &c. &c. ; and also, as stated 
above, from wood. Except in the case of 
the last, it is produced by the acetous fer- 
mentation, which is carried on under a tem- 
perature approaching 80° Fahr. 

The wine vinegars, or French vinegars, 
are made chiefly from the lighter wines by 
a careful process of fermentation. They 
are usually better and stronger than those 
of British manufacture, and .more free from 
adulteration. British vinegars made from 
malt, sugar, &c, generally want the aroma 
of the French ; most of them contain sul- 
phuric acid, in the proportion of one thou- 
sandth part, as permitted by law, but some- 
times in much larger quantity. Vinegars 
are also liable to contain metallic impuri- 
ties, owing to the readiness with which they 
act on many metals with which they may 
come in contact in process of manufacture. 
These impurities are got rid of by the pro- 
cess of distillation ; consequently a distilled 
vinegar, or acetic acid, is used for medicinal 
purposes. The addition of sulphuric acid 
to malt vinegar is permitted, to counteract 
a tendency to pass into the putrefactive fer- 
mentation. The colour of the brown vine- 
gars is generally imparted by burnt sugar. 
According to the investigations of the "Lan- 
cet Commission," it appears that the chief, 
and almost the sole adulteration of vinegar 
is by sulphuric acid, in excess beyond the 
legal quantity. 

The domestic manufacture of vinegar is 
so simple, that those who wish it can easily 
render themselves independent of the manu- 
facturer, and, indeed, many housekeepers 
do manufacture their own. It is not uncom- 
mon, at least in some parts of the country, 
to see standing near the fire a large brown 
jar, tied over with a porous cloth, in which 
the process of vinegar-making is carried on 
by means of the "vinegar-plant," as it is 
called. Of this plant, which is in the form 
of a large, flat, leathery fungus, Mr. Fletcher, 
a correspondent in the Lancet, gives the fol- 
lowing account and mode of using: — ''Put 
the plant — a young one — in an earthen jar, 



add to it half a pound of the coarsest moist 
sugar, and half a pound of treacle, with five 
pints of milk- warm water ; cover it lightly 
over so as to keep out the dust, but not the 
air, and then put it in a moderately warm 
place ; there let it remain seven weeks, not 
disturbing it more than you can help. At 
the end of that time, pour off what is now 
the clear vinegar, and keep it in well-corked 
bottles for use. Again add to the plant the 
same quantity of water, sugar, and treacle, 
as before. At the end of the second seven 
weeks, the plant will have become like two 
thick pancakes, and they may be easily di- 
vided, care being taken not to tear the old 
or new plant. If the plant is exposed to the 
cold, or kept too long out of the liquid, it 
will become black, and die." Another re- 
ceipt is given in the Lancet as follows : — 
" For every gallon of hot water take eigh- 
teen ounces of sugar, and when the syrup 
has cooled to 75°, add four per cent., by 
measure, of yeast. When the vinous fer- 
mentation is pretty well advanced, in the 
course of two or three days, rack off the 
clear wasn from the lees into a proper cask, 
and add one ounce of wine-stone, and one 
of crushed raisins for every gallon of water. 
Expose it in a proper manner, and for a 
proper time, to the acetifying process, and 
then rack off the vinegar, and fine it upon 
beech-chips." It should be afterward put 
into bottles, which are to be well corked. 

The action of vinegar upon the system 
requires to be considered both in a medicinal 
and in a dietetic point of view. 

The strong acetic acid is a powerful irri- 
tant, causing redness, and if long applied, 
blistering of the skin. It is also used as an 
external application to warts, corns, &c, 
which it often quickly removes, acting as a 
solvent to their albuminous and gelatinous 
constituents. [It is also an excellent article 
as an escharotic dressing to certain stages of 
open cancer, cloths wet with it being applied 
to the sores.] When the strong acetic acid is 
employed as a solvent for aromatic essential 
oils, it constitutes the aromatic vinegar, or, 
as it was formerly called, "thieves' vine- 
gar." This preparation derived its name 
and its reputation as an antidote to conta- 
gious emanations, from its first having been 
used in the time of the plague, by those who 
wished to plunder the houses or persons of 
the dead or dying without risk. If they 
escaped, it was probably from the confidence 
inspired by the possession of such a supposed 
protection — for vinegar, of any kind, can 
afford no real protection against contagion ; 
that is, it can exert no chemically destruc- 
tive effect over the contagious emanations in 



VIO 



560 



VIS 



the way that chlorine does. Nevertheless, 
vinegar, plain or aromatic, either sprinkled 
about, or burned in a sick room, is often 
agreeable and refreshing ; only, its use should 
not be permitted to supersede more essential 
purifications. Vinegar, diluted with water, 
in the proportion of one or two tablespoon- 
fuls to the half-pint, is used for sponging the 
skin in febrile diseases. It is also a good 
addition to gargles in sore-throat. Before 
the more powerful astringent gargles are 
used, one sixth-part of vinegar may be added 
with advantage to the warm gruel or water 
gargle. It assists the separation of the 
tough mucus, which is apt to cling about the 
throat in such cases. 

As an internal remedy, vinegar is but little 
used; it is, however, employed as a solvent of 
a few medicinal substances. — See Squill. As 
a dietetic condiment, vinegar is unquestion- 
ably useful and wholesome ; more so, how- 
ever, to some persons than to others. It is 
generally considered, in common with other 
vegetable acids, to promote the digestion of 
oily food, and probably there is something 
instinctive in its frequent addition to such 
aliment. But if, in moderate proportions, 
vinegar assists digestion, taken immoderately 
it is very injurious, destroying the digestive 
powers, and even inducing actual disease of 
the stomach. It is from this injurious effect 
upon the digestion, that vinegar has acquired 
the reputation for reducing corpulency, 
which occasionally tempts foolish people to 
have recourse to it for this purpose. The 
practice cannot be too strongly condemned. 

VIOLET.— The flowers of the common 
sweet violet are employed to impart their 
colour and fragrance to a syrup, which is 
often given to children for colds and coughs. 
It is said to be slightly laxative. The root 
of the sweet violet possesses gentle emetic 
powers, similar to those of ipecacuanha. 
The two roots have some resemblance in form. 

VIPER. — See Wounds, Poisoned. 

VISION — Is the power of taking cogni- 
zance of the size, colour, position, &c. of 
objects, external to the body, by means of 
rays of light, which are received upon a 
nervous expansion, capable of conveying the 
impressions received by it to the sentient 
being. In the lowest tribes of animals, the 
organs of vision, or eyes, are of compara- 
tively simple construction, but the same or- 
gans in man are most exquisitely elaborate. 
Under article "Eye," this structure has al- 
ready been entered into as far as space per- 
mitted. Fig. cxl. represents a diagram* of 



* This, it must be remembered, is only a diagram, 
not a picture. 



Fig. cxl. 




the section of the human eye, representing 
the parts essential to vision — first, a dark 
chamber, (1,) lined by the nervous retina, 
and glazed anteriorly by the glass or cor- 
nea, (2.) The rays passing through the 
cornea, and striking upon the nervous re- 
tina, would probably be sufficient to convey 
to the mind an impression of light and 
shade, and, perhaps, a general, though con- 
fused idea of external objects ; but to confer 
the perfect, accurate vision we enjoy, other 
arrangements were necessary ; consequently, 
we find the lens (3) suspended, as it were, 
in front of an exquisitely transparent jelly, 
which fills the cavity (1) and the space be- 
tween the lens, and the cornea filled with 
transparent fluid. The result is, that the 
rays proceeding from external objects, in 
their passage through these various trans- 
parent substances, become so collected and 
arranged (fig. cxli.) that by the time they 

Tig. cxli. 




reach the back of the eye, or the sensitive 
nervous retina, they form in it exact minia- 
ture pictures of external objects — the picture, 
however, being placed upside down. This, 
perhaps, will be better understood, by trac- 
ing the direction of the rays proceeding 
from the objects (fig. cxli. 5) to the reversed 
image of it formed at the back of the eye, 
(fig. cxli. L.) In addition to these arrange- 
ments for collecting and arranging the rays, 
there is superadded the iris (fig. cxl. 4) — . 
(see Eye) — in the centre of which is the 
aperture of the pupil, through which all 
the rays pass ; and as the iris has the power 
of diminishing or enlarging this aperture, 
it acts as a regulator of the amount of light 



VIS 



561 



VIS 



admitted into the interior of the eye. . How 
it is, that, although images are formed in 
the retina in a reversed position, we see 
them correctly, is not at present satisfac- 
torily explained. 

Every one who has used a lens or magni- 
fying glass, is aware that in oder to see an 
object distinctly through it, it must be kept 
at a certain definite "focal"' distance from 
the object. The same law applies to the eye ; 
its lenses are so regulated, that the focal 
distance of most healthy, well-formed eyes 
is the convenient distance of about ten 
inches ; in other words, in order that an 
object, such as print, may be distinctly seen, 
that its image may form a distinct picture 
in the retina of the eye, it requires to be 
placed at the above distance. Now, the 
proper collecting and arranging of the rays 
of light which go to form the image of 
external objects in the retina in the interior 
of the eye, although they depend partly 
upon the substance of the transparent bodies 
or lenses the rays pass through, depend 
also greatly upon the curves of the lenses ; 
that is, if sight is to be perfect at a distance 
of ten inches, the curve of the cornea espe- 
cially (fig. cxl. 2 — cxli. 4) must bear a defi- 
nite relation to the rest of the eye. It, 
however, occurs, that in many eyes, the 
cornea, instead of the usual curve, projects 
too much, is too convex; the consequence is, 
that the rays which pass through it from ex- 
ternal objects placed at the ordinary dis- 
tance from the eye, are too rapidly collected 
or brought together, so that, instead of 
forming the distinct or focal image exactly 
in the retina, they form it a little in front, 
as at fig. cxli. 2, and therefore confusedly 
To remedy this, a person in whom the cornea 
is too convex, instinctively brings objects 
closer — sometimes very close — to the eye, 
as, by doing so, according to the laws of 
light, he causes the distinct image formed 
in the eye to be thrown farther back, that 
is, to be formed in the retina, instead of 
before it. The condition is in fact that of 
" short sight." As, however, it is neither 
convenient, nor always possible, to approach 
objects close to the eye, it is usual to remedy 
the defect by the use of glasses, which, be- 
ing made concave, the reverse of the too 
convex cornea, counteract the effect of the 
latter, by somewhat scattering the rays of 
light before they reach the eye. In old age, 
generally, the condition of the eye is ex- 
actly the reverse of the above, the cornea 
becomes flattened, so that instead of collect- 
ing the rays too quickly, it does not collect 
them quickly enough; consequently, the dis- 
tinct image they form, or ought to form, i 



will fall rather behind the retina, as at fig. 
cxli. 3, and the image in the retina will be 
indistinct. To remedy this defect, convex 
glasses or lenses are used, in the form of 
spectacles, &c, as they assist the cornea to 
collect the rays more quickly than in its 
flattened condition it is capable of doing. 
Such are the nature, causes, and rational 
modes of correcting some of the most com- 
mon derangements to which vision is liable. 

Vision may be interfered with by causes 
which obstruct the access of light to the 
nervous expansion or retina, or by those 
connected with the retina itself, or with its 
nervous communications in the brain. — See 
Amaurosis — Brain. In the former case, 
" specks," or opacities on the cornea, opaci- 
ties of the lens, constituting "cataract," 
(see Cataract,) inflammation, acute or 
chronic, may be the obstructing causes. 
But, whatever the case, or whatever the 
probable cause, when so delicate and valu- 
able an organ as the eye is concerned, no 
time should be lost in submitting it to pro- 
per medical examination. For further in- 
formation see Amaurosis — Cataract — Eye. 

VIS MEDICATRIX NATURAE, Tendency 
to Health, Natural Powers of Recovery, 
or or Healing, are all phrases expressive 
of the same thing : of that power or tend- 
ency implanted in a living, organized body 
by its Creator, to restore to a state of order 
whatever portion of its living organization 
may, by circumstances, have been thrown 
into disorder. By disorder, is here meant 
either what medical men call " organic dis- 
ease," that is change of structure palpable 
or appreciable; or what they call "func- 
tional disease," or "functional disorder," 
in which the functions of a part only are 
affected, or in which, if structure is altered, 
our means of investigation are not sufficient 
to enable us to detect the change, and we 
can only judge of the disease by its func- 
tional symptoms. 

The existence of a power tending to health 
(of a vis medicatrix natures) has been re- 
cognised from the earliest times ; but medi- 
cal men have never explained in what that 
power consists ; it is, probably, connected 
with that principle of life which all created 
things derive from Him who made them. 
Without it the efforts of the physician or 
surgeon would be futile. The ends of the 
fractured bone might be placed in apposi- 
tion, or the edges of the wound drawn to- 
gether, but in the absence of the vis medi- 
catrix, they would remain so only so long 
as retained in place by art, however long 
the artificial restraints might be applied. 
True it is that the natural tendency to cure 



VIS 



562 



VIS 



may be much weakened — may be almost 
apparently absent — may be vanquished by 
the power of disease, and at last is van- 
quished by the power of death ; but why 
and how this is, we know not, cannot know, 
till we explain what that is which we call 
"vis medicatrix," — nay, further, till we ex- 
plain the why and wherefore of disease, 
why each and all possess certain tendencies 
to disease, which may, sooner or later, ac- 
cording as they are favoured or not by cir- 
cumstances, show themselves, and over- 
come the natural tendencies to health and 
order in our material systems. These things 
are connected with the deeper arcana of 
our being. In this place the question re- 
quires more practical consideration. Not- 
withstanding the recognition of the "vis 
medicatrix" from the earliest times, it has 
too often been lost sight of in the treatment 
of disease and injury, especially in former 
years ; physicians and surgeons acted as if 
they were the real powers for restoring 
health, instead of only being the assistants 
of those powers, and in this way arose an ar- 
tificial, officious system of medicine, and a 
meddlesome surgery, from which the worst 
results ensued. The natural powers, instead 
of being assisted, were thwarted, and embar- 
rassed or weakened ; if they did ultimately 
succeed in throwing off the disease, or in re- 
pairing the injury, it only served to prove 
what the natural powers could do even under 
such circumstances. In times gone by, a gun- 
shot wound was treated with scalding oils, 
scarified, &c. &c. ; it is now more simply 
and successfully conducted to cure by the 
use of water alone. — See Dressing. To sim- 
ple wounds, balsams and spirits of various 
kinds were applied, which now under the 
plain water dressing quickly and painlessly 
get well. But even now, so strongly is the 
idea of the healing power of plasters enter- 
tained by the popular mind, that the cure 
of a wound is attributed directly to these 
applications, which only fulfil the mecha- 
nical end of holding its edges together, that 
is, of putting the injured parts in such a 
position that the natural powers of healing 
can be exerted. 

Formerly, small-pox, fever, and such dis- 
eases, were treated by stimulants within, 
and by the stimulant action of heat without, 
in the form of hot rooms, closed curtains, 
and loads of bed-clothes; and, as the re- 
verse of this, it is not long since the natural 
powers, that would cure if they were per- 
mitted, were weakened by indiscriminate 
bleeding. Even now, numbers in this 
country do not think it possible to get rid 
of any disease without drugs. 



By these observations, it is not meant to 
weaken the confidence of any in the cura- 
tive or salutary powers of medicines, which 
are true and real blessings ; but it is in- 
tended to point out how, by losing sight too 
much of the natural implanted power of 
resisting and throwing off disease possessed 
by the living body, injurious systems of 
officious meddling prevailed. Indeed, it 
may be, that at present the current has set 
too strongly the other way, and many are 
too much inclined to be altogether skeptical 
as to the sanative powers of medicine. 
This, it need scarcely be said, is an extreme 
equally vicious with the other which trusted 
all to it alone. We know that the vis medi- 
catrix naturae, the natural tendency to health, 
is strong, and will often prevail even in the 
most adverse circumstances ; but we also 
know that it is often weak, that it fails to 
overcome, or that while it is fighting the 
battle, its resources, its "commissariat," 
so to speak, fails. In such cases we know 
that assistance must be given from without 
by those means, or agents, which He who 
gave the one power within the body, has 
endowed with powers capable of assisting 
that power, of aiding it in the combat. 

Nothing, perhaps, makes the above re- 
marks more obvious than the circumstances 
which occur in continued fever. This dis- 
ease is generally admitted to be a con- 
tinued state of disordered action in the 
system, in which (although at times the 
powers seem to be completely overwhelmed) 
the tendency is in a large number of cases 
to run a certain course, ending in recovery, 
or in the victory of the tendency to health 
ofer the acting causes of disorder. None, 
perhaps, are bold enough to profess to cure 
a fever — to profess to remove the disease by 
active treatment, either directly medicinal, 
or otherwise; and the man who attempts 
it will probably do so at the peril of his 
patient. The wise physician is content to 
leave to the vis medicatrix the removal 
of a disturbance for which he can offer 
neither rational explanation nor method of 
direct cure. But if in eschewing all active 
interference, he defers to the power within, 
in rendering his assistance to that power, 
he fulfils a most important — a necessary 
office, and often assists to save a life, which 
the unassisted powers of the body must 
have lost. 

The office of the physician in such a case 
is to preserve those outward conditions of 
health which it is every man's duty to pro- 
vide for himself when he has health and 
strength to do so, albeit these conditions now 
require nice management. The blood of the 



VIS 



563 



VOM 



fever patient is disordered, (poisoned.) The 
office of the plrysician must be, by seeing 
that his patient draws pure air into his lungs, 
to facilitate the purification of the vital fluid. 
The exhalations of the body by the skin, &c. 
are depraved ; he must see that by the re- 
moval of these, and of all things which can 
absorb and retain them, the diseased action 
is not assisted; the excretions into the 
bowels are depraved, offensive, morbid ; the 
due evacuation of these must be attended to ; 
the natural appetite and power of digestion 
is all but annihilated, but a process is going 
on within, which is consuming, burning up 
the frame-work, and may come to bear 
upon the vital tissues. To prevent this, the 
medical man must support strength by 
gelatinous soups, &c, which pass easily, and 
with little digestive effort, into the circula- 
tion ; and, if the disease goes on, if the "vis 
medicatrix" is still combating, and requires 
but a little time longer, if then all the avail- 
able supplies for carrying on the ordinary 
processes of vital warmth, &c. are ex- 
hausted, he must, with wine or brandy, 
(alcoholic fuel,) keep, almost artificially, the 
machinery at work. In such offices as the 
above, and many more, surely there is 
abundant room for the skill, the judgment, 
the interference, of a medical man, without 
his attempting to take into his own hands 
the office of that power which he cannot 
supersede, but which he may greatly thwart. 
In such a disease as fever, it is true, me- 
dicine, although often, or rather always, 
requisite, is not so to the same extent 
that it is in other diseases. But even in 
others, in which, such as neuralgia, we can 
often directly trace the removal of the dis- 
order to the administration of the remedy, 
we can only look upon the power of the 
latter as the assistant to the natural tend- 
ency to cure. There are, it is certain, 
some diseases, such as cancer, which re- 
sist not only all efforts for their removal 
from within, but all the assistance we can 
give by remedy. Why it is so we cannot 
tell. That they are thus "incurable," is, 
probably, because we are ignorant of the 
remedy which might give the assistance to 
the natural tendency to health, which would 
enable it to overcome the disease, just as 
there are certain obstinate ulcers, or affec- 
tions of the skin, which resist many modes 
of treatment, and at last yield under the 
influence of a particular remedy — but yet 
to the remedy can only be ascribed the 
power of assisting. 

The present subject has been dwelt upon, 
because, as already observed, from the ex- 
treme which at one time existed, of trusting 



all, or to say the least, too much to medL 
cines, drugs, &c, there certainly has been 
a tendency in many to discard these alto- 
gether, and to trust entirely to the powers, 
the " vis medicatrix naturre." As in most 
other things, in the medium will be found 
the best course ; and he, probably, will 
treat disease most successfully, who endea- 
vours, as in the free ventilation, &c. around 
the fever patient, to put the natural powers 
of resisting and casting 'off disease in as 
favourable a position as possible, — who 
trusts those powers, but yet watches their 
operations, and who is prepared, with full 
confidence in the efficacy of medicines, to 
use them decidedly and actively, when ra- 
tional ground for doing so appears. 

There has been, undoubtedly, far too much 
trusting to drugs alone, and far too great 
neglect of the general principles of health, 
in the treatment of disease, but it is folly 
on that account to attempt to cast aside 
medicines altogether. If the Author of all 
things implanted in the living animal body 
a "vis medicatrix," he also endowed other 
substances with the capability of assisting 
that power. We can see how the neglect 
of the first was an error ; surely to ignore 
the last must be so too. 

VITRIOL. — See Sulphuric Acid and 
Sulphates. 

VOICE, or Vocal Sound — Produced in 
the larynx, (see Lungs,) is the endowment 
of animals generally, and differs from speech, 
possessed by man alone ; the latter, physic- 
ally speaking, depending upon the forma- 
tion and action of the parts about the mouth. 
Crying, singing, and the sound of speech, 
all depend upon the action of the larynx, 
which partakes of the characters of both a 
wind and of a stringed instrument. In 
some diseases, the alteration in the voice is 
very characteristic. In Asiatic cholera, it 
acquires a very peculiar pitch ; in con- 
sumption, it is often of a remarkable hollow 
character. In some forms of disease it may 
be almost lost. — See Aphonia. 

Refer to Cry of Children — Reading Aloud, 

VOMITING— Is the action of discharging 
the contents of the stomach through the 
gullet and mouth by muscular effort, or 
rather by a combination of muscular efforts. 
Formerly, it was imagined that vomiting 
depended upon " convulsive" action of the 
stomach alone. After that it was thought 
that the stomach was passive in the act, and 
that the pressure of the muscles of the 
belly, thrown into violent action, was -the 
sole cause. It is now well ascertained that 
both these agencies are called into play when 



MM 



VOM 



564 



VOM 



vomiting occurs. That the stomach does, 
by the action of its muscular fibres, assist 
in the expulsion of its contents, but that its 
efforts are greatly aided by the muscles of 
the abdomen, including the diaphragm. — See 
Diaphragm. Every one is conscious that 
previous to the act of vomiting, a deep in- 
spiration is taken. By this the diaphragm 
is forced downward toward the cavity of 
the abdomen, and being there fixed, or ren- 
dered tense, by the contraction of its own 
fibres, it offers a fixed point of resistance, 
against which the stomach can be pressed 
by the contraction of the muscles in the 
forepart of the abdomen. At the moment 
that this almost convulsive pressure is ex- 
erted on the stomach, and by the stomach 
on its contents, the muscular fibres at the 
" cardiac" junction of the stomach with the 
gullet (see Stomach) are relaxed, so as to 
permit of the passage upward of the 
matters contained in its cavity, while, at the 
same time, the glottis is closed, so as to 
protect the larynx and air-passages, as in 
swallowing. 

Vomiting is frequently preceded by nau- 
sea, (see Nausea,) but not always. Pro- 
bably it is not so in the vomiting of infants 
which overfill their stomachs, for nausea is 
a sensation which causes uneasiness and 
distress, and yet the little creatures gene- 
rally look remarkably happy while they 
relieve their stomach of the overload. 
Again, some persons, especially dyspeptics, 
possess the power of vomiting at will, and 
can, without any feeling of nausea, dis- 
charge the contents of the stomach ; neither 
is there much, if any feeling of nausea con- 
nected with the vomiting which sometimes 
follows coughing, sobbing, &c. 

The causes of vomiting are very nume- 
rous. It may depend on local irritation of 
the stomach by bile, mucus, &c, or by indi- 
gestible food, by medicine, or by poison ; it 
may be excited by the mechanical effects, 
and probably through the intimate nervous 
communication in cough, hiccup, sobbing, 
laughing, &c. It is often sympathetic with 
and symptomatic of disease or accident in 
distant parts, or of excited action in distant 
organs, as in the case of the womb in preg- 
nancy, or in sea-sickness. Irritating or 
tickling the throat likewise causes vomiting. 
In some persons, disagreeable or peculiar 
tastes, smells, and even sights and sounds, 
will give rise to vomiting ; mental emotion 
will produce it, and certain drugs, such as 
tartar emetic, give rise to it if injected into 
the blood. At the onset of acute disease, 
vomiting is a common symptom. When a 
person becomes affected with vomiting, it is 



of course well to keep these various causes 
in mind; for though, in the majority of in- 
stances perhaps, vomiting depends upon dis- 
order in the stomach itself, it must evidently 
be of much consequence to recognise it as 
symptomatic of disease, which is often of a 
serious character. 

When vomiting has been preceded by 
symptoms of indigestion, or when it is of a 
bilious character, accompanied with furred 
tongue, &c, the probability is that it de- 
pends upon the presence of bile or other 
matters. In such cases, if the natural pro- 
cess of relief appears inclined to be suffi- 
ciently energetic, it will be enough to assist 
by drinks of tepid-water or gruel, or of 
chamomile-tea ; if the action is not suffi- . 
cient, an emetic (see Emetics) may be given 
to fulfil the natural indications. These 
attacks of spontaneous vomiting from dis- 
order of the digestive organs are frequently 
accompanied with diarrhoea, but when this 
does not occur, it is generally advisable to 
give aperient medicine in some form, and 
as the stomach often remains unsettled, 
nothing seems sooner to restore it than a 
few effervescing draughts, either simple or 
containing a tonic bitter. — See Indigestion. 

Vomiting, however, may continue from 
simple irritability of system or stomach, 
after the irritation in the latter organ has 
been removed ; when it does, means for 
allaying that irritability must be resorted 
to, similar to those employed when the vo- 
miting is the result of sympathy, as it is in 
pregnancy, &c. &c. In any case, obstinate 
vomiting is so distressing a symptom, and 
one so injurious to some patients, that it is 
desirable at all times to put a stop to it. For 
this purpose the remedies recommended are 
very numerous. 

If there is offending matter on the sto- 
mach, which is the cause of the vomiting, 
it is of course useless to attempt to stop the 
latter till the former has been removed, as 
adverted to above. 

As general remedies in vomiting, efferves- 
cing draughts are the most safely usable 
by an unprofessional person ; also alkalies, 
or magnesia, if there is acidity ; and with 
these it is advisable at times to combine a 
stimulant, sal-volatile, or if calcined mag- 
nesia is used, a little sherry. Creasote 
might be employed in an emergency without 
medical sanction, but certainly not prussic 
acid, which is often so efficacious in proper 
hands. Besides internal remedies, assist- 
ance may be derived from external applica- 
tions, such as three or four leeches to the 
pit of the stomach if there is much tender- 
ness, or a mustard-plaster, or blister ; posi- 



W AI 



565 



WAL 



tion, too, whether recumbent or not, may- 
make considerable difference. It may be 
well not entirely to neglect the indication 
of appetite, or of any unusual craving for 
food of a particular kind; its gratification 
may stop the symptom. When vomiting 
comes on without obvious cause, and when 
it continues to recur, a medical man should 
be seen at once, for it may be symptomatic 
of serious disease. If without obvious rea- 
son, it happens shortly after a meal, and 
especially if more than one person is af- 
fected, the possibility of poison is not to be 
forgotten. 

Refer to Creasote — Emetics — Nausea — Poi- 
son — Sea-Sickness. 

WAISTCOATS, UNDER.— See Clothing 
— Flannel — Wash-Lbather, &c. 

WAKEFULNESS.— See Age, Old— Sleep, 
&c. [The fluid extract of valerian, in doses 
of forty drops to half a teaspoonful every 
two hours, will often afford relief.] 

WALKING — Is the natural exercise of 
man, and for the strong and healthy it is 
the best. Even in the case of the debili- 
tated and of the aged, it should not be neg- 
lected: no other mode of exertion diffuses 
the blood and accelerates its circulation 
so thoroughly throughout the body. The 
principal caution required for such persons 
is not to continue their exercise till exhaus- 
tion occurs. Children are not unfrequently 
injured and weakened in constitution by 
their daily exercise being a walk, too often 
carried to fatigue, especially in summer. 
When attainable, a play-ground in which 
rest and exercise can be taken alternately, 
and at will, is much preferable to the former. 
Any unusual peculiarity in walking, espe- 
cially in children or young people, should 
not be permitted to pass unnoticed ; it may 
be the first indication of spine or hip-disease. 

Refer to Exercise. 

WALLS and WALL-PAPERS.— The prin- 
cipal object, on the score of health, to be 
regarded in the external walls of dwellings 
is that they shall be sufficiently thick for 
wai-mth, and not of such porous material 
as will too readily absorb or give out moist- 
ure. Some kinds of stone and badly-made 
bricks do this, and render dwellings un- 
wholesome. The defect of outer walls, either 
as regards material or thickness, may be 
considerably ameliorated by lathing and 
plastering within. In covering the inner 
walls of houses either with paint or paper, 
too little regard, perhaps, has hitherto been 
paid to the effect of the materials which 
are used on health. In another part of this 
work, it was stated that colours containing 
2 X 



lead and arsenic have been found to affect 
injuriously the occupants of rooms to the 
walls of which they have been used. More- 
over, as light exerts so strong an influence 
upon health, it is not unlikely that wall- 
colours, [and papers,] especially in the vari- 
ation from light to dark, may be found to do 
the same. [Chamber papers should also al- 
ways have small and irregular figures, to 
prevent the eye, especially of an invalid, 
from being fatigued or strained by constant- 
ly looking at it, as is often the case during 
sickness, especially in brain affections.] 

Wall-papers are of course liable to the 
same objections as wall colours, and also to 
another connected with the size, by means 
of which they are attached. This will be 
best illustrated by the following "Hints 
on Paper-hanging," from a late number of 
Household Words : — 

"Many a fever has been caused by the 
horrible nuisance of corrupt size used in 
paper-hanging in bedrooms. The nausea 
which the sleeper is aware of on waking in 
the morning, in such a case, should be a 
warning needing no repetition. Down should 
come the whole paper, at any cost or incon- 
venience, for it is an evil which allows of 
no tampering. The careless decorator will 
say that time will set all right — that the 
smell will go off — that airing the room well 
in the day, and burning some pungent thing 
or other at night, in the mean time, will do 
very well. It will not do very well ; for 
health, and even life, may be lost in the in- 
terval. It is not worth while to have one's 
stomach impaired for life, or one's nerves 
shattered, for the sake of the cost and 
trouble of papering a room, or a whole 
house, if necessary. The smell is not the 
grievance, but the token of the grievance. 
The grievance is animal putridity, -with 
which we are shut up when this smell is 
perceptible in our chambers. Down should 
come the paper, and the wall behind should 
be scraped clear of every particle of its last 
covering. It is astonishing that so lazy a 
practice as that of putting a new paper 
over an old one should exist to the extent 
it does. Now and then an incident occurs 
which shows the effect of such absurd 
carelessness. Not long ago, a handsome 
house in London became intolerable to a 
succession of residents, who could not en- 
dure a mysterious bad smell which per- 
vaded it when shut up from the outer air. 
Consultations were held about drains, and 
all the particulars that could be thought of, 
and all in vain. At last a clever young 
man, who examined the house from top to 
bottom, fixed his suspicions on a certain 



W AL 



566 



W AL 



room, where he inserted a small slip of glass 
in the wall. It was presently covered, and 
that repeatedly, with a sort of putrid dew. 
The paper was torn down, and behind it was 
found a mass of old papers, an inch thick, 
stuck together with their layers of size, and 
exhibiting a spectacle which we will not 
sicken our readers by describing." 

WALNUTS — Are about as wholesome and 
unwholesome as nuts generally. The infu- 
sion of walnut-tree leaves has been highly 
extolled as a remedy in scrofula. 

WARM BATH.— See Bath. 

WARM FLUIDS.— See Diluents— Heat, 
&c. 

WARTS — Are enlargements of the papillae 
of the true skin, and thickening of the cover- 
ing epidermis or scarf-skin. They are most 
usual in children, up to a little beyond pu- 
berty, and generally occur on the hands, 
sometimes on the face. In the latter situa- 
tion they are better not interfered with. 
When situated on the hands, they often dis- 
appear of themselves. When their removal 
is desired, strong acetic acid, applied every 
two or three days, is certainly the best re- 
medy ; caustic, however, or tying, or cutting 
them off, are measures also resorted to. 
When a wart on the face, especially in 
those advanced in life, appears inclined to 
become ulcerated, or irritated, it ought to be 
shown to a medical man. It may require 
removal, from degenerating into cancer. 

Refer to Skin. 

WASHING.— See Ablution. 

WASH-LEATHER, or Chamois Leather 
— Is often serviceable when worn next the 
skin, as an under waistcoat, by those subject 
to rheumatism. 

Refer to Rheumatism. 

WASP.— See Stings. 

WASTING.— See Atrophy— Tabes. 

WATER.— This apparently simple fluid, 
considered by the ancients as one of the 
elementary or simple^bodies, is composed of 
the two gases, oxygen and hydrogen, in a 
state of chemical combination, in the pro- 
portion of eight parts of the former to one 
of the latter, by weight. Chemists demon- 
strate the gaseous composition of water in 
two ways : they either decompose the fluid 
by means of electricity, and collect the two 
gases separately, or they form it by causing 
the two gases to unite in proper proportion. 
Indeed, the formation of water by the union 
of the gases, may be witnessed by any one 
in the moisture evolved inside a gas lamp, 
in consequence of the union of the burning 
hydrogen with the oxygen of the atmo- 
sphere. 

Water, when perfectly pure, is transpar- 



ent and colourless, without taste or smell. 
It freezes at 32°, and boils at 212° Fahr. It 
is, however, impossible, perhaps, to procure 
perfectly pure water, except by the process 
of artificial distillation; even rain-water, 
which is the purest natural water, although 
collected at a distance from human habita- 
tions, is found to contain traces of ammonia, 
and sometimes of nitric acid; if collected 
near dwellings, it is of course liable to con- 
tract much greater impurity. Nevertheless, 
rain-water, being the product of natural dis- 
tillation, that is, having passed into the at- 
mosphere in the form of vapour, before its 
descent as rain or snow, is free from the 
saline and other impregnations which it ne- 
cessarily possesses as soon as it has come in 
contact with the earth. It would require a 
volume, fully to illustrate the important ne- 
cessities and expediencies which water ful- 
fils to creation generally, and to man in 
particular. Three-fourths of the weight of 
his body is composed of it, and a due supply 
of moisture is absolutely requisite for the 
performance of the functions of life, espe- 
cially those of digestion and nutrition. As 
the body is continually suffering loss of its 
water by the action of the kidneys, skin, 
lungs, &c, so it is constantly in need of 
fresh supplies. These are furnished mainly 
by drinks of various kinds, but also in con- 
siderable quantity in the solid aliment. 
Wheat flour contains about 14 per cent, of 
water, fresh meat about 75, and cow's milk 
about 87 per cent., and other things in like 
proportion. 

With the exception of air, no necessity of 
man's living existence, perhaps, exercises 
more powerful and direct influence for good 
or evil, than the water he imbibes ; indi- 
rectly, also, it affects his moral condition, 
whether considered as a beverage or accord- 
ing to its economic uses. Notwithstanding, 
however, the acknowledged utility in every 
way of a free supply of pure water, it must 
be considered not only an anomaly, but a 
disgrace to the boasted civilization of the 
first half of the nineteenth century, that so 
little attention has been given to supplying 
the people with this necessary of healthful 
existence, physical and moral. In their 
provision for water, the ancients far, very 
far surpassed the moderns, as the remains 
of their magnificent aqueducts testify, and 
bestowed great care and expense on the 
means of procuring it pure. As stated 
above, rain or snow furnishes water freer 
from impurities than that procured from 
any other source ; the absence of all saline 
impregnations especially, renders such water 
peculiarly well adapted for cleansing pur- 



WAT 



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poses ; it dissolves soap easily and readily, 
not curdling it as the bard waters do. As 
rain-water is seldom used for drinking, on 
account of its vapid taste, its having run off 
lead-covered roofs is comparatively of less 
consequence ; but as it may be used for 
cooking, it should be borne in mind that it 
may acquire poisonous impregnations from 
the above source. 

Rain-water which has descended upon, 
and entered the earth, becomes, as stated 
above, impregnated with impurities of vari- 
ous kinds ; these vary according to circum- 
stances; they are classed as mineral or 
saline, and as vegetable or animal impuri- 
ties. There may also be impurities which 
are wholly dissolved in the fluid, and others 
which are merely mechanically suspended ; 
the latter are capable of being completely 
separated by filtration — the former are 
not. 

The most important and generally abun- 
dant saline impurity in water is the bi-car- 
bonate of lime, from which hard water 
chiefly derives its character ; besides this 
salt of lime, however, there are also often 
present bi-carbonate of magnesia, and sul- 
phate of lime, bi-carbonates of soda and 
potash, common salt and iron ; the latter 
impurity, however, is not very common, 
except in mineral springs ; when it does 
occur in a water commonly used, it gives 
an inky taste, and causes a yellowish tinge 
in clothing washed in it. 

The earthy salts, that is, those of lime 
and magnesia, are the chief sources of hard- 
ness in water ; excess of carbonic acid and 
the presence of iron are occasional causes 
not often met with. Filtering such water 
does not in any way modify its hardness. 
When the hardness of water arises from ex- 
cess of carbonic acid, exposure to the air re- 
moves the inconvenience in a great measure, 
and also does so slightly in water rendered 
hard by the presence of the bi-carbonates 
of lime or magnesia ; such waters, however, 
are softened in some degree by long boiling, 
which causes the separation of the salt of 
lime or magnesia, in the form of an insolu- 
ble carbonate ; this is in fact the chief con- 
stituent of the crust or "fur" which forms 
inside of boilers, kettles, &c, in districts 
where the water is hard. It is said that 
when it is desired to remove this fur, it may 
be done by boiling in the vessel a solution of 
muriate of ammonia. 

The separation of the earthly salts may 
be effectually accomplished by the process 
patented by Dr. Clarke, of Aberdeen. 

This process is based upon the follow- 
ing :— 



The bi-carbonate of lirne,* that is, lime ir. 
combination with two parts of carbonic acid, 
is soluble to a considerable extent in water, 
and is thus dissolved in hard waters gene- 
rally. Again, lime or quick-lime, which has 
been entirely freed from carbonic acid, is 
also soluble in water, (see Lime;) but when 
lime is in combination with one part only of 
carbonic acid, it is perfectly insoluble, being 
then in a state of chalk. It will now be 
evident, that if the clear solution of quick- 
lime, that is, of lime without any carbonic 
acid at all, is mixed in proper proportion 
with water which dissolves lime, combined 
with two parts of carbonic acid, and that if 
that which has no carbonic acid takes one 
part from that which has, an insoluble car- 
bonate will be formed, and fall to the bot- 
tom, leaving the water free or nearly so 
from lime, and thus the hardness will be 
removed. The annexed will probably make 
the above somewhat more intelligible. 

Cnl , Mn /-t,™« i f Mixed in the water, 

Soluble f Lime.... 1 Carbonic Acid 

Bi-carbonate^ Carbonic I d form tw0 ts of ' 
of Lime. I Acid 2-{ - ; „,„ M „ /-.„_•._„+„ „* 



Soluble ( T • 
Quick-lime. X^^ 6 - ■ 



insoluble Carbonate of 
1 | Lime, which falls to the 
1_ bottom. 



Those who desire more information on the 
above important process, will find it detailed 
in the excellent report of Dr. Clarke given 
before the Parliamentary Commissioners. 
The same gentleman speaks strongly of the 
importance of a due supply of soft-water, 
especially to the poorer classes ; and re- 
marks, that owing to the additional expense 
in soap, and to the extra wear and tear of 
clothing when the washing is done in hard 
water, habits of cleanliness are discouraged 
both as regards clothes and person. It may 
be remarked, that hard waters are far 
more frequent either from streams or sunk- 
wells ; and that springs, especially from the 
surface of hilly or undulating countries, are 
often extremely soft, such springs being in 
fact supplied by surface water — that is 
water which has only percolated through the 
upper strata, and has not passed through 
those which furnish the deeper springs, with 
their saline, lime, and magnesia impregna- 
tions. 

For purposes of drinking and cooking, 
and especially the former, the importance 
to a population of a due supply of good, 
pure water, cannot be over estimated. If 
the water is impure, it either injures the 
health or drives people to take it in combi- 

* As the same demonstration belongs to magnesia, 
which is moreover much less important, and less abun- 
dant than lime, the latter only is mentioned on account 
of brevity. 



WAT 



568 



WAT 



nation, too often with spirits, or under other 
forms, and thus engenders habits of drink- 
ing. It is, indeed, not improbable, that 
many of the artificial drinks have been re- 
sorted to solely as substitutes for bad water. 
In the choice or appreciation of a drinking- 
water, people will, perhaps, be greatly 
guided in their judgment as to pleasant- 
ness by the nature of that to which they 
have been accustomed. As a general rule, 
however, most people prefer a water which 
contains a slight amount of mineral ingre- 
dient. At the same time, those who have 
habitually drunk even very hard water, do 
not at first relish that of a softer character. 
Water which has been drawn for some time, 
becomes, as all know, unpleasant and vapid ; 
this is often accounted for by the loss of 
carbonic acid, or air, which most water 
contains naturally; but Dr. Clarke denies 
this cause, and attributes the change to 
increased temperature. Another, and pro- 
bably more powerful cause of the acquired 
unpleasantness than either of the above, is 
the facility with which water attracts at- 
mospheric impurities and exhalations, and 
there are generally sufficient of these to be 
met with. 

A small amount of mineral ingredient may 
not be, and probably is not injurious ; but 
water containing any great amount cannot 
be regularly consumed without risk to 
health, although more to some constitu- 
tions than to others. It is tolerably certain 
that the origin of " bronchocele" is con- 
nected with the presence of lime and mag- 
nesia salts in the waters of the districts in 
which the disease prevails. Dr. Paris says, 
"We have known patients, after drinking a 
glass of water, from a sense of weight and 
oppression at the stomach, at once pro- 
nounce the existence of foreign ingredi- 
ents." Dr. Prout remarks, "With respect 
to waters, it may be observed, that hard 
and impure waters possess great, and gene- 
rally very unfavourable influence in urinary 
diseases." Bad as hard waters may be, 
those impregnated with decaying vegetable 
or animal matter of any kind are beyond 
comparison worse, and are fertile sources 
of disease. Indeed, there is every evidence 
to show that fever may be directly origin- 
ated in a locality, from the drinking-water 
of the inhabitants being contaminated with 
decaying substances, and also that the pre- 
disposition to attacks of malignant cholera 
is greatly increased thereby. Dysentery is 
another disease which has often originated 
from drinking bad — especially marsh-water. 
Such water often contains insects or animal- 
culse. From these, and from mechanical 



impurities, it may, however, be freed by fil- 
tration. — See Filter. It ought also to be 
remembered, that though the water may be 
good when drawn, if it be preserved in bad 
receptacles, such as butts, the wood of 
which is decayed, or in cisterns lined with 
lead, on which the water acts, (see Lead,) 
or where it is exposed to contract impuri- 
ties from the atmosphere, a really whole- 
some fluid may be converted into an un- 
wholesome or even poisonous one. 

It is perhaps going too far to say that 
man should never drink any thing but the 
natural beverage provided for him; that it 
is the only wholesome, regular drink of 
healthy men, is certain ; but to contend that 
it never should be varied, is inconsistent 
with the law which seems so general, that 
change within certain limits is more benefi- 
cial than unvarying uniformity. Moreover, 
if water be the most abundant natural beve- 
rage, milk and vegetable juices furnish 
others in great abundance, and there can 
be no question that tea and coffee are pro- 
vidential provisions for man's health and 
comfort. — Kefer to Tea — Stimulants, Sfc. At 
whatever other times water is drunk, and in 
whatever proportion to other beverages, it 
is never more beneficial to the majority of 
people than on first rising in the morning ; 
then, a draught of pure fresh-drawn water 
is a most admirable persistent tonic, which 
may be continued a life through ; it has, 
too, the advantage of stimulating the bowels, 
and assists to keep them open. Some few 
persons of weak digestive and nervous 
power cannot take a large draught, though 
they may a small one. Another most whole- 
some period for a good draught of water, 
with persons of tolerably good nervous 
power, is just before dinner. Many, how- 
ever, commit the error of drinking water 
too largely with their meals. This acts in- 
juriously by washing down the food insuffi- 
ciently masticated, by giving a sort of arti- 
ficial appetite, so that more than enough is 
consumed, and injures digestion by lower- 
ing the temperature of the stomach. Too 
large a draught of cold water when the 
body is heated — especially if exhausted — it 
is well known, is apt to prove serious, per- 
haps fatal. — See Shock. In disease, both as 
an external application, (see Ablution — Af- 
fusion, §c.,) and as an external remedy, 
water is most valuable ; and, indeed, in 
febrile diseases attended with much thirst, 
may be allowed largely with the greatest 
benefit. Moreover, pure cold water is gene- 
rally preferred, at least for a time, to all 
the artificial drinks. There is among the 
poor, and even among others, an unaccount- 



WAT 



569 



WE A 



able prejudice against allowing the sick to 
drink cold water. There need be no fear 
when it is craved by feverish thirst ; indeed 
few febrifuges excel it as a remedy. 

In conclusion, other sanitary arrange- 
ments and regulations are comparatively 
useless, without a good and easily accessi- 
ble supply of pure water ; without it, clean- 
liness in person, or clothes, or house, is im- 
possible, sewerage arrangements cannot be 
properly carried out ; and, in short, welfare, 
both physical and moral, it might be said 
spiritual, depends upon it. 

Refer to Diluents — Baths — Cold — Heat — 
also to sanitary articles generally. 

WATERS, MINERAL.— A mineral water 
is one which differs from the fluid as it usu- 
ally flows from the earth, in possessing, na- 
turally, sensible taste or smell, or a higher 
temperature than ordinary. 

Mineral waters are usually divided into 
Saline — Chalybeate — Sulphureous — Acidu- 
lous — and Hot. The principal mineral 
springs in Britain are adverted to under 
separate articles in the present work ; those 
who desire more information will find it in 
the useful publications of Mr. Lee on the 
Watering Places, Baths, &c, of both this 
country and the continent. [Those in the 
United States are chiefly found in the States 
of New York, Virginia, and Kentucky, and 
the American reader will do well to consult 
the work of Dr. Bell, of Philadelphia, on 
Baths and Mineral Waters.] 

WATER-BEDS and CUSHIONS. — See 
Bed, Elastic. 

WATER-DRESSING-.— See Dressing. 

WATERBRASH — Pyrosis — Is a dis- 
order characterized by copious vomiting of 
clear fluid — either sourish or tasteless — 
from the stomach. It is a frequent accom- 
paniment of chronic indigestion, and those 
who live much on innutritive vegetable food 
are peculiarly liable to it. Before the fluid 
is brought up, there is often pain, more or 
less severe, experienced at the pit of the 
stomach. Improved diet, and the treatment 
of indigestion generally, are the most suit- 
able measures. Under article "Saliva," an 
affection which is generally confounded with 
waterbrash is alluded to. 

Refer to Indigestion. 

WATER IN THE CHEST— [Hydrotho- 
rax] — Is the effusion or throwing out of the 
watery or serous portion of the blood into 
the cavity of the pleura between the lungs 
(see Lungs) and ribs. Such an occurrence 
may be the effect of two different causes ; 
the most usual, especially when the water 
forms rapidly, being inflammation of the 
pleural covering of the lungs, or pleurisy. 
2x2 



— See Inflammation. In this case the effii' 
sion of fluid is usually confined to one side 
of the chest. 

Water in the chest, however, especially in 
the aged, may be caused by affection of the 
heart or lungs, and obstructed circulation, 
in which case it often occurs on both sides, 
and is accompanied with other dropsical 
symptoms. — See Dropsy. The difficulty of 
breathing, caused by a collection of water 
in the chest, is often extremely distressing, 
and is liable to be aggravated or relieved by 
particular positions of the body. When the 
effusion is large, it very perceptibly bulges 
out the side on which it is situated. When 
there is air as well as fluid in the cavity, 
slight shaking of the body causes a very 
audible splashing sound. These symptoms, 
however, more generally follow after pleu- 
risy. 

It is not likely that an unprofessional per- 
son could detect the presence of water in 
the chest ; suspicion of such being the case, 
should at once cause proper medical assist- 
ance to be sought ; in the mean time, the pal- 
liative remedies recommended in "Dropsy" 
may be resorted to, and if the breathing is 
very distressing, and the patient not very 
debilitated, a large blister may be applied 
over the chest, as a means of affording tem- 
porary relief. 

Refer to Dropsy — Lungs — Inflammation. 

WATER IN THE HEAD. — [Hydro- 
cephalus.] — See Brain. 

WATER STROKE.— A rare form of "wa- 
ter in the head," characterized by its very 
sudden development. It has invariably 
proved fatal. 

Refer to Brain. 

WAX — Is a secretion of the bee, formed 
from the sugar which it collects, or with 
which it may be fed, and is not, as usually 
has been imagined, formed from the pollen 
or flower-dust. When first formed it is said 
to be quite white, becoming yellow from 
contact with the honey. In this yellow con- 
dition it is, when the combs are melted to- 
gether, the common beeswax of the shops. 
It is, however, purified and bleached for 
medicinal purposes, and is then generally 
met with in the form of round white cakes. 
Wax is now only used in medicine in the 
formation of, and for giving consistence to, 
plasters, ointments, &c. 

WEANING. — The weaning of infants 
must depend upon two considerations, the 
condition and health of the mother or nurse, 
and the age of the child. If the mother be 
in such a condition of health that she can- 
not nurse her infant, with benefit either to 
herself or it, weaning of course must take 



WEA 



570 



WHI 



place at once ; but in the generality of cases, 
the proper time is about the ninth or tenth 
month, when the first four teeth have ap- 
peared. Indeed, the development of the 
teeth may be taken as the signal that other 
food is required ; if, therefore, their ap- 
pearance is delayed, suckling may in most 
instances be prolonged, for the reason that 
the late appearance of the teeth is frequently 
associated with delicacy of constitution, and 
then it is desirable for the child to be kept 
longer at the breast. 

Previous to weaning, the child should be 
gradually accustomed to other food. It is 
desirable for weaning to take place in fine 
weather, when the infant can be carried a 
good deal out of doors. Should disorder of 
the bowels or other symptoms of illness 
arise, it must be managed as recommended 
under article " Children," to which the 
reader is referred. 

Refer also to Nurse. 

WEATHER.— See Climate— Seasons, &c. 

WEEPING EYE— Is the flow of tears over 
the cheek, in consequence of the lachrymal 
sac and passage into the nose being ob- 
structed. [It often requires an operation 
to cure it.] 

Refer to Eye. 

WEIGHTS and SCALES— Are most ne- 
cessary adjuncts to the domestic laboratory, 
&c. As all, probably, are aware, the weights 
used in the dispensing of medicines are spe- 
cial for the purpose, constituting apotheca- 
ries' weight. In apothecaries' weight the 
pound and ounce are the same as in Troy 
weight ; that is to say, the pound contains 
5760 grains, or twelve ounces of 480 grains 
each. Instead, however, of the ounce being 
divided into pennyweights, it is divided into 
eight drachms (or drams) of sixty grains 
each, each dram containing three scruples 
of twenty grains each. The following table 
illustrates these divisions, and also the 
peculiar signs of the various divisions em- 
ployed by medical men : — 

Symbol. Grains 

One pound lb.. ..12 ounces 57C0 

One ounce ^i... 8 drams 480 

One drachm or dram gi ... 3 scruples 60 

One scruple Qi... 20 grains 20 

One grain gr. i. 

The weight itself is simply signed thus, 
^ ; the additional mark thus, Bji, stands for 
one, or thus for ,^ij ; so with grains, it is 
gr. i, or gr. ij, or gr. iij, as the case may be. 
When it is desired to express half a weight, 
it is written thus, gss, or T)ss. The weights 
themselves are always made of brass, the 
grains in thin plates stamped with as many 
dots as they "weigh grains, the heavier 



weights with the character of each : weights, 
however, are made, the grains with the num- 
bers in figures, and the others with both 
figures and the name legibly stamped upon 
them. Unprofessional persons who may 
forget, or who may become confused with 
the characters, will find it more advan- 
tageous to provide themselves with weights 
of the latter kind. 

The scales employed for dispensing medi- 
cine are generally of brass, and should be 
of a convenient small size, care being taken 
to ascertain that they weigh true. After 
these scales have been used, they should 
always be well wiped — otherwise they are 
apt to become corroded. On account of this 
tendency, the scale "pans" are sometimes 
made of glass, and also of the metal plati- 
num ; but the former are of course liable 
to get broken, and the latter are very ex- 
pensive. Neither are requisite ; the brass 
are perfectly sufficient, with the most ordi- 
nary care. 

WEN. — The popular name for'a tumour, 
especially when situated about the throat. 
— See Tumour. 
WHEAT.— See Bread— Grains, &c. 
WHEY.— See Mile:. 
WHITE-LEG— [Milk-Leg.]— See Leg. 
WHITE-SWELLING.— See Knee. 
WHITES— Called by medical men Leu- 
corrhea. — This extremely common and trou- 
blesome female discharge may occur in a 
variety of constitutional conditions and cir- 
cumstances, but more generally it is asso- 
ciated with general debility, and almost 
certainly so, if it has continued profuse for 
any length of time. For the latter reason, 
it ought not, as too often is the case, to be 
neglected, for not only may the constitution, 
the general health and strength, be fatally 
injured by it, but a comparatively mild and 
easily removable affection may be con- 
verted into one of an inveterate and serious 
character. 

The importance of these remarks may be 
imagined, when it is stated that Dr. Ash- 
well, one of the highest authorities on these 
subjects, says, "Of all the diseases peculiar 
to the sex, there is none so common. Few 
married women, particularly if they are 
mothers, escape its attacks." By the same 
authority, the varieties of the affection are 
divided into the mild, acute form, accom- 
panied with more or less inflammatory ac- 
tion ; the chronic and inveterate or habitu- 
ally established leucorrhea ; and the va- 
riety symptomatic of other diseases, as of 
the womb, &c. 

An acute or inflammatory form of < ' whites" 
may arise in those who are in tolerable health, 



WHI 



571 



WHI 



the symptoms being so mild that they are 
either unattended to, or are quickly removed 
by rest in every sense of the word, local and 
general, by cleanliness, and by such anti- 
phlogistic means as reduced diet and gentle 
aperients, especially mild salines, with per- 
haps one or two doses of gray powder, at 
bedtime. 

In those of plethoric habit, especially in 
the middle periods of life, the inflammatory 
symptoms may be of greater severity, re- 
quiring the above treatment to be more 
vigorously carried out, and combined with 
fomentations, hip-baths, and leeches ; at the 
same time, in such cases, whether mild or 
severe, it will be advisable both to cleanse 
and soothe the internal parts, by the use of 
tepid water and a syringe. When all in- 
flammatory symptoms have disappeared, 
some astringent wash may be substituted 
for the simple water, and used either cold 
or tepid, whichever appears to be most bene- 
ficial. Some of the forms of lead lotion 
(see Lead) answer well ; or one made with 
five or six grains of sulphate of zinc to the 
ounce of water ; or an alum wash in similar 
proportions to the last, or decoction of oak 
bark, or of green tea ; in short, any mild 
astringent. It must be remembered, how- 
ever, that in all cases, the strictest cleanli- 
ness is absolutely requisite, both as preven- 
tion and cure. Indeed, the neglect of this 
is one of the most frequent causes of the 
disease. When whites occur in a weak in- 
dividual, they may, (being unaccompanied 
with any inflammatory action,) require the 
use of astringents from the first, with tonics, 
mineral acids, quinine, and iron, with good 
diet, and wine, or malt liquor; probably also 
tepid or cold salt-water hip-baths. The 
bowels in all such cases require strict at- 
tention, and should be regulated by castor- 
oil, rhubarb and magnesia, or by cold clys- 
ters. In tolerably strong habits, small doses 
of Epsom salts, in combination with sul- 
phuric acid, answers extremely well. Due 
attention should of course be given to exer- 
cise, and rest at nights must be taken upon 
a hard bed. 

In the milder attacks of leucorrksea, a 
little well-applied domestic management 
will often be sufficient to remove the symp- 
toms ; but when these become in the least 
urgent, a medical man ought to be consulted, 
before the disease becomes habitually local. 
To allow of its continuance, from motives of 
mistaken delicacy, or from carelessness, is 
a serious, it may be a fatal mistake ; for, as 
stated above, its continuance gradually un- 
dermines the powers of the constitution, and 
dropsy, consumption, and other diseases of 



debility, may be originated in consequence. 
Moreover, when family is desired, the wish 
is not so likely to be accomplished as long 
as the discharge continues, and miscarriage 
is more liable to occur. The ordinary func- 
tion of menstruation, moreover, is apt to 
become deranged. — See Menstruation. 

As a further reason for submitting con- 
tinued or severe cases of the affection in 
question to the care of medical men, is the 
fact of the white discharge being at times 
symptomatic of disease connected with the 
womb. Sometimes, however, it is the result 
of irritations in the bowels, caused by ac- 
cumulations in them, and sometimes by 
worms. To sum up, it should be remem- 
bered, that the disease is often the result 
of neglect and want of sufficient cleanli- 
ness ; that it may occur in a form more or 
less inflammatory, when it requires sooth- 
ing remedies ; that after the inflammatory 
stage, and often without it, especially in the 
debilitated, it requires astringent and tonic 
treatment, rather than relaxing; that if 
neglected, it is liable to become an obsti- 
nate disorder, and, by its continuance, seri- 
ously to injure the constitution; and that it 
may be symptomatic. Lastly, that in all 
but the mildest cases, the nature of the dis- 
ease requires proper medical treatment, and 
perfect rest in every sense. This article 
cannot be concluded without the fact being 
alluded to, that the occurrence of the dis- 
ease in its aggravated form, and the occa- 
sional consequences it then gives rise to, 
have been the means of raising unfounded 
suspicions of moral impurity, and of creat- 
ing discord where it ought not to exist. 
Never ought such ideas to be entertained 
for one moment in the mind, still less given 
in words, except when based upon the care- 
ful examinations and opinions of more than 
one medical man. 

Kefer to Menstruation. 

WHITEWASHING— By means of lime, is 
one of the most powerful means of general 
household purification which it is possible 
to employ, especially on the large scale on 
which such purification is often required in 
the dwellings of the poorer classes, particu- 
larly in towns. Lime absorbs powerfully 
the carbonic acid from the atmosphere ; and 
in this, and probably in other ways, tends 
greatly to remove the most fertile sources 
of disease. 

The effect of whitewashing with lime in 
this way could not be more strikingly shown 
than it was in one of the recent epidemics 
of fever in Edinburgh. According to Mr. 
Ramsay's Report to the Commissioners of 
Police, " The business of whitewashing was 



WHI 



572 



WHI 



commenced on the 14th of September, and 
continued to the 30th of October, and less 
extensively up to the 14th of December," 
during which period, he states, there were 
washed — 

"690 staircases, 
1531 passages, 

2120 apartments, exclusive of 
1212 places cleaned previous to that 
date, making a total of 5553 different places, 
at a total expense of £77." Mr. Ramsay- 
further states, " The effect of these lime- 
washings on the epidemic has been matter 
of great interest to myself; and I have 
watched with the most anxious care to as- 
certain whether any new cases of fever oc- 
curred in dwellings previously subjected to 
purification ; and I have pleasure in saying, 
that out of a great number of cases reported 
to me, with two exceptions, the whole turned 
out to be cases of relapse." 

Beyond these, Mr. Ramsay failed to dis- 
cover any other cases. The above is strong 
evidence. It might render it a question for 
boards of guardians and others, whether, 
to supply gratuitously every necessitous oc- 
cupier of a house with lime sufficient to 
whitewash once, if not twice a year, might 
not be real economy, and diminish poor- 
rates, as well as disease. Moreover, it has 
been pointed out, that free light, and light- 
coloured walls, tend to promote health ; in 
this way, the white colour of lime-wash 
must be an additional counter-agent to 
causes of disease. 

Refer to Houses— Light — WaUs. 

WHITLOW — Is abscess of a finger or 
thumb, but in this situation is rendered ex- 
tremely distressing, and even serious, as 
regards the use of the member, in conse- 
quence of the matter being generally con- 
fined by the firm skin, and subjacent firm 
fasciae or fibrous membranes which are con- 
nected with the tendons, by means of which 
the fingers are moved. The matter often 
has great difficulty of reaching to the sur- 
face, and of being discharged, and probably 
lies next the bone. The consequence of all 
this, especially if the inflammation is very 
acute, is to give rise to disease of the bone, 
or to mortification of the finger generally ; 
in either case, the member is rendered worse 
than useless, or requires amputation. Whit- 
lows are certainly more common in those 
who employ their hands in hard labour, also 
in cooks and individuals who are exposed to 
wounds from bones, &c. 

The symptoms are deep-seated throbbing 
pain in the affected member, which con- 
tinues increasing till it becomes almost in- 
tolerable ; the finger feels "ready to burst," 



and if examined, the skin is found tense 
and hard, and more or less inflamed. If no- 
thing be done to remedy this state of things, 
the symptoms increase, the whole arm be- 
comes affected, is more or less swollen and 
inflamed, especially in the course of the 
absorbent vessels, (see Absorbent,) and the 
glands in the arm-pit are swollen and pain- 
ful. At last the matter finds exit some- 
where, by the skin becoming ulcerated, not 
unfrequently about the nail. When this 
happens, there is relief to the severe symp- 
toms, but probably so much mischief has 
been done to the member, that the results 
above described — mortification or death of 
the bone and the finger — occur, and it is 
lost. To prevent such a serious conse- 
quence, it is needless to say that active 
measures should at once be resorted to, and 
the case seen by a medical man as soon as 
possible. 

On the first symptoms of whitlow occur- 
ring, however, the disease may in some cases 
be arrested at once, by thoroughly rubbing 
over the whole of the affected member with 
lunar caustic. This proceeding, however, 
must be resorted to at once, and accompanied 
with reduced diet and active purging, with 
blue pill and black draught. It must be con- 
fessed, too, it is more efficacious in those 
the skin of whose fingers has not been hard- 
ened by labour, and in whom the disease is 
generally least severe. But the most ef- 
ficacious proceeding in whitlow, when there 
is evidence of matter having formed, (see 
Inflammation — Pus,) is to lay open the finger 
down to the bone, by means of a lancet or 
knife. This proceeding, of course, ought 
to be done by a medical man if possible, but, 
under circumstances, it might be resorted to 
by an unprofessional person. It is certainly 
attended with great momentary pain, but 
gives otherwise very great relief, and often 
saves a finger. After it is done, the ordi- 
nary treatment of abscess, poultice and 
water-dressing, will be requisite. When 
from timidity on the part of a patient (al- 
though chloroform might certainly be used) 
or other cause, a whitlow is not opened early, 
the only proceeding is to poultice assiduously 
till the matter finds vent, to support the 
hand and arm in a sling, to regulate the 
bowels, and to soothe the excessive suffering 
by opiates. After the matter is discharged, 
poultice for a short time, followed by water- 
dressing, will be most suitable, if the finger 
is saved. In some of these cases, the simple 
poultice or water-dressing requires shortly to 
be exchanged for a more stimulating and as- 
tringent application. None answers better 
than tincture of myrrh, in the proportions 



WIL 



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of from two drachms to one ounce to the 
half-pint of water. 

WILLOW-BARK.— See Salicine. 

WIND. — See Flatulence. 

WINDPIPE.— See Lungs. 

WINE — Strictly speaking, is the fer- 
mented juice of the grape alone. It, or 
rather sherry wine only, is used medicinally 
to form a vinous tincture, or "wine" of 
various drugs. The most commonly used 
preparations are the wines of aloes, of anti- 
mony, of colchicum, of ipecacuanha, and of 
opium. — See Articles. For the dietetic pro- 
perties and uses of wines, the reader is re- 
ferred to Stimulants. 

WISDOM-TOOTH.— See Teeth. 

WOMB. — In medical language, the Uterus. 
This most important organ is, in its ordi- 
nary condition, situated in the cavity of 
the pelvis, but when distended, as in preg- 
nancy, it rises into the cavity of the abdo- 
men. — See Abdomen. Somewhat triangular 
in form, it is covered by the general lining 
membrane of the abdomen and pelvis, the 
peritoneum, and is held in its place by va- 
rious ligaments. The affections of the 
womb may be considered as those which are 
connected with the state of pregnancy, 
(see Pregnancy ',) and those which are not. 
In the latter case it is liable, though rarely, 
to be the seat of inflammation, the affection 
being characterized by the usual symptoms 
of inflammation, local and constitutional, 
and requiring the same management as in- 
flammatory affection (peritonitis) of the 
bowels generally. Congestion of blood, en- 
largements, tumour, and polypus; diseases 
of its neck, including cancer, &c, are among 
the affections to which the womb is liable. 
It is also exposed to displacements, (dislo- 
cations as it were,) from before backward, 
or the reverse ; and, likewise to coming or 
"falling" down, or, as it is called, "pro- 
lapsus." The latter occurrence is the most 
usual after the time of child-bearing is 
past, in women who have borne large fami- 
lies, and especially in those who have neg- 
lected themselves after confinement, by 
getting up too soon. It is, therefore, a fre- 
quent complaint among the lower orders, 
who are in a measure forced to neglect 
themselves under the circumstances. The 
falling or prolapsus of the womb is per- 
mitted by general laxity of the parts, but 
especially of the ligaments which ought to 
retain the organ in place. It is further 
aggravated by the congested and enlarged 
state of it, which thence results. Such a 
state of matters cannot be too soon recti- 
fied, and by all means ought to be placed 
under the management of a medical man, 



who will recommend such a one of the va- 
rious instruments contrived for such cases, 
as may appear most suitable. In the mean 
while, rest in the horizontal posture, and 
general soothing treatment, are the best 
palliatives. And if, in the mean time, cir- 
cumstances render it impossible for the in- 
dividual to remain quiet, comfort will be 
derived from the use of such a bandage as is 
represented in the article " Prolapsus." The 
other displacements of the womb, backward 
or forward, are more usual in its enlarged 
condition — in pregnancy especially ; the 
former is often the result of permitting the 
bladder to become unduly distended, so that 
by its weight it presses the womb out of 
place, and into such a position that it can- 
not easily recover itself. In these, and in- 
deed in all affections of this organ, the as- 
sistance of a medical man cannot be too 
soon procured. Domestic treatment can do 
little or nothing for their permanent relief, 
although it may, if properly directed, pal- 
liate considerably the more urgent symp- 
toms. The affections of the womb may of 
course develop with greater or less rapid- 
ity ; some are sudden in their onset, and 
urgent in their symptoms ; others arise al- 
most imperceptibly, and go on slowly. La 
most cases, however, there is sense of un- 
easiness and dragging weight about the 
parts, perhaps actual pain of more or less 
severity ; the functions of the bladder may 
be interfered with, and irritability or diffi- 
culty occasioned ; or difficulty or pain be 
experienced in emptying the bowels. Under 
some circumstances, discharges of blood or 
matter may take place. — See Menstruation — 
Whites, $c. The constitution may sympa- 
thize more or less, and irritable fever arise, 
or obstinate vomiting, or dyspepsia, with 
excessive nervous irritability and hysteria. 
Under circumstances, when symptoms like 
the above, or others suspected to be in con- 
nection with the womb, show themselves, 
an individual can scarcely err in assuming, 
if possible, entirely the horizontal posture. 
If there is much pain, and especially any 
symptoms of feverishness, fomentations to 
the lower bowels, perhaps leeches, may be 
used; and when the suffering is great, 
opium given by the mouth or in clyster. At 
the same time, the strictest attention must 
be paid to the due action of the bowels, by 
means of castor-oil, senna, &c, or, in full 
habits, by salines, perhaps following mode- 
rate doses of blue-pill ; but all preparations 
containing aloes must be sedulously avoided. 
Clysters of cold, tepid, or warm water simply, 
or rendered more aperient by the addition of 
medicines, are often useful. The diet must 



WOM 



574 



WOE 



be regulated according to the habit and con- 
stitution of the patient. If this be full, a re- 
duction, especially in stimulants, may safely 
be made ; but if the habit be moderate, the 
diet may be kept so too. In the weakly and 
debilitated, it may require to be increased, 
especially if there is any drain, such as 
discharge of blood, &c, going on. — See 
Abortion — Menstruation — Whites, §c. The 
above are palliative measures, which may 
be safely resorted to under most circum- 
stances. They are, however, palliative only. 
Curative means can only be carried out by 
a medical man, under whose care all affec- 
tions of this organ, so closely connected 
with female health, happiness, and well- 
being, should be placed without delay — 
without waiting for serious symptoms to 
arise. Moreover, it should be remembered, 
that there are states of impaired health, of 
a dyspeptic and nervous character espe- 
cially, dependent on uterine derangement, 
which in itself gives no marked sign. 

In some affections of the womb, it be- 
comes absolutely necessary for a medical 
man to resort to means of examination, 
which, though they cannot fail to be highly 
repugnant to the feelings, no woman of 
truly delicate and pure mind would object 
to, when it has been fully explained to her 
by a professional attendant in whom her 
confidence is placed, that such examination 
is positively required. It may be that the 
zeal of some has led them to disregard, 
perhaps too much, the feelings of patients 
suffering from these peculiar diseases, and 
to be too ready to avail themselves of all 
means of investigation — but these are the 
exceptions. 

WOMAN. — See Child-birth — Education 
— Menstruation — Pregnancy — Whites, 
&c. 

WOOD-SORREL.— See Oxalic Acid. 

WOOL and WOOLLEN CLOTHING.— 
See Clothing. 

WORMS. — There are various parisitic 
animals which infest the human body. Some, 
such as the acari, occupying the external 
surfaces only, while others, called by medical 
men " entozoa," are developed and live in 
the interior of the body. Of these the 
commonest and best known are the five 
species of " worms" which infest the ali- 
mentary canal. They are the common 
round worm ; the thread, or maw, or chest 
worm ; the long thread-worm ; the common 
tape-worm, and the broad tape-worm. 

The common round worm of the intes- 
tines was for long confounded with the 
common earth-worm, although it is difficult 
to imagine how it could be. It is firmer in 



substance, and much more acutely pointed, 
at both ends than the latter, of a paler 
yellowish pink, and more transparent. Its 
length varies from a few inches to a foot. 
This worm is more common during the 
early periods of life, and exists in many 
children without giving rise to any apparent 
disorder, unless it is developed in great 
numbers ; very frequently, perhaps, after a 
dose of aperient medicine, a round worm is 
passed from the bowels by a child in whom 
such a parasite was not suspected to exist. 
The occurrence not uncommonly causes 
much needless alarm ; a very large number 
of children, to all appearance well, are so 
infested, and the excretion of one worm is 
no proof that there are more. At the same 
time the occurrence should always give rise 
to investigation, and to the employment of 
remedies calculated to remove any more of 
the animals which may exist. The usual 
site of these round worms is in the small 
intestines ; but, occasionally, they find their 
way into the stomach, and are vomited or 
got rid of by the mouth ; most commonly 
they pass off by the bowels. 

The thread or maw or chest [seat] worms 
are familiar to most persons ; they resemble 
long maggots, or bits of white thread, and 
are very lively in their movements when 
first expelled. These worms usually infest 
the lowest bowel, or rectum, in which they 
often exist in immense numbers, passing 
off with every evacuation, either separate 
or rolled in masses ; they also creep from 
the bowels ; they are found too, occasion- 
ally, in the upper part of the alimentary 
canal — hence the name of chest-worm popu- 
larly given. In this case the worm is 
coughed or "hawked" up. The thread 
worm is most commonly met with in chil- 
dren, but also occurs in adults, especially 
such as are weak and unhealthy. The 
long thread-worm does not occur in the im- 
mense numbers of the smaller variety, but 
seems to exist in most persons without 
causing much inconvenience. The tape- 
worms are quite the most formidable, and 
produce the most serious consequences of 
any of the intestinal parasites. The broad 
tape-worm occurs chiefly on the continent. 
The common tape-worm, (fig. cxlii.,) which 
is usually met with in this country, grows 
to many feet in length, extending, indeed, at 
times, almost throughout the entire length 
of the intestines. It is, as represented, flat 
and jointed, the edges of the joints being 
somewhat waved. At the head (fig. cxlii. 1) 
it becomes much tapered, but, downward, 
increases in breadth, sometimes to as much 
as half an inch or more, again tapering off 



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575 



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toward the tail. In colour, it is a dirty- 
white. Generally, one worm only exists in 
the bowels at a time, but sometimes there 
are more. 

The symptoms caused by the different 
species of worms are in some respects si- 
milar ; they are, more or less emaciation 
although the appetite is good, unhealthy 
hue and pallor of the skin, furred tongue, 
and unpleasant breath, ahd frequent griping 
pains in the bowels, which are irregular — 
the chief characteristic of the evacuations 
being increased secretion of mucus, with 
perhaps an inclination to sliminess. Itch- 
ing and picking of the nose in children is 
often set down as indicative of the presence 
of worms, but it is also a symptom of intes- 
tinal irritation from other causes ; it can- 
not, therefore, be considered as conclusive. 
Indeed, it is a question whether any symp- 
tom except the appearance of worms in the 
evacuations can be considered positive. 
The appetite is apt to be capricious, and 
there are symptoms of general digestive 
disorder. Some patients complain of feel- 
ing the movements, but (except in the case 
of tape-worm) this is probably imaginary. 
Pei-haps some of the most important effects 
produced by worms are those which result 
in irritation of the nervous system. Chil- 
dren more particularly exhibit them. They 
grate their teeth at night, talk in sleep, or 
wake up screaming ; they are irritable and 
fretful. In other cases, various convulsive 
or spasmodic affections, such as St. Vitus's 
dance, squinting, stammering, obstinate 
cough, and many others, have been dis- 
tinctly traced to the presence of worms. 
The thread-worm, in addition to constitu- 
tional irritation, causes much inconvenience 



from the constant and sometimes intolerable 
itching it gives rise to about the fundament. 
The tape-worm seems to cause more uneasi- 
ness in the bowels than the other varieties, 
and its occurrence is certainly characterized 
by more emaciation and general debility. 

The origin of worms in the intestinal 
canal is unexplained, although many causes 
which favour their occurrence are assigned. 
The water which is habitually drunk, the 
diet, especially if it consists of a large pro- 
portion of vegetable aliment, &c, have been 
cited as causes ; but perhaps no special ori- 
gin can be proved, unless it be the depriva- 
tion of salt, which certainly has appeared, 
in the case of prisoners punished in this 
way in Holland, to favour the formation 
of worms. Debility, from whatever cause 
arising, is undoubtedly the condition which 
chiefly favours the generation of these pa- 
rasites. 

To get rid of worms, two sets of remedies 
— purgatives and tonics — are requisite ; the 
first to clear away the offenders, the latter 
to correct the debility which usually favours 
their existence. 

For the round worm, the best purgatives 
for children are calomel and scammony, or 
calomel and jalap, given at intervals of a 
few days, so as to purge briskly ; the tonic 
— and some preparation of iron is generally 
the best — being given in the intervals. At 
the same time the diet should be strength- 
ening, well seasoned with salt, and ought 
to include a due proportion of fresh animal 
food. In the case of the thread-worms, the 
same general treatment is advantageous ; 
but as they chiefly inhabit the lower bowels, 
their removal is much facilitated by the use 
of clysters, either of salt-water, or of some 
bitter infusion, or of turpentine, the latter 
being more applicable in the case of adults. 

For the cure of tape-worm, many reme- 
dies, and especially turpentine, have been 
used, but now they may safely be said to be 
reduced to two — the kousso and the fern, to 
the articles on which the reader is referred. 
— See also Pomegranate. [The efficacy of 
pumpkin-seeds has been already referred 
to. — See Tape-worm.'] 

WORMWOOD.— This common plant, 
known by its many cut leaves, silky on the 
under sides, and by its strong odour, is not 
much used in medicine at the present time, 
although it is a good aromatic bitter and 
tonic. The tops should be collected early 
in August and dried. Half an ounce may 
be infused in a pint of water, and of this a 
teacupful taken twice a day. 

WOUNDS — Are separations of the sub- 
stance or tissues of the body, effected by 



— — — ^^— 



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576 



WOU 



violence. They may, as all are aware, be 
occasioned by a variety of causes ; accord- 
ing to these causes, therefore, they are usu- 
ally classified by surgeons into simple cuts, 
or "simple incised" wounds; into bruised 
and lacerated wounds ; punctured wounds ; 
poisoned and gunshot wounds ; the treat- 
ment of each variety being in some degree 
different, although there are certain general 
principles which must be observed in the 
management of all ; these ought to be im- 
pressed upon the minds of those who may 
be called upon to direct the management 
of such accidents, and no kind of medical 
or surgical knowledge, perhaps, is likely to 
prove more useful to unprofessional persons 
in out-of-the-way places. 

The first circumstance, generally, which 
calls for attention as the consequence of a 
wound is the effusion of blood, but none of 
the consequences, perhaps, exhibit greater 
variation. Sometimes an extensive injury 
may by inflicted, even the arm torn off at 
the shoulder, and yet the loss of blood be 
extremely small ; on the other hand, a punc- 
ture with a pen-knife, if it penetrates an 
artery, may be sufficient to place life in the 
greatest immediate jeopardy. As a general 
rule, probably, putting the opening of large 
vessels out of the question, a greater amount 
of blood is lost after simple cuts than after 
any other description of wound. When 
laceration or bruising takes place, there is 
usually, by stretching, or otherwise, of the 
coats of the arteries, a sufficient amount of 
mechanical impediment caused to modify 
greatly, if not wholly to prevent, any he- 
morrhage. As, under articles Artery and 
Hemorrhage, the various modes of arresting 
the effusion of blood have been fully entered 
into, it is unnecessary to reiterate them 
here. When a wound is small, the best 
method of treatment is to tie it up at once 
with a piece of linen rag; this is usually 
sufficient at once to stop the bleeding, par- 
ticularly if rest and position (see Position) 
are attended to ; the small quantity of blood 
which may exude, quickly dries upon the 
wound, and forms a kind of glue which 
effectually excludes the air. As no better 
dressing can be used, it may be left on till 
the cut is well ; in some cases, before using 
the linen, it may be advisable to draw the 
edges of even a small cut together, by 
means of adhesive plaster, or material of 
some kind. — See Plaster. Although linen is 
mentioned in the above directions, of course, 
should it not be at hand, soft calico may be 
used, or other soft material. 

When a wound is extensive and the bleed- 
ing profuse, it will not do to bind it up in 



this way ; first, because it probably would 
not be sufficient to arrest the flow, and if it 
did so ultimately, it would retain a large 
amount of clotted blood, either in or about 
the wound, in such a way as to interfere 
with the healing process. In a large wound, 
therefore, it is necessary that the bleeding 
should be almost entirely arrested (see He- 
morrhage) before it is dressed, that is, closed 
up, &c. 

The first end in view when a wound is 
dressed, is to get as much of it as possible, 
to heal by the "first intention," or by " ad- 
hesive inflammation." — See Adhesion, that 
is, to get the several parts to adhere at once, 
without formation of matter, and thus with 
as little pain and trouble as may be. When 
the wound is a simple cut, such as that made 
by the surgeon's knife, this desirable termi- 
nation may be expected, and often realized; 
even the extensive surfaces exposed in am- 
putation of the thigh will heal in this way 
almost entirely ; to attain the end, however, 
in many wounds, considerable care is re- 
quisite. In the first place, the wound must 
not be closed so soon as that a clot of blood 
will form between the exposed surfaces ; if 
it does, unless extremely thin, it will pre- 
vent union. In the second place, when the 
wound is closed, its surfaces must be placed 
in as accurate a position as possible, and 
must be thus held together till the process 
is complete. To effect and maintain this 
apposition or contact, various agencies are 
employed, and of these, position is not the 
least important, (see Position,) that is, the 
placing of the parts so that the surfaces of 
the wound may, as far as possible, fall into 
contact, and that, when other dressings are 
applied, there may be no dragging to get 
things to meet. Thus, in a wound of the 
forepart of the neck, it is requisite to fasten 
the head so as to prevent its being thrown 
back. — See Cut-throat. At the same time, 
position must be regulated with a view to 
prevent hemorrhage. The wounded parts 
being properly placed, the next object is to 
draw the surfaces into as close apposition as 
possible ; in some cases, this is sufficiently 
well done by means of strips of adhesive 
plaster, (fig. cxliv. 1,) placed at such inter- 
vals as will permit discharge of matter, 
should any form. Frequently, however, 
from the nature, site, or extent of the 
wound, plaster is not sufficient to keep the 
edges together, or to counteract the natural 
resilient tendency of the skin to retract 
when severed. In such instances, stitches, 
or, as they are called by medical men, 
"sutures," are employed. These consist 
of a piece of sufficiently stout silk or linen 



wou 



577 



WOU 



thread passed through the thickness of the 
true skin, (fig. cxliv. 2,) at about the dis- 
tance of a line from each of the severed 
edges. The thread is passed by means of a 
curved surgical needle, (fig. cxliii.,) and the 
.Fig. cxliii. 




Fig. cxliv. 

two ends being tied as represented, (fig. cxliv. 
2,) bring the edges together, and retain them 
most effectually in contact ; that is, provided 
the stitch is not made use of to drag parts into 
place : this it should never do. If there is a 
continued strain upon the sutures, not only 
do they cause much pain, but they quickly 
cause ulceration, which, by detaching, ren- 
ders them perfectly useless. The surfaces 
of a wound having been brought into con- 
tact, a piece of thin linen, soaked in water, 
should be placed over it, and if possible, a 
lightly applied bandage. This not only 
keeps the dressing in place, and assists to 
exclude air, but gives support, which is al- 
ways serviceable, and often, in large wounds, 
absolutely necessary. The bandage may be 
kept wet with cold or tepid water, as most 
agreeable to the feelings of the patient. 
When a wound progresses well toward re- 
covery, when there is no appearance of 
discharge, or so little that it is neither in- 
convenient nor offensive, there should be no 
meddling ; the less the processes of repara- 
tion are disturbed the better, and in some 
cases a week may be allowed to elapse 
before the dressings are disturbed ; they 
may of course require it before, especially 
in warm weather. — See Dressing. It ought 
to be remembered, that in the treatment 
of all wounds, it is important to exclude 
the action of the air as far as possible ; and 
2Y i 



it should be taken as an aphorism, that 
rest, simplicity, and cleanliness are the 
great promoters of healing ; the last being 
best attained by the use of water alone. 
No balsams or similar applications should 
be employed ; and, except it be a little per- 
fectly sweet fresh lard occasionally, oint- 
ment may be entirely dispensed with. 

The above observations have been directed 
specially to simple incised wounds ; when 
laceration or contusion accompanies the in- 
jury, the principle must be to get the wound 
as much into the condition of a simple inci- 
sion as possible. To do this — the wound 
having been thoroughly cleansed from dirt, 
grit, &c, by means of a soft sponge and 
water, and any foreign body which can be 
easily reached, removed — all parts not abso- 
lutely detached from the body are to be 
placed as nearly as possible in the natural 
position, stitches and plasters being used to 
retain them, and free exit left for the dis- 
charge of matter ; over these there must be 
applied either poultice or water-dressing, 
and a bandage may be necessary or not, ac- 
cording to circumstances. 

Lacerated and contused wounds are al- 
ways followed by more or less inflammation, 
with discharge of matter, and frequently by 
mortification of some of the injured parts. 
Often in different portions of the same wound 
may be seen simple adhesion, suppuration, 
and mortification going on at the same time. 
In consequence of these changes, the' dress- 
ings of lacerated wounds require frequent 
renewal, the greatest cleanliness being ob- 
served. In the course of a few days, after 
the infliction of the injury, if any parts are 
killed, or mortify, it is indicated by their 
assuming the characteristic appearance, (see 
Mortification;) the wound in such cases is to 
be managed (modified, of course, by cir- 
cumstances) as directed in the above arti- 
cle. Such wounds, whether portions of 
the tissues have mortified or not, ultimately, 
(if they do well,) assume the characters of 
ulcers tending to heal, and require similar 
treatment. — See Ulcer. Punctured wounds 
are often more dangerous and troublesome 
to heal than their appearance would lead to 
be supposed. Their danger is, of course, 
commensurate with the importance of the 
parts wounded ; on this account such cases 
should always be seen by a medical man. 
Generally, a simple poultice or water-dress- 
ing is the most appropriate application. 
Rest, too, should always be observed, and 
low diet, at least till proper advice has been 
procured. A wound from a barbed instru- 
ment, such as a fishing-hook, may be re- 
ferred to the class of punctured wounds. 



wou 



578 



YEL 



The best mode of extraction is to cut off the 
dressing of the hook, if there be any, and 
to push it entirely through by the shank. 
Gunshot wounds partake more or less of 
the nature of lacerations and contusions. 
When small shots have entered beneath the 
skin, any that can be very easily detached 
may be ; but it is well not to be too assi- 
duous on this point. In such cases, perhaps 
the best thing that can be done, till a sur- 
geon is procured, is to use means to check the 
bleeding; to place the sufferer in as easy and 
advantageous position as possible ; to apply 
poultice or water-dressing to the wound, and 
to counteract shock, (see Shock,) by the cau- 
tious administration of stimulants. Either 
in this case, or in that of any other wound, 
if there is much shock to the system, it 
must be counteracted, and, at the same 
time, if circulation in the wounded member 
is interfered with, means must be used to 
preserve sufficient natural heat, &c. 

Poisoned wounds are wounds in which the 
division of the tissues, or even the abrasion 
of the outer skin, is accompanied with the 
insertion of poison of some kind, whether 
that of a gnat or of a wasp, of a rabid 
dog or of a snake. The wound in itself is 
generally trifling, perhaps not more than a 
scratch, but its character depends upon the 
nature of the poison inserted ; a slight mo- 
mentary pain or itching maybe the greatest 
inconvenience, or speedy death may follow, 
or the poison may take days or weeks to 
develop, as it does in inoculated small-pox 
or hydrophobia. ' When an individual suffers 
from a wound known or believed to be poi- 
sonous, immediate steps should be taken 
to prevent, if possible, the poison being ab- 
sorbed into the system. The steps to be 
taken are sufficiently detailed in the article 
"Hydrophobia," and the minor applications 
to the bites of gnats, &c. will be found 
under " Stings." The most serious poisoned 
wounds which can be suffered from are 
those of the serpent tribe : they are not only 
quickly followed by extreme cold swelling 
of the limb, but by great or fatal depres- 
sion of the system generally. The latter 
consequence has been painfully illustrated 
in the recent instance of death in ninety 
minutes, of one of the keepers of the Zoo- 
logical Gardens, from- the bite of the cobra 
de capello, or poisonous hooded-snake of 
India. In addition to the local treatment 
of the wound, (see Hydrophobia,) continued 
friction with some oily material appears to 
be most generally useful, while, at the same 
time, stimulants are freely given internally 
to counteract the depression. Of course, any 
stimulant first attainable should be used; 



b«t ammonia appears to be most highly re- 
commended. In a communication in the 
Lancet, for October last, respecting the re- 
cent death from the cobra, by a gentleman 
at one time resident in India, it is stated, 
"So well aware are the native medical staff, 
and all intelligent natives, of the efficacy of 
ammonia in these bites, that they commence 
with it on the instant, not waiting for supe- 
rior advice." A teaspoonful of sal-volatile 
may be given every five or ten minutes in a 
wineglassful of water, till reaction is tho- 
roughly established. 

Such cases as the above are not common 
in England ; they sometimes, however, do 
occur in consequence of the bite of the adder 
or viper, the only species of poisonous snake 
common to this country. [In certain sec- 
tions of the United States, the bite of the 
rattle-snake is not a very rare accident. 
Cures have been accomplished by causing 
the patient to drink whisky until "dead 
drunk." Sometimes a quart of whisky has 
been required.] The common "ringed- 
snake" is harmless ; it has a yellow spot 
on each side of the neck, whereas the 
adder is of a dirty yellow colour throughout, 
marked with black spots, and the belly 
black. Poisoned wounds, such as those 
sometimes received in dissection by medical 
men, or by cooks and others who have to 
handle dead animal substances, are apt to 
give rise to symptoms resembling whitlow* 
and require similar treatment. — See Whit- 
low. They may, however, place life in much 
jeopardy by the constitutional affection they 
give rise to, and by causing the formation 
of abscesses in various parts of the body. 
Such, and indeed any severe cases of poi- 
soned wound, ought to be put under medical 
care without delay. 

Refer to Ammonia — Lock-jaio — Scalp, $c. 

YAWNING.— See Gaping. 

YAWS. — A peculiar tropical disease, ac- 
companied with a skin eruption. The ad- 
vice given under "Tropical Diseases" applies 
also to this affection. 

YEAST.— See Fever— Poultice. 

YELLOW FEVER.— This epidemic dis- 
ease, chiefly known as a visitant of the West 
Indies and of the shores of the North Ame- 
rican continent, but which has also visited 
Southern Europe, is characterized by many 
of the general symptoms of fever ;. there is, 
it is said, however, peculiar headache from 
the commencement, situated behind the eyes. 
The irritability of the stomach is a peculiar 
feature in the course of the disease, and the 
matter vomited often assumes the appear- 
ance of black coffee-grounds, known as the 






YEW 



579 



ZYM 



"black vomit." The occurrence of this, 
with suppression of urine, is considered un- 
favourable. The yellow colour of the skin 
is not invariable. The advice given under 
" Tropical Diseases" applies likewise to this. 
All that an unprofessional person could do 
in the absence of proper aid, would be to 
follow out the general principles laid down 
in article "Fever." [A tablespoonful of 
yeast every two hours is a favourite and 
often safe domestic remedy — if medical^ad- 
vice cannot be obtained.] 

YEW-BERRIES.— The beautiful berries 
of the yew-tree occasionally tempt- children 
to eat them, and the leaves have been given 
ignorantly as medicine. Both are extremely 
poisonous. A child has died within four 
hours after eating a quantity of the berries. 
The symptoms appear in some degree to 
resemble those of poisoning by belladonna, 
and treatment similar to that recommended 
in such cases should be adopted. It is 
thought that the poison resides chiefly in 
the seeds of the berry. 

ZINC. — This now well-known metal 
yields some useful medicinal preparations. 
Of these the principal are the oxyde, the 
sulphate, and the chloride. The metal itself, 
which is of pale bluish colour, was some 
years ago introduced for various cooking 
purposes, and especially for dairy utensils, 
but seems to have been abandoned as un- 
suitable. — See Cream. The oxyde of zinc 
is a white, tasteless, rather light powder. 
It is used externally in the form of oint- 
ment in various skin-affections ; the propor- 
tion is one of zinc to six of lard or simple 
ointment. Internally, it is used principally 
in spasmodic diseases, such as epilepsy, and 
St. Yitus's dance. In the latter disease, the 
author has used it successfully ; the dose 
from two to six grains twice or three times 
daily in the form of pill. 



The sulphate of zinc, or " white vitriol," is 
a most useful preparation. It is sold in 
the form of small white crystals, somewhat 
resembling those of Epsom salts. It has a 
strong metallic, very unpleasant, styptic 
taste. As an external astringent applica- 
tion it is used in solution, and forms one of 
the most serviceable collyria, or eye-lotions, 
in the strength of from one to four grains 
to the ounce of distilled or rain-water. 
When used to ulcers, the strength may be 
increased to double. Its principal internal 
use is as an emetic, being admirably calcu- 
lated, from the rapidity with which it causes 
vomiting, to empty the stomach in cases of 
poisoning, as by opium or other narcotic 
drugs. The dose, as an emetic, is from 
fifteen to twenty grains, in a wineglassful 
of water. The salts of zinc are said to have 
themselves proved poisonous, but very rarely 
so ; moreover, by the rapidity with which 
they cause vomiting, they must in great 
measure prove their own antidotes. In 
such cases, the treatment should be similar 
to that for poisoning by blue vitriol. — See 
Copper. 

Chloride of zinc is chiefly used as an ex- 
ternal caustic, and also as a disinfecting 
agent. It is said to enter into the compo- 
sition of Sir W. Burnett's "disinfecting 
fluid." 

ZYMOTIC — Is a term recently introduced 
into medical science, and is probably fami- 
liar to most from its occurrence in the regu- 
larly published reports of the " Public 
Health." The term includes the various 
epidemic, endemic, and contagious dis- 
eases, such as fever, small -pox, &c, which 
originate, or are supposed to originate, from 
a morbid poison being introduced into, and 
gradually extending itself throughout the 
system. The process is likened to that of 
fermentation, and the term is derived from 
the Greek verb signifying to ferment. 



CONCLUDING ADDEESS. 



In bringing to a conclusion the "Dic- 
tionary of Domestic Medicine and House- 
hold Surgery," the author solicits the atten- 
tion of his readers to a few remarks on the 
objects, tendencies, and uses of the work. 

The first desideratum in such a publica- ' 
tion was to supply, at a price which might 
put it iu the power of those of even very 
limited means, a work containing as large j 
an amount of information as possible upon 
the proposed subjects, while, at the same 
time, the range of those subjects should be 
sufficiently extensive. It need scarcely be 
remarked, that for the attainment of these 
ends, it has been requisite, as far as could 
be done, to avoid repetition, and to make 
references supply the place of reiterated 
details. Even references, however, could 
not be fully given without the sacrifice of 
much valuable space ; those, therefore, which 
are inserted, are not by any means set forth 
as complete, but rather as guides, to show 
how the reader may derive information by 
turning to various parts of the work. Xo 
other plan would have admitted of the ne- 
cessary condensation. It certainly would 
be more convenient for reference, when any 
individual disease is treated of, if all par- 
ticulars as to exact doses of medicine, &c. 
were entered into in each separate article ; 
but to have repeated this, time after time, 
must have either greatly augmented the 
size of the volume or greatly curtailed the 
space necessary for other subjects. Neither 
was it requisite so to do, for — and to this 
attention is specially directed — all necessary 
information ought to be easily found by re- 
ference, either to the articles on the medi- 
cines recommended, or to those suggested to 
the mind by the nature of the subject under 
investigation. The author would strongly 
advise the more inexperienced especially, I 
2t2 



never to give a medicine recommended un- 
der any article on a disease, without first 
turning to the article on the medicine, in 
order to be aware of any peculiarities in 
action, mode of administration, or other- 
wise. Moreover, it should be remembered 
that the graduation of doses to different 
ages is given under article "Medicines." 

By some persons, a Dictionary of Medi- 
cine is looked upon as a work to which they 
ought to be able to run at any time, or in 
any emergency, and to find just what they 
want in a moment. This is a great mistake ; 
in order that a work like a comprehensive 
dictionary should be found thoroughly use- 
ful, it must be read. No medical man, 
when he consults a volume of reference, 
expects to find what he wants in a moment ; 
how much less likely, then, is an unpro- 
fessional person to do so. True, the effort 
has been made in the present work, to give 
the information as simply and clearly as 
possible, and when there is no time for 
reading : the author trusts it has been done 
in such a manner, that a few minutes' glance 
over an article may ajjord much that is use- 
ful ; but, it is repeated, the full benefit of 
such a work can only be attained by atten- 
tive perusal of the subjects, if possible, in 
connected series. 

Throughout the Dictionary, the endea- 
vour of the author has been to adhere 
closely to the doctrine of the first few lines 
of the Preface, " that the information given 
should be safely usable by those who are put 
in possession of it." In order to do this, 
he has striven to take the intelligence of 
the reader along with him ; to give, in the 
first place, general views of the structure 
and functions of the living body, and of the 
sanitary relations, external and internal, on 
which the perfect working, the integrity, 

551 " 



582 



and health of these depend; to point out 
how disorder and disease is most likely to 
arise or to be originated, and by what ra- 
tional means — the why and the wherefore — 
these are to be combated. This plan pre- 
cluded almost entirely the giving of prescrip- 
tions, the recipes, one "good for" one thing, 
and another " good for" some other thing — 
of which people are so fond-. It is the recipe 
system which has been the great stepping- 
stone for quackery, and the monstrous evil 
and system of deception is only to be got 
rid of by the diffusion of proper views of 
the true nature of rational medical treat- 
ment ; views which make clear that this is 
not a mere system of drugging, but is 
founded upon a scientific, enlightened con- 
sideration of the laws which govern, and of 
the requirements which are necessary for 
the due preservation of the various func- 
tions of the living body, in health, and not 
less so in disease. The author would add 
one more to his often repeated cautions to 
unprofessional persons, not to tamper with 
serious disease — would bid them remember, 
that many of the directions given in the 
present work are for use, only when no pro- 
per medical aid is at hand. 

In conclusion, if success and wide circu- 
lation afford any criterion, the author has 



' WtrXJ 

CONCLUDING ADDRESS. 

the gratifying assurance, that the "Dic- 
tionary of Domestic Medicine and House- 
hold Surgery" has supplied a want, and is 
likely to prove serviceable to the class of 
the community for which it was chiefly in- 
tended. Equally gratifying is the know- 
ledge, that in the execution of a work on 
popular medicine, he has not forfeited the 
esteem and good-will of his professional 
brethren ; and that in addition to the favour 
of the general press, and to that of private 
professional testimony, some of the most 
influential medical journals in the kingdom 
have given their approval of his labours. 
He well knew that, in undertaking a work 
of the kind, he was doing what would at first 
subject him to criticism, if not to censure ; 
that he was entering upon almost forbidden 
ground; on that ground he never would 
have entered, but for the consciousness that 
it might be trodden, not only without injury 
to the honour of his profession, but with 
benefit to those classes who most require 
enlightenment on the subjects treated of; 
and that, in adding his efforts for that en- 
lightenment, he was giving real, earnest 
assistance toward hastening the downfall 
of quackery, in whatever guise it may show 
itself. S. T. 

November, 1852. 



THE END. 



TYPED BY L. JOHN^ T & CO. 
PHILADELPHIA. 



f?*fiP. 



